Abstract:
A dispensing system and associated method provides a turnkey solution for dispensing pharmaceutical products such as solid medications and nutritional supplements to be taken orally in health care settings, including but not limited to long term care (LTC) and assisted living settings.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
       [0001]    This application is a continuation application of, and claims the benefit of priority under 35 U.S.C. §120 from, U.S. application Ser. No. 12/559,630, filed Sep. 15, 2009, which claims priority from, U.S. Provisional Patent Application Ser. No. 61/120,209, filed Dec. 5, 2008. The entire contents of each of the above applications are incorporated herein by reference. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    This invention relates generally to systems and associated methods for distributing pharmaceutical products and, more particularly, to automated dispensing systems and associated methods for distributing pharmaceutical products for individual patients in health care facilities. 
         [0003]    Hospitals, long term care and other health care facilities distribute and administer pharmaceutical products to patients in individual doses numerous times per day. Pharmaceutical products such as prescription medications, nutritional supplements and the like are often stored in bulk by pharmacies and are repackaged into containers of multiple doses based on individual prescriptions for retail or outpatient distribution. For inpatient or in-facility distribution, pharmacies also often repackage bulk pharmaceuticals into “unit of use” or “unit dose” packages, for example, multiple blister packs that are connected together in a strip that contain multiple single doses of the pharmaceutical product. 
         [0004]    The traditional method for distributing individual dosage units of pharmaceutical products to patients begins with the generation of a patient order by a physician for particular medications. The patient order is delivered to the pharmacy. There, the process of interpreting the patient order, pulling the specified medication or supplements from the drug storage areas, packaging the medication or supplements, and labeling the package is routinely done manually by pharmacy support personnel. After a final check by the facility pharmacist, the packaged individual dosage units are ready for distribution. In large facilities, the packages containing the patient&#39;s order are forwarded to individual nursing units where nursing staffers distribute and administer them to the patients. 
         [0005]    There are several disadvantages associated with the traditional method of distributing individual dosage units of pharmaceutical products. To begin with, the process is labor and cost intensive. Many separate labor steps are required to fill a single patient order. In large facilities servicing hundreds of patients each day, the staffing requirements to rapidly process patient orders are substantial. In addition, with so many human inputs required in the existing process, there may also be a risk of human error. 
         [0006]    As an attempt to address at least some of the issues with respect to staffing requirements and human error, a variety of automated medication dispensing systems have been developed. The current landscape for automated medication dispensing is dominated by a 30-day system utilizing either “bingo cards” or unit doses supplied in 30-day box. The known systems provide a 30-day or other multi-day supply for each patient pass-time for each prescription on a relatively long term basis. In the event the patient is discharged or the treatment is changed, the unused portion of the 30-day supply cannot be cost effectively reused even though the product may be labeled appropriately. The labor cost required to reintroduce the pharmaceutical products back into the distribution system and to maintain the integrity and traceability of manufacturer and expiration data exceeds the value of the pharmaceutical products, even if the substantial restocking fees are paid by the healthcare system. As a result, such unused pharmaceutical products are returned to the pharmacy for disposal. This disposal of unused pharmaceutical products is a significant waste of those resources as well as a detriment to the environment. 
         [0007]    One known pharmaceutical package dispensing system automates various aspects of the task of filling patient orders for units of use pharmaceuticals. The system employs a number of storage cartridges arranged in stacked rows on a frame. The cartridges contain strips of unit dose packages of pharmaceutical products. The packages consist of individual unit dose blisters. Each of the blisters contains a unit of use, e.g., a single tablet or capsule. Several blister packages are joined together to form the linear strips such that a given cartridge may contain several such strips stacked vertically or in roll form. Each cartridge is provided with a forward-facing opening through which a portion of the lowermost blister strip contained therein projects. A pick device is movable adjacent a respective row of cartridges to a desired location adjacent a cartridge. The pick device pulls the blister strip out of the cartridge and a cutting blade mounted on the pick device cuts an individual blister from the strip. The severed blister pack free-falls onto a conveyor or into a bin on the pick device or elsewhere and when the pick device has finished picking blisters for the order, it discharges the blisters in the bin onto a tray. The tray serves as an accumulation point servicing multiple pick devices. The tray is moved to a discharge location to dump the blisters by gravity from the tray into a funnel of a packaging station. 
         [0008]    The drug dispensing machine described above and similar such systems have several disadvantages. To begin with, only one tray and discharge slide for the multiple pick devices is provided. Therefore, a pick device may have to wait for a tray to empty, which significantly reduces the picking efficiency of the pick devices and throughput of the dispensing machine. Second, the cartridge, pick device and bin design can lead to difficulties when a given blister strip is pulled, cut and dropped from the cartridge. The opening through which the blister strips project allows for significant lateral play by the strips. Further, the size of the unit doses may vary greatly and pick device retrieval and cutting mechanisms must be adjusted to accommodate unit doses of different sizes. This can lead to misalignments with the cutting blade. The gravity free-fall of the severed unit doses often results in missing or jammed unit doses producing incomplete orders and requiring manual intervention to dislodge, retrieve and/or collect the errant unit doses. 
         [0009]    Hence, there is a continuing need to improve a system and overall methodology for dispensing medication orders for individual patients in health care facilities. 
       SUMMARY OF THE INVENTION 
       [0010]    This invention has many aspects and embodiments generally directed to a process or method and associated system and sub-systems to provide a turnkey solution for dispensing medications and nutritional supplements to be taken administered in health care settings, including but not limited to long term care (LTC) and assisted living settings. Bulk pharmaceutical products are converted to individual packaged unit doses and ultimately individually packaged pass-time bags for each patient on a 24-hour schedule. Additionally, inventory management is also automated. The various safeguards and measures built into the system of this invention include unit dose scanning at various steps as well as personal inspections, as needed, to increase patient safety, eliminate waste and increase labor efficiency by reducing and/or minimizing the disposal of unused pharmaceutical products. 
         [0011]    One objective of this system and methodology is to avoid the need for disposal of prescriptions medications and nutritional supplements thereby attacking the waste and inefficiency issues at their source. This invention in one embodiment is a pharmaceutical dispenser for prescriptions, medication and nutritional supplements. Positive control of each unit dose package is maintained throughout the entire process. In other words, gravity feed and the random nature of medications freefalling through the system is avoided according to one aspect of this invention. 
         [0012]    The individual pharmaceutical products are packaged in unit dose packages and multiple such unit dose packages are arranged in a storage tube. After the filled storage tubes are prepared and entered into the inventory database, they are loaded into an automated dispenser at appropriate locations for the automated filling and packaging of individual med pass patient orders. The dispenser provides an automated solution to the efficient and timely preparation of med pass orders handled in LTC and assisted living settings by filling individual med pass orders for each patient and assembling them in a bag of unit dose pharmaceutical products and staking individual bags together. The dispensing system of this invention may be located remotely from the LTC facility and will serve multiple facilities. The staked bags are then packed in a tote and delivered to the LTC for distribution. At each step in the process, the unit dose pharmaceutical products are tracked via a bar code scanner and the status of each unit dose is cataloged and regularly updated in the information management system database. 
         [0013]    The design of the overall system and its individual components according to this invention allows for physical control of each unit dose from start to finish without any unit dose “free fall” in the system. This process is automated and does not rely upon manual sorting. The med pass bags are consolidated into the final shipping container and do not require manual sorting and packing. 
         [0014]    The dispenser according to one embodiment of this invention utilizes two distinct dispensing modules or schemes for dispensing the unit dose packages; however, each of the unit dose packages are housed within storage tubes in the dispenser. One aspect of this invention is multiple buffers in which unit dose packages for a particular patient order are selected from the storage tubes in advance of their being assembled into the patient&#39;s order thereby enhancing the speed and efficiency of filling patient orders. 
         [0015]    The dispensing system according to one aspect of this invention is an automated medication/supplement dispenser configured to store and dispense individual unit doses of pharmaceutical products and to assembly the dispensed pharmaceutical products into individual time-pass medication (med pass) orders to be delivered to a healthcare or LTC facility. The dispenser is divided into distinct dispensing modules dedicated to dispensing pharmaceutical products based on the frequency of demand of these items. A first dispensing module of the dispenser stores and dispensing high-demand pharmaceutical products, and a second dispensing module of the dispenser is configured to store and dispense low/medium demand pharmaceutical products. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0016]    The various features and advantages of this invention, and the manner of attaining them, will become more apparent and the invention itself will be better understood by reference to the following description of embodiments of the invention taken in conjunction with the accompanying drawings, wherein: 
           [0017]      FIG. 1  is a perspective view of a pharmaceutical dispensing system according to one embodiment of this invention; 
           [0018]      FIG. 2  is a perspective view of a first dispensing module and an adjacent portion of a conveyor of the dispensing system of  FIG. 1 ; 
           [0019]      FIG. 2A  is a perspective view of one embodiment of an individual unit dose pharmaceutical package containing a single dose of medication or supplement; 
           [0020]      FIGS. 3 and 4  are perspective and end views, respectively, of a channel nest carrier adapted to be mounted on the conveyor of the dispensing system and to receive individual packages of unit dose pharmaceutical products on the channel nest carrier; 
           [0021]      FIG. 5  is a perspective view partially broken away of a bank of storage tubes holding unit dose pharmaceutical packages adjacent channel nest carriers in the first dispensing module of the dispensing system according to one embodiment of this invention; 
           [0022]      FIG. 6  is an enlarged view similar to  FIG. 5  with one of the storage tubes and channel nest carriers partially broken away; 
           [0023]      FIGS. 7-9  are cross-sectional side-elevational views of the operation of an insertion plunger mechanism inserting individual unit dose pharmaceutical packages from the storage tubes of the first dispensing module into the channel nest carriers on the conveyor according to one embodiment of this invention; 
           [0024]      FIG. 10  is a perspective view of one embodiment of a second dispensing module of the dispensing system of  FIG. 1  according to one embodiment of this invention; 
           [0025]      FIG. 11  is a perspective view of a bank of storage tubes containing unit dose pharmaceutical packages in the second dispensing module of the dispensing system shown in  FIG. 10 ; 
           [0026]      FIG. 12  is a perspective view of one row of the bank of  FIG. 11  with a storage tube being inserted therein; 
           [0027]      FIG. 13  is an enlarged perspective view of a portion of the row of  FIG. 12  with the storage tube retained therein; 
           [0028]      FIG. 14  is a perspective view depicting a pick device and transfer station of the second dispensing module; 
           [0029]      FIG. 15  is a front elevational view of a pick device and associated gantry for moving the pick device relative to the bank in the second module of the dispensing system according to one embodiment of this invention; 
           [0030]      FIG. 15A  is a partial cross-sectional view taken along line  15 A- 15 A of  FIG. 22 ; 
           [0031]      FIG. 16A  is a cross-sectional side-elevational view of the pick device and an associated transfer mechanism of the second dispensing module taken along line  16 A- 16 A of  FIG. 15 ; 
           [0032]      FIG. 16B  is an enlarged cross-sectional view of a gripper on the pick device engaging a unit dose pharmaceutical package in a storage tube on the second dispensing module; 
           [0033]      FIG. 17  is a partial cross-sectional view depicting a vacuum manifold of the pick device; 
           [0034]      FIGS. 18A-18D, 19A-19C, 20A-20C and 21  are sequential cross-sectional views of the pick device operation of the second dispensing demand module retrieving a unit dose pharmaceutical package from the bank and transferring it to a transfer mechanism according to one embodiment of this invention; 
           [0035]      FIGS. 22-24  are sequential cross-sectional side-elevational views of the transfer mechanism on the pick device transferring unit dose pharmaceutical packages to a transfer station adjacent the conveyor of the dispensing system according to one embodiment of this invention; 
           [0036]      FIG. 25A-25B  is a flow chart depicting the overall operation of the dispensing system according to one embodiment of this invention; 
           [0037]      FIG. 26  is a flow chart depicting the operation of a high-demand dispensing module according to one embodiment of the dispensing system of this invention; 
           [0038]      FIG. 27  is a flow chart depicting the operation of a portion of a high-demand dispensing module according to one embodiment of the dispensing system of this invention; 
           [0039]      FIG. 28  is a flow diagram depicting the operation of a pick device associated with the high-demand dispensing module according to one embodiment of the dispensing system of this invention; 
           [0040]      FIG. 29  is a flow diagram depicting the operation of a camera inspection system according to one embodiment of this invention; 
           [0041]      FIG. 30  is a flow diagram depicting a printer for the bagging system associated with one embodiment of this invention; and 
           [0042]      FIG. 31  is a flow diagram depicting the operation of a bagging system according to one embodiment of this invention. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0043]    A dispensing system  10  according to one embodiment is shown in  FIG. 1  and is configured to store and dispense individually packaged and labeled doses of medications/supplements, and to assemble the dispensed medications/supplements into individual medication orders, such as time-pass medication orders to be delivered to a long-term care (LTC) facility, for example. It will be appreciated, however, that a dispensing system  10  in accordance with this disclosure may alternatively be configured to dispense other items. The dispensing system  10  is divided into distinct modules that are dedicated to dispensing the medications/supplements based on the demand, or order frequency, of those items. In the embodiment shown, a first module  12  is configured to dispense medications/supplements having a relatively high-demand or order frequency, and a second module  14  of the dispensing system  10  is configured to store and dispense medications/supplements having a relatively lower demand or order frequency. 
         [0044]    In the embodiment shown and described herein, the medications/supplements are provided in packages  16  sized to receive an individual dose of a particular medication/supplement, commonly referred to as a blister pack. With reference to  FIG. 2A , an exemplary package  16  includes a base portion  18  defining a cavity for receiving the individual dose of the medication/supplement  20 , and a generally planar closure  22  disposed over an open end of the base portion  18 . The peripheral dimensions of the blister capsule base portion  18  of the unit dose packages are smaller than the perimeter dimensions of the upper, generally planar closure  22  of the packages  16 . The packages  16  may be provided with information  24  related to the medication/supplement  20  contained in the packages  16 , such as the name of the medication/supplement  20 , the manufacturer, the date manufactured, the lot number, and/or other information. In the embodiment shown, information  24  is provided on the closure portion  22  and includes machine-readable information, such as a barcode, that may be used to facilitate the automated storing, tracking, dispensing, and packaging of orders. 
         [0045]    With continued reference to  FIG. 1 , the dispensing system  10  further includes an endless conveyor  30  with a plurality of carriers  32  that move past the first, high-demand module  12  and the second, low-demand module  14  to collect ordered medications/supplements and carry them to a designated location for further processing. In the embodiment shown, a first, upstream end  34  of the conveyor  30  is positioned adjacent the high-demand module  12 . The carriers  32  are moved along the conveyor  30  past the high-demand module  12  and the low-demand module  14  toward a second, downstream end  36  where the medications/supplements are packaged in packaging or bagger station  26  into boxes, cartons or totes  28  for delivery to the LTC facility. Each carrier  32  defines a dedicated or designated space on the conveyor  30  for a particular order. 
         [0046]    In the embodiment shown in  FIG. 1 , the conveyor  30  has a pair of oppositely disposed, longitudinally extending rails  38   a , and  38   b  supporting the plurality of carriers  32 . The conveyor  30  may further have cross-members  40  extending between the rails  38   a ,  38   b  and support legs  42  configured to support the longitudinally extending rails  38   a ,  38   b  a distance above a floor surface. The endless conveyor  30  carries the plurality of carriers  32  linked together along a conveyor path  31 . The conveyor  30  and associated conveyor path  31  extends from an upstream end  34  toward the downstream end  36  of the dispensing system  10 . The various components, modules and stations of the dispensing system are each coupled to an operator&#39;s control station  240  for command and control of the dispensing system  10 . 
         [0047]      FIGS. 3 and 4  depict an exemplary carrier  32  having an elongate, generally rectangular body  50  having a longitudinal slot or channel  52  formed into one side and extending between the longitudinal ends of the body  50 . The channel  52  is shaped complementarily to the shape of the packages  16  and includes a deep central portion  54  and shallower side portions  56   a ,  56   b  disposed on opposite sides of the central portion  54 , so that a package  16  can be received in the channel  52  with the base portion  18  positioned in the central portion  54  and the sides of the closure  22  supported on the side portions  56   a ,  56   b . The channel  52  is open at both ends to permit unit dose package  16  to be inserted from either end and into the channel  52  during assembly of a particular order. The channel  52  is uniquely shaped to receive unit dose packages  16  containing individual doses of medications/supplements. The side portions  56   a ,  56   b  are enclosed at their upper ends, such as by top plates  58  or other structure so that packages  16  received in the channel  52  are constrained for movement only along a longitudinal direction of the channel  52 . The carriers  32  are moved along the conveyor path  31  past each of the modules  12 ,  14  to receive the medications/supplements that make up a particular order. Depending on the number of medications/supplements in a particular order, one or more of the carriers  32  may be assigned to the order. After receiving the unit dose packages  16  from each module  12 ,  14 , the carriers  32  are advanced downstream by the conveyor  30  along the conveyor path  31  to the packaging station  26 . In one embodiment, the conveyor  30  is configured to incrementally move the carriers  32  from the upstream end  34  to the downstream end  36  such that a carrier  32  is indexed approximately every 3 seconds. 
         [0048]    While the dispensing system  10  shown in  FIG. 1  shows a single first module  12  and a single second module  14  located on the same side of the conveyor  30 , one of ordinary skill in the art will appreciate that other arrangements for the modules  12 ,  14  relative to the conveyor  30  are encompassed within the scope of this invention. For example, the dispensing system  10  may include multiple first modules  12  arranged on the same side of the conveyor  30  and/or on opposite sides of the conveyor  30 ; likewise, multiple second modules  14  can be included with the dispensing system  10  on the same side and/or opposite sides of the conveyor  30 . Likewise, in some embodiments of the dispensing system  10 , the first or second module  12 ,  14  may be omitted for certain applications or multiple first or second modules  12 ,  14  may be included with only a single second or first module  12 ,  14  as is appropriate for the particular application. 
         [0049]    As shown in  FIGS. 1-2 , the first or high-demand module  12  of the dispensing system  10  is located upstream from the second or low-demand module  14  along the conveyor path  31  of the conveyor  30  and travel of the carriers  32 . The high-demand module  12  in one embodiment includes two units or banks  13  of storage tubes  15 , each positioned on opposite sides of the conveyor  30 , although only one unit  13  is shown in  FIGS. 1 and 2  for clarity. Each unit  13  of the high-demand module  12  includes a number of vertically oriented storage tubes  15  such that the unit dose packages  16  in each tube  15  are stacked vertically one upon another. The unit dose packages  16  are loaded in storage tubes  15  in a generally vertical stack and similarly oriented with the base portion  18  depending downwardly from the upper planar closure portion  22  of the package  16 . 
         [0050]    Each storage tube  15  in each of the units  13  of the high-demand module  12  has a generally U-shaped cross-sectional configuration ( FIG. 5 ). The storage tubes  15  are releasably mounted to an insertion plunger mechanism  17  of the high-demand module  12  so that empty or partially empty tubes  15  may be removed and replaced on the high-demand module  12  with filled tubes  15 . Alternatively, the tubes  15  in the high-demand module  12  can be refilled from a portable storage tube (not shown) through the open upper end of the tube  15  without removal of the tube  15  from the module  12 . An open longitudinal slot  19  of each storage tube  15  is oriented outwardly and away from the conveyor  30  when the storage tube  15  is mounted on the high-demand module  12 . As shown in  FIG. 6 , a weight  21  is at the top of each stack of unit dose packages  16  housed in a storage tube  15  to partially compress the stack and force it downward toward a bottom dispensing end  23  of the vertically oriented storage tube  15 . 
         [0051]    Referring to  FIGS. 6-9 , each storage tube  15  mounted in the high-demand module  12  has an insertion plunger mechanism  17  associated with it and positioned adjacent the bottom dispensing end  23  of the storage tube  15 . The insertion plunger mechanism  17  has a support housing  39  and a generally L-shaped plunger  25  mounted to a pneumatically actuated rod  27  which reciprocates toward and away from the conveyor  30  in a direction generally parallel with the orientation of the carriers  32  on the conveyor  30 . The rod  27  is coupled to a pneumatic actuator  37 . A longer leg  29  of the plunger  25  is oriented generally horizontally and is also aligned with the carriers  32  on the conveyor  30 . A leading upper edge  43  of the plunger  25  is at the juncture between the long leg  29  and a short leg  33  of the plunger  25  with the short leg  33  depending vertically downward from the upper long leg  29 . An interior face  35  of the shorter leg  33  is connected to the reciprocating rod  27  of the insertion plunger mechanism  17 . The extended, rest position of the plunger  25  effectively seals the end of the carriers  32  of the conveyor  30  and the dispensing end  23  of the tube  15  to inhibit loss of unit dose packages  16  ( FIG. 7 ). 
         [0052]    As the respective carriers  32  advance on the conveyor  30 , they are sequentially aligned with the individual storage tubes  15  in the high-demand module  12 . Each of the storage tubes  15  in the high-demand module  12  includes similar medications/supplements  20  and more than one storage tube  15  in the high-demand module  12  may include unit dose packages  16  filled with the same medication/supplement  20  as another storage tube  15  in the high-demand module  12  so as to provide increased capacity for more frequently prescribed medications/supplements  20 . When an identified carrier  32  is aligned with a storage tube  15  in the high-demand module that houses a unit dose package  16  containing a medication/supplement  20  to be included in the specified order, the rod  27  retracts in the direction of arrow A in  FIG. 8  such that the upper edge  43  of the L-shaped plunger  25  is positioned on an outboard side of the downwardly depending base portion  18  of the lowermost unit dose package  16  in the storage tube  15 . The rod  27  then extends in the direction of arrow B in  FIG. 9  from the housing of the insertion plunger mechanism  17  thereby pushing the plunger  25  toward the conveyor  30  and carrier  32 . The plunger  25  likewise pushes the lowermost unit dose package  16  from the storage tube  15  toward and into the aligned carrier  32  on the conveyor  30 . Each carrier  32  is generally U-shaped and has the channel  52  to receive the opposed edges of the upper planar closure portion  22  of the unit dose package  16 . As the unit dose package  16  is inserted into the carrier  32 , the plunger  25  remains resident below the storage tube  15  and the upper, longer leg  29  of the plunger  25  retains the now lowest unit dose package  16  in the tube  15  until such time as that unit dose package  16  is to be dispensed from the storage tube  15  and into an appropriate carrier  32  on the conveyor  30 . 
         [0053]    The plunger  25  can be actuated multiple times per conveyor index. This capability, combined with the use of opposing units  13  of storage tubes  15  on opposite sides of the conveyor  30  in the high-demand module  12 , allow for the opposite sides of each carrier  32  to be filled simultaneously with unit dose packages  16  from the appropriate storage tubes  15  thereby increasing the throughput of the high-demand module  12 . 
         [0054]    The low-demand module  14  is downstream from the high-demand module  12  ( FIG. 1 ) and includes two banks or units  66  of medication/supplement storage tubes  74 , one unit  66  positioned on each lateral side of the conveyor  30  although the units  66  on only one side of the conveyor  30  are shown in  FIG. 1  for clarity. As is the case with the high-demand module  12 , the units  66  may feed unit dose packages  16  to the opposite ends of the carriers  32 , although this is not accomplished simultaneously from the opposite ends of the carriers to inhibit the unit dose packages  16  from being pushed to the opposing unit  66 . 
         [0055]    When the carriers  32  on the conveyor  30  that are assigned to a particular order are aligned with slots on a transfer station  64  adjacent the conveyor  30  in the low-demand module  14  that contain the packages  16  for that particular order, the medications/supplements  20  are pushed into the assigned carrier  32 . The assigned carrier  32  may already have unit dose packages  16  therein from the upstream high-demand module  12 . 
         [0056]    The conveyor  30  thereafter carries the carriers  32  to the packaging station  26  for final packaging and assembly of the patient orders. During movement of the packages  16 , the carriers  32 , transfer nests, and transfer stations are each configured to maintain positive control of the medications/supplements  20  such that no medication/supplement  20  is allowed to “free fall” during the dispensing process. 
         [0057]    Referring now to  FIG. 10 , the low-demand module  14  includes a storage module  60  for storing the individually packaged and labeled medications/supplements, a pick device  62  for retrieving selected medications/supplements from the storage module  60 , and a transfer station  64  for delivering the selected medications/supplements to the carriers  32  of the conveyor  30  to fill orders. The storage module  60  has one or more storage units  66  positioned alongside the conveyor  30 , as may be desired, to accommodate storage of the medications/supplements needed to fill the medical orders. With continued reference to  FIG. 10 , and referring further to  FIGS. 11-13 , each storage unit  66  has a plurality of generally rectangular, vertically-spaced plates  68  and a plurality of laterally spaced walls  70  disposed between each plate  68  to define an array of elongate bins  72  configured to receive storage modules or tubes  74  containing stacked packages  16  of the individually packaged medications/supplements. 
         [0058]    The storage tubes  74  are slidably received in the respective bins  72  at first, receiving ends  76  of the bins  72 . In the embodiment shown, the plates  68  and walls  70  of the storage unit  66  are formed from aluminum sheet material. The walls  70  are formed with notches  78  and tabs  80 , and the plates  68  are formed with corresponding slots (not shown) whereby the walls  70  and plates  68  may be assembled together to form the array of bins  72 . In the embodiment shown, the bins  72  have a generally rectangular cross-sectional shape, as do the storage tubes  74  that are received within the respective bins  72 . In this embodiment, the tubes  74  are formed from extruded plastic material and an end cap  82  disposed at one end of the tube  74  facilitates dispensing the packages  16  there from. 
         [0059]    As shown in  FIG. 13 , the end cap  82  includes a slot  84  along an upwardly facing side of the storage tube  74  whereby an individual unit dose package  16  may be moved in a direction transverse to the longitudinal axis of the storage tube  74  for removal of the package  16  from the storage tube  74  through the slot  84 . With continued reference to  FIG. 13 , each bin  72  is provided with a registration pin  90  proximate a second, dispensing end  92  that faces the pick device  62 . As the storage tubes  74  are placed within the respective bins  72 , the registration pins  90  engage another slot  94  formed on the end cap  82  to position the end cap  82  at a location that facilitates engagement and retrieval of the individual unit dose package  16  stored in the tube  74  by the pick device  62 , as will be described in more detail below. 
         [0060]    As depicted in  FIG. 11 , each storage unit  66  is supported on a base  100  so that storage tubes  74  supported in the bins  72  of the storage unit  66  may be positioned for proper access by the pick device  62 . The base  100  includes a generally flat plate  102  that may be bolted or otherwise secured to the floor surface. The array of bins  72  may be pivotally coupled to the plate  102  by appropriate pin connections  104 ,  106 , and may be adjusted to have a desired inclination angle relative to the floor surface by an adjustable link  108  coupled between the array of bins  72  and the plate  102 . The inclined orientation of the bins  72  of the storage unit  66  places the dispensing ends  92  of the bins  72  at a lower elevation than the receiving ends  76 . The packages  16  of medications/supplements  20  are stacked one atop another within the storage tubes  74 , and the storage tubes  74  are slidably received within the respective bins  72  of the storage unit  66 . The storage tubes  74  are inserted with the end caps  82  positioned at the dispensing ends  92  of the bins  72  such that the stacked packages  16  within the tubes  74  are urged by gravity in a direction toward the end caps  82  at the dispensing ends  92  of the bins  72 . A weight (not shown) may be provided on top of the uppermost package  16  within each storage tube  74  to facilitate movement of the packages  16  toward the end caps  82 . 
         [0061]    As depicted in  FIG. 16B , each bin  72  may be provided with a sensor  97  proximate the dispensing end  92  for detecting the presence of packages  16  within the storage tube  74  supported in the bin  72 , and for communicating with a control  240  to indicate when the storage tube  74  needs to be replaced with a storage tube  74  filled with packages  16 . The bins  72  may also be provided with one or more sensors  99  for detecting the presence of a storage tube  74  in the bin, and for communicating with the control  240  when a storage tube  74  is not in the bin  72 . In the embodiment shown, in  FIGS. 16B and 18B , sensors  97  for detecting the presence of packages  16  in a storage tube  74  are located with the registration pin  90 . Each storage tube  74  contains only a single type of medication/supplement  20 , and the storage tubes  74  may be provided with information  96  identifying the particular type of medication/supplement contained within the packages  16  stacked within the tube  74  ( FIG. 13 ). In one embodiment, the information provided on the storage tubes  74  includes machine readable information, such as bar codes, RFID, or other types of machine readable information, to facilitate the automated storage, tracking and dispensing of the medications/supplements. 
         [0062]    The medications/supplements  20  stored in the array of bins  72  of the storage units  66  of the storage module  60  are retrieved by the pick device  62  and are delivered to a transfer station  64  for subsequent transfer to a designated carrier  32  as the carrier  32  moves past the transfer station  64  on the conveyor  30 , as will be described in more detail below. With reference to  FIGS. 10 and 14 , the pick device  62  includes a pick head  110  and a transfer nest  112  supported on a transfer frame  114  that moves with the pick head  110 . The pick device  62  is supported on a vertically inclined gantry  116  having vertical frame members  118  and horizontal frame members  120  positioned proximate the dispensing ends  92  of the bins  72  of the storage module  60  for access to the storage tubes  74 . A gantry cross member  122  is driven by a first motor  124  for movement longitudinally along the horizontal frame members  120 , and a second drive motor  126  moves the pick device  62  vertically along the gantry cross member  122  so that the pick head  110  can access any of the plurality of storage tubes  74  housed in the storage module  60 . Flexible cable guides  128   a ,  128   b  may be provided adjacent the gantry cross member  122  and/or the horizontal frame members  120  to house cables or wires extending between the pick device  62  and corresponding power supplies and/or control modules. 
         [0063]    As shown in  FIGS. 15 and 16A , the pick head  110  includes a plurality of grippers  130  extending from a rotatable housing  132  for engaging and retrieving selected packages  16  from the storage tubes  74  supported in the storage module  60 . Four grippers  130   a ,  130   b ,  130   c ,  130   d  are depicted and are collectively referred to as “grippers  130 ” herein. The transfer nest  112  is supported within a transfer frame  114  coupled to the pick head  110  for movement therewith, such that packages  16  selected by the pick head  110  may be received onto the transfer nest  112  and subsequently delivered to the transfer station  64 . In the embodiment shown, the transfer nest  112  includes four slots  134  for receiving the packages  16  of medications/supplements from the grippers  130  of the pick head  110 . It will be appreciated, however, that the transfer nest  112  may alternatively have a fewer number or a greater number of slots  134 , as may be desired. The slots  134  of the transfer nest  112  are configured to receive the packages  16  from the grippers  130  of the pick head  110  and to maintain positive control over the motion of the packages  16  as they are moved to the transfer station  64 . To this end, the slots  134  are shaped complementarily to the shape of the packages  16 , in a manner similar to the channels  52  of carriers  32  and as depicted in  FIG. 15A . 
         [0064]    The transfer nest  112  is movable along a shaft  140  in a longitudinal direction relative to the pick head no so that the selected packages  16  of medications/supplements may be received in one of the plurality of slots  134  on the transfer nest  112  by aligning a selected slot  134  in registration to receive a package  16  from the grippers  130  of the pick head no. The transfer nest  112  is also pivotable about a shaft  142  coupled to the transfer frame  114  to position the transfer nest  112  adjacent the transfer station  64  for delivery of the selected packages  16  of medications/supplements to the transfer station  64 . In the embodiment shown, the transfer nest  112  is pivotally coupled to the transfer frame  114  by a shaft  142  received in shaft supports  144  extending from the transfer frame  114 . A bracket  146  extending from the transfer nest  112  is coupled at a pivot joint  148  to the end of a drive rod  150  of a pneumatic piston  152 , whereby the transfer nest  112  can be pivoted around the shaft  142  by actuation of the pneumatic piston  152 , from a first position wherein the transfer nest  112  is located adjacent the pick head  110  for receiving the selected packages  16  of medications/supplements (depicted in  FIGS. 14 and 15 ), to a second position wherein the transfer nest  112  is positioned adjacent the transfer station  64  (depicted in  FIG. 22 ). 
         [0065]    Referring again to  FIG. 14 , the transfer station  64  includes a slide assembly  160  for moving the packages  16  of medications/supplements  20  from the transfer nest  112 , and a queue support  162  for receiving the packages  16  of medications/supplements from the transfer nest  112  and supporting them until the carrier  32  assigned to receive the packages  16  of medications/supplements for a particular order is positioned at the queue support  162  in registration for receiving the packages  16 . The slide assembly  160  has a plurality of individually actuatable slide members  164  having upwardly extendable prongs  166  that engage the packages  16  of medications/supplements supported on the transfer nest  112  when the transfer nest  112  has pivoted to the second position. The prongs  166  slide the packages  16  of medications/supplements from the transfer nest  112  into corresponding channels  168  formed in the queue support  162  of the transfer station  64 . In the embodiment shown, the channels  168  formed in the queue support  162  are shaped complementarily to the shape of the packages  16  of medications/supplements, in a manner similar to the channels  52  of carriers  32 , such that the packages  16  received in the respective channels  168  of the queue support  162  are constrained and allow for movement only along longitudinal directions of the channels  168 . 
         [0066]    With continued reference to  FIG. 15 , and referring further to  FIG. 16A , operation of the pick device  62  to retrieve selected packages  16  of medications/supplements from the storage tubes  74  supported in the array of bins  72  of the storage units  66  and to place the selected packages  16  in the transfer nest  112  for subsequent transfer to the transfer station  64  will now be described. The pick device  62  has a pick head  110  having four grippers  130  disposed generally circumferentially around a housing  132  of the pick head  110  and arranged such that pairs of grippers  130   a ,  130   c  and  130   b ,  130   d  are positioned on diametrically opposite sides of the housing  132 . Each gripper  130  has a gripper arm  170  slidably received in guides  172  coupled to the housing  132  to facilitate movement of the gripper arms  170  along radial directions relative to the housing  132 . Springs  174  coupled to the gripper arms  170  and contacting the guides  172  bias the gripper arms  170  in directions radially outwardly from the housing  132 . The housing  132  of the pick head no is rotatable to index the grippers  130  from positions adjacent the storage tubes  74 , for engaging and retrieving packages  16  of medications/supplements, to positions adjacent the transfer nest  112  for placing the selected packages  16  into one or more slots  134  of the transfer nest  112 . 
         [0067]    As depicted in  FIG. 18D , the pick head  110  of the embodiment shown is rotatably indexed by a Geneva drive mechanism  180  for successive, intermittent positioning of the respective grippers  130  adjacent the storage module  60  and the transfer nest  112 . A driven wheel  182  is rotatably supported on a central shaft  184  of the pick head  110  and is driven for intermittent rotation by a drive wheel  186  supported on a rotating drive shaft  188  spaced from the central shaft  184 . As the drive wheel  186  rotates, engagement rods  190  positioned on diametrically opposed sides of the drive wheel  186  engage corresponding slots  192  formed in the driven wheel  182  to rotate the driven wheel  182 . The driven wheel  182  is coupled to an index plate  194 , which is in turn coupled to the pick head housing  132 , whereby intermittent rotational motion is imparted to the housing  132  to move the grippers  130 . 
         [0068]    The pick head  110  is also configured to move the gripper arms  170  along directions extending radially from the housing  132  to facilitate engaging the packages  16  of medications/supplements stored in the storage tubes  74  and placing the selected packages  16  within slots  134  on the transfer nest  112 . Radial movement of the gripper arms  170  is controlled by a rotating cam plate  200  disposed within the pick head housing  132 . An aperture  202  formed in the cam plate  200  defines a cam surface  204  that engages follower pins  206  coupled to the proximal ends  208  of the gripper arms  170 . In the embodiment shown, the cam surface  204  is configured to move one pair of diametrically opposed gripper arms  170  radially outwardly (associated with grippers  130   b  and  130   d , for example) while the other oppositely disposed pair of gripper arms  170  is moved radially inwardly (associated with grippers  130   a  and  130   c , for example). The inward/outward motion of the gripper arm pairs is alternated as the cam plate  200  rotates within the pick head housing  132 . 
         [0069]    The distal end  210  of each gripper arm  170  includes a suction cup  212  for applying vacuum pressure to the planar closure  22  of a package  16  positioned adjacent the dispensing slot  84  of a storage tube  74 . The distal end  210  of each gripper arm  170  may include a pin  214  for positively engaging an edge of the closure  22  of the package  16  to facilitate lifting the package  16  from the dispensing slot  84  of the storage tube  74 . However, the pin  214  may be eliminated to avoid possible damage to the packages  16  during transfer to the slots  134 . Vacuum pressure is supplied to the suction cups  212  by conduits  220  that are operatively coupled to a vacuum manifold  222  disposed within the pick head housing  132  and to a vacuum passage  223  in the gripper arm  170 . As shown in more detail in  FIG. 17 , the vacuum manifold  222  comprises a vacuum passage  224  configured to provide vacuum pressure to the suction cups  212  of the respective grippers  130  at appropriate positions of the grippers  130  relative to the pick head housing  132  to facilitate retaining the packages  16  on the distal ends  210  of the gripper arms  170  from the time that the packages  16  are retrieved from the storage tubes  74  until the packages  16  are placed in the slots  134  of the transfer nest  112 . To this end, the vacuum passage  224  has a first portion  224   a  that extends generally circumferentially around a portion of the pick head housing  132 , and a second portion  224   b  extending in a radial direction along the manifold  222  and communicating with an outlet port  226  coupled to a source of vacuum pressure. 
         [0070]    With continued reference to  FIGS. 16A and 16B , the retrieval of a selected package  16  from a storage tube  74  by the pick head  110  will now be described. In  FIG. 16A , the pick head  110  has been moved to a location relative to the storage module  60  to position a first gripper  130   a  adjacent a storage tube  74  supported in the storage module  60  and containing a plurality of packages  16  of a particular medication/supplement required to fill an order. The distal end  210  of the first gripper arm  170  is spaced from the end cap  82  of the storage tube  74 . With the first gripper  130   a  positioned adjacent the storage tube  74 , vacuum pressure is supplied to the suction cup  212  by the vacuum manifold  222 . The cam plate  200  rotates to move the first gripper arm  170  in a direction toward the end cap  82  of the storage tube  74  such that the suction cup  212  engages the surface of the closure  22  of the lower-most package  16  in the storage tube  74 , and the pin  214  engages the side edge of the package  16 , as depicted in  FIGS. 12A and 12B . The vacuum pressure applied at the suction cup  212  draws the package  16  firmly against the distal end  210  of the first gripper  130   a , and lifts the package  16  through the dispensing slot  84  of the end cap  82  as the Geneva drive mechanism  180  is indexed to the next position, as depicted in  FIGS. 18D and 19A . 
         [0071]    Referring now to  FIG. 19A , the selected package  16  is supported on the distal end  210  of the first gripper  130   a  adjacent a sensor  230  configured to detect the presence of a package  16  on the first gripper  130   a . The sensor  230  may also be configured to read machine readable information provided on the package  16 . The sensor  230  can therefore be used to confirm that a package  16  was retrieved by the first gripper  130   a  and that the selected package  16  is the package  16  intended to be selected to fill the order. Indexing of the Geneva drive mechanism  180  to move the first gripper  130   a  and the package  16  supported thereon adjacent the sensor  230  also moves the second gripper  130   b  into a position for engaging and retrieving another package  16  from the storage tube  74 , in the event that more than one dose of the medication/supplement is required to fill the order. If a different medication/supplement is required, the pick device  62  may be moved on the gantry  116  to position the second gripper  130   b  adjacent an appropriate storage tube  74  containing packages  16  of the desired medication/supplement. 
         [0072]    The cam plate  200  then rotates to move the first gripper  130   a  supporting the package  16  in a direction radially inwardly toward the pick head housing  132 , while at the same time the second gripper  130   b  is moved radially outwardly to engage a subsequent package  16  supported in a respective storage tube  74  for retrieval of the package  16  as described above.  FIG. 19C  depicts the vacuum manifold  222  and illustrates how vacuum pressure is maintained at the suction cup  212  of the first gripper  130   a  adjacent the sensors  230 . 
         [0073]    Referring now to  FIG. 20A , the Geneva drive mechanism  180  indexes the first gripper  130   a  to a position adjacent the transfer nest  112 , while simultaneously moving the second gripper  130   b  (now supporting a package  16 ) adjacent the sensor  230 , and moving the third gripper  130   c  adjacent the storage module  60  to a position to retrieve a subsequent package  16  from the same storage tube  74 , or from a different storage tube  74 , as may be required. As the drive wheel  186  of the Geneva drive mechanism  180  continues to rotate, the cam plate  200  rotates to move the first gripper  130   a  radially outwardly to position the package  16  in registration with a selected slot  134  of the transfer nest  112 , as depicted in  FIG. 20B . Simultaneously, the second gripper  130   b  is moved in a direction radially inwardly, while the third gripper  130   c  is moved radially outwardly to engage a subsequent package  16 .  FIG. 14C  illustrates the vacuum manifold  222  with the first gripper  130   a  adjacent the transfer nest  112  and shows how vacuum pressure is applied to the suction cup  212  at this position. As the first gripper  130   a  is subsequently indexed to the next position, vacuum pressure applied through the first portion  224   a  of the vacuum passage  224  is shut off to the conduit  220 , and the package  16  is released into the slot  134  on the transfer nest  112 , as illustrated in  FIG. 21 , which depicts the pick head  110  indexed to the next successive position by the Geneva drive mechanism  180 , whereby the second gripper  130   b  is in position to place a package  16  supported on the second gripper  130   b  onto the transfer nest  112 . After the last package  16  in an order is picked, the Gantry  116  moves the pick device  62  to a location between the storage units  66 , where there are no storage tubes  74 . Since there are no packages  16  present, the pick device  62  can advance two positions thereby transferring the packages already supported by the remaining two grippers  130  into the slot  134  of the transfer nest  112  without acquiring additional packages  16 , completing the order. 
         [0074]    After the packages  16  of medications/supplements associated with one or more orders are placed on the transfer nest  112 , the pick device  62  is moved by the gantry  116  to a position adjacent the transfer station  64 . The pneumatic piston  152  is then actuated to pivot the transfer nest  112  from the first position adjacent the pick head  110  to the second position adjacent the slide assembly  160  of the transfer station  64 , as depicted in  FIG. 22 . With the transfer nest  112  in the second position, one or more of the slide members  164  may be actuated to push the selected packages  16  from the slots  134  on the transfer nest  112  into corresponding channels  168  on the queue support  162  in registration with the slots  134  of the transfer nest  112 , as depicted in  FIG. 23 . The packages  16  of medications/supplements supported in the queue support  162  are held until the designated carrier  32  assigned to receive the particular order associated with the medications/supplements is in position adjacent the corresponding channel  168  of the queue support  162 . Thereafter, the prongs  166  of the slide member  164  are further actuated to push the corresponding packages  16  of medications/supplements from the queue support  162  into the appropriate carrier  32  on the conveyor  30 , as depicted in  FIG. 24 . 
         [0075]    After the packages  16  of medications/supplements have been moved from the transfer nest  112  to the slide assembly  160 , the transfer nest  112  is pivoted from the second position back to the first position, adjacent the pick head  110 , and the pick device  62  is moved on the gantry  116  to a position adjacent a selected storage tube  74  for retrieval of a package  16  required for the next order. The process described above is repeated to assemble additional orders. After the packages  16  of medications/supplements for an order have been transferred from the queue support  162  to the assigned carrier or carriers  32 , the slide members  164  return to retracted positions as depicted in  FIG. 22  to await the delivery of the next batch of packages  16  from the pick device  62 . Having received all of the packages  16  of medications/supplements required to fill the orders, the carriers  32  continue along the conveyor  30  to a packaging station for subsequent processing into appropriate containers for delivery to the one or more long-term care facilities. A camera station with at least one sensor  41  is positioned downstream of the low-demand module  14  and upstream of the packaging or bagger station  26  to verify the medications/supplements  20  in the carriers  32  via the bar code  24  on each package  16  in the carrier  32 . 
         [0076]    The low-demand module  14  according to one embodiment of this invention is disclosed in related patent application Ser. No. ______, (attorney ref.: IDS-04C) filed on even date herewith and incorporated by reference herein in its entirety. 
         [0077]    In the embodiment shown, the low-demand module  14  of the dispensing system  10  includes five individual transfer stations  64  configured to receive packages  16  of medications/supplements for transfer to respectively assigned carriers  32  on the conveyor  30 , as described above. It will be appreciated, however, that the dispensing system may alternatively include fewer than five transfer stations  64 , or greater than five transfer stations  64 , as may be desired for the particular requirements of the dispensing system  10 . The provision of one or more transfer stations  64  enables the pick head  110  to preselect the packages  16  of medications/supplements associated with a plurality of orders and transfer the packages  16  into respective queue supports  162  to serve as a buffer and to accommodate substantially continuous operation of the conveyor  30 . 
         [0078]    The dispensing system  10  further includes a control  240  configured to receive orders for medications/supplements and to process the orders for delivery to a LTC facility. Orders may be electronically received by the control  240  from one or more LTC facilities, such as by transmission over a network, or by any other suitable method. Alternatively, orders can be input directly into the control  240  via an appropriate interface, such as a keyboard or other suitable devices. The control  240  identifies which medications/supplements  20  are required from the high-demand module  12  and the low-demand module  14  to fill each order. In one embodiment, the orders corresponding to each medication pass to be administered to a particular patient for that particular day are processed by the control  240  such that the packages  16  of medications/supplements  20  for each medication pass to be administered to the patient are assembled into a package, and the packages of medication passes are then grouped together in totes  28  for delivery to the LTC facility. 
         [0079]    The control  240  assigns one or more carriers  32  to receive the packages  16  of medications/supplements for each order. The control  240  then controls the movement of the carriers  32  on conveyor  30  through the high-demand module  12  and the low-demand module  14  to receive the packages  16 . The control  240  controls operation of the low-demand module  14  to retrieve the packages  16  of medications/supplements for the orders ahead of the arrival of the carriers  32  assigned to the orders and while the carriers  32  are receiving the ordered medications/supplements from the high-demand module  12  as the carriers  32  are moved past the high-demand module  12 . The transfer stations  64  provide a buffer to accumulate the medications/supplements in advance of the arrival of the carrier  32  for the specific order. The control  240  is coupled to an order entry database and via a web service the orders are passed to the dispensing system  10  one at a time. Alternatively, multiple orders may be passed at a time, for example, ten orders passed at a time. As such, the remaining, subsequent orders are buffered in the database. 
         [0080]    In another embodiment, the dispensing system  10  may be configured to receive and process short turn-around time orders (“stat orders”) that are received separately from the periodically received orders from the LTC facilities. The control  240  integrates the stat orders into the orders being processed and may direct the assembled stat order to a separate location for subsequent handling. The control  240  may also be configured to receive signals from various sensors associated with the dispensing system  10  to facilitate managing operation of the dispensing system  10 . For example, in one embodiment, the control  240  is configured to receive signals from sensors  97 ,  99 ,  230  of the low-demand module  14  related to the detection of packages  16  in a storage tube  74 , the presence of storage tubes  74  in a bin  72 , and the presence of a package  16  supported on a gripper  130 , respectively. When the control  240  receives a signal from a sensor  97  indicating that the storage tube  74  associated with the sensor  97  is empty, control  240  provides a signal to an operator indicating that the storage tube needs to be replaced or replenished. When control  240  receives a signal from a sensor  99  indicating that a storage tube  74  is not detected in the associated bin  72 , the control may provide a signal to an operator indicating the detected absence of a storage tube  74 . Inventory status is maintained in the control  240  and the sensor  230  provides a fail-safe check in case the inventory is not correct in that the control  240  will not direct the pick device  62  to pick from an empty location. When control  240  receives a signal from a sensor  230  indicating that a package  16  was not detected on a gripper  130 , the control may provide a signal to an operator that the package  16  was not detected. The control  240  may also flag the order associated with the detected absence of the package  16  based on input from camera station with at least one sensor  41  for separate processing to confirm that the order is faulty and, optionally, to correct the error in filling the order. The control  240  may also be configured to stop operation of the dispensing system  10  when a detected error will adversely affect operation of the dispensing system  10  to fill orders. 
         [0081]    The control  240  may also be configured to optimize the picking of packages  16  from the storage module  60  and the transfer of the packages  16  to the carriers  32 . In particular, the control  240  may be configured to monitor the order frequency of the medications/supplements and to assign locations for the storage tubes  15  or  74  in the bins  72  of the storage modules  60 ,  13  based on order frequency. For example, the control  240  may assign locations for storage tubes  74  containing medications/supplements  20  that have a relatively higher order frequency to be placed in bins  72  that are located relatively lower in the storage units  66  and/or are positioned relatively closer to the transfer stations  64  so that the distance required to be traversed by the pick device  62  to retrieve packages  16  of high-demand medications/supplements is minimized, thereby decreasing the time required to transfer packages  16  for the orders in the queue supports  162 . Accordingly, the particular locations of the storage tubes  15 ,  74  of the storage modules  13 ,  60  can be dynamic and may be modified by the control  240 , as may be desired for efficient processing of orders. 
         [0082]    In another aspect, the control  240  may be configured to track the dispensing of medications/supplements from the storage tubes  15 ,  74  within the modules  12 ,  14  and to provide signals to an operator when the supply of packages  16  in a given storage tube  15 ,  74  is becoming low. This allows replacement of the storage tubes  15 ,  74  or, alternatively, replenishment of the packages  16  within the storage tubes  15 ,  74 , at convenient times. The dispensing system  10  is also configured to facilitate replacement of the storage tubes  15 ,  74  or, alternatively, replenishment of the packages  16  within the storage tubes  15 ,  74 , on-the-fly while the dispensing system  10  is operating to fill orders. In particular, the configuration of the storage modules  13 ,  60  facilitates access for removal and replacement of storage tubes  15 ,  74  while the dispensing system is operating to fill orders. In the event that the pick device  62  attempts to retrieve a package  16  from a storage tube  74  when the storage tube  74  has been removed for replacement, the control  240  receives a signal from sensor  99  associated with the bin  72  and may control the pick device  62  to wait until the storage tube  74  has been replaced before attempting to retrieve the package  16 . 
         [0083]    While  FIG. 1  illustrates the dispensing system  10  as having a high-demand module  12  and a low-demand module  14  provided on only one side of the conveyor  30 , the dispensing system  10  may alternatively be configured with high-demand modules  12  and low-demand modules  14  provided on both sides of the conveyor  30 , to accommodate the quantity of medications/supplements and throughput requirements of the system, as may be desired. In such a configuration, the high-demand modules  12  and low-demand module  14  on both sides of the conveyor  30  are controlled by a common control  240 , however, the packages  16  of medications/supplements may be transferred to the carriers  32  moving along the conveyor  30  from the high-demand modules  12  and low-demand modules  14  on both sides of the conveyor  30 . 
         [0084]    One aspect of the dispensing system of this invention is the structure and process for maintaining positive control (i.e., no free-fall or gravity induced movement of the unit dose packages) through the dispensing operation of each module  12 ,  14 . This aspect minimizes mishandled, lost, errant or jammed packages  16  in the filling of patient orders. 
         [0085]    Additionally, at least three levels of buffering for the advanced picking of medications/supplements  20  in the order filling process are provided with the dispensing system  10 . The dispensing system  10  of this invention utilizes at least three distinct levels of buffering or picking packages  16  in advance of the arrival of the conveyor driven carrier  32 . For example, the physical distance between the upstream high-demand module  12  and the downstream low-demand module  14  that the carriers  32  must travel allows for one level of buffering. With respect to the low-demand module  14 , the multiple transfer nests located on the pick device allow for an additional level of buffering such that specific medications/supplements can be picked from the storage tubes  74  of the low-demand module  14  and placed in any of the five transfer nests on the pick device and remain there while additional medications/supplements  20  are picked in advance of the approaching carriers  32  assigned to the respective orders. 
         [0086]    A third level of buffering is the transfer stations  64  positioned adjacent the conveyor path  31  in the low-demand module  14 . The medications/supplements  20  picked and held in the transfer nests  112  on the pick device  62  can be transferred to one of the transfer stations  64  in advance of the arrival of the designated carriers  32  for the associated order. While those medications/supplements reside at the transfer station  64  awaiting transfer to the approaching designated carriers  32 , the pick device  62  is free to return to the storage tubes  74  of the low-demand module  14  to pick medications/supplements  20  for subsequent orders. Therefore, the dispensing system  10  of this invention utilizes at least three levels of buffering and it is believed that this feature is both beneficial and efficient compared to known dispensing systems. 
         [0087]    Labor savings and safety of the system have been previously identified herein. However, the fact that the control  240  may compare the unit dose package barcode  24  to the prescription order and the med pass bag  47  barcode compared to the carrier ID (and therefore back to the prescription order) at the time of prescription fill is an advantage. This feature is the basis for eliminating the need for added nurse or other practitioner checks often required in manual and other automated dispensing systems (the first being at order entry and the second being at conversion from bulk to unit dose in the prepack operation). This method of cross-checking both the unit dose packages  16  and the med pass bag  47  back to the original order are a beneficial aspect of this invention. 
         [0088]    Referring to  FIGS. 25A-31 , flow charts depicting the operation of dispensing system  10  are presented. In  FIGS. 25A-25B , a flow chart depicting the overall operation of the dispensing system  10  according to one embodiment of this system is shown.  FIGS. 25A-25B  outline the high level functions of the dispensing system  10  and its interactions with the control  240  or fill event configurator (FEC). The interaction between the components of the dispensing system  10  and the FEC or control  240  is facilitated by a group of web services that pass packets of data back and forth between the database and the components of the dispensing system  10 . 
         [0089]    The dispensing system  10  is an interrelated collection of the various stations that function independently and in coordination via the FEC or control  240  with one another to process patient orders for medications/supplements. The FEC or control  240  provides for each of the stations to have completed the work required to fill a particular order prior to the conveyor  30  and associated carriers  32  being indexed to the next position. As such, each of the stations or modules can function asynchronously to facilitate parallel processing of individual medications/orders. The dispensing system  10  continues to operate until each of the assigned tasks is accomplished and at that point, an additional data packet is requested and transferred to the FEC/controller  240 . The dispensing system  10  continues to request data packets until a subsequent data packet is delivered or the dispensing system  10  is shut down. 
         [0090]    The dispensing system  10  as depicted in  FIGS. 25A-25B  accepts prescription orders from a pharmacy information management system (PIMS) through the FEC or control  240 . The dispensing system  10  picks and packs the orders based on rules received from the FEC for such operation. 
         [0091]    Referring to  FIGS. 25A-25B , the dispensing system  10  operations can be described as follows. To begin filling and processing a prescription order for a medication/supplement, the control or FEC or control  240  at  300  dynamically imports the prescription order from the pharmacy information management system or PIMS. Then at  302  a technician selects a cycle run  304  or non-cycle run  306  and the FEC implements the criteria from designated facility configurations for processing the prescription order. For a non-cycle run  306 , the criteria from the facility configuration is implemented on a non-cycle basis. Next, the FEC or control  240  determines the suggested module (high-demand or high-demand module) at  308  for the order. The technician then has the option of accepting or adjusting the suggested order at  310  and to start the dispensing system  10 . Once the dispensing system  10  is started, the dispenser sends an inventory call to the FEC at  312  which then returns the full inventory listing at  314 . 
         [0092]    The overall operation continues in  FIG. 25B  at which the dispensing system  10  sends a signal at  316  to the bagging system. The FEC or control  240  then returns a get bags unit indicator  318  at which time the system determines at  320  whether the bags were returned with unused medications/supplements. If bags were not returned, then the FEC determines whether all conveyor carriers are empty at  322  and, if so, then the process is returned to the bag call step  316 . If they conveyor carriers  32  were not returned empty, then the FEC returns a short-fill authorization signal at  324  for further attention and processing by the technician. If bags were returned at  320 , then the dispensing system  10  assigns conveyor carriers  32  at  326  accordingly and allocates appropriate inventory. Next, the dispensing system  10  at  328  sends an inventory synchronization signal to the FEC. The FEC then returns an inventory synchronization signal at  330  to the dispensing system  10  and for determination whether all orders were allocated at  332 . If it is determined that the orders were not allocated, then the FEC must determine whether to replenish  334  and, if so, then the process is returned to step  324  for a short-fill authorization. If replenish at  324  is not indicated then a supervisor override order  336  for a short fill is required. If all the orders were allocated, then the control  240  queries whether any work was required by the particular module or station  338  and if no work was required, then the conveyor is indexed to the next position  340 . If work is required, then it is accomplished  342  and the work signal is once again queried  344  prior to indexing the conveyor  340  to the next position. Once the conveyor is indexed to the next position, the control  240  queries at  346  whether the conveyor carrier is at a zero empty position and, if so, then the system is returned to the bag call step  316 . 
         [0093]    Referring to  FIG. 26 , the operation of the high-demand module  12  is shown. The high-demand module  12  dispenses unit dose packages  16  directly into the carriers  32  on the conveyor  30  and can operate multiple times per conveyor index to increase the throughput of the entire dispensing system  10 . The high-demand module  12  operation begins with the control query at  348  of whether the conveyor  30  and associated carriers  32  are on station at the high-demand module  12 . If the response is yes, then the control  240  queries at  350  whether work is required for dispensing the unit dose package  16  from the aligned storage tube  15  of the high-demand module  12 . If a positive response is indicated, then the package  16  is pushed into the aligned carrier  32  on the conveyor  30  at  352 . If it is determined at  354  that the pusher or insertion plunger mechanism  17  is retracted at the home position ( FIG. 8 ), then the control  240  updates the pick status and dispenser inventory at  356  and returns to the work required query step  350 . If the insertion plunger mechanism  17  is not identified at its home position, then a fault is indicated  358 . 
         [0094]    Referring to  FIG. 27 , the operation of the low-demand module  14  is depicted. The transfer stations  64  of the low-demand module  14  provides an intermediate cue for medications/supplements stored in the low-demand module  14  of the dispensing system  10 . This allows the pick device  62  to pre-process orders before the assigned carrier  32  on the conveyor  30  reaches the predetermined transfer location. 
         [0095]    As shown in  FIG. 27 , the operation of the low-demand module  14  begins with a scan  362  of the conveyor carriers  32  for requirements of medications/supplements for a given prescription order from the low-demand module  14 . Next, the dose required from the low-demand module  14  is then determined at  364  and if such a requirement is identified, then the order data is copied at  366  into a virtual transfer nest data base which indicates the status of medications and supplements and associated packages  16  in the transfer stations  64  of the low-demand module  14 . Next, a determination is made at  368  whether the transfer station  64  has four channels  168  for associated orders. It should be readily understood that this number is not a limitation on this invention and can be any appropriate number for the system requirements. If the virtual transfer nest does not have four orders, then the process returns to scan the conveyor carriers for other low-demand module requirements at  362 . If the four channels of the virtual transfer nest are full, then the next step is a sequential scan  370  for empty transfer nests, and, if it is determined at  372  that one is available, then the order data is copied  374  into the transfer nest. If one is not available, then a determination is made at  376  if there is an empty transfer nest. If so, then data is copied into the empty nest  378 . If the nest is not available at  376 , then it is determined at  380  whether the conveyor  30  is aligned with the transfer station  64 . If so, then the determination is made at  382  if the doses in the transfer nest correspond to the order data in the aligned conveyor carriers. If not, then the process is returned to the sequential scan  370  for an empty transfer nest. If so, then the data is copied  384  from the virtual transfer nest and determination is then made if the pusher is at the home position  386 . If the pusher is not appropriately positioned, then a fault is detected  388 . If the pusher is at the home position, then the associated packages are pushed  390  into the aligned conveyors for completion of this cycle of loading of packages  16  from the low-demand module  14  onto the conveyor carriers  32 . 
         [0096]      FIG. 28  shows the operation of the pick device  62  in the low-demand module  14 . The pick device  62  functions asynchronously from the conveyor  30  to ensure that the transfer stations  64  ( FIG. 27 ) have the prescribed medications/supplements to complete the orders as the appropriate carriers  32  on the conveyor  30  arrive at the module  14 . As shown in  FIG. 28 , this process begins with an order acceptance step  394  from the transfer nest and then a determination is made  396  whether work is required for the low-demand module  14  to fill the prescription order. If no work is required, then the process returns to the order acceptance step  394 . If work is required, then the pick device  62  is moved  398  to the appropriate position relative to the respective storage unit bin  72  to retrieve the appropriate medications/supplements. The pick device  62  then picks  400  the leading package  16  from the storage unit bin  72  and a determination  402  is made whether the pick was successful. If not, a fault indication is issued  404 , but if the pick was successful, then the pick status and dispenser inventory is updated  406 . The determination  408  is then made whether an additional dose is required from that bin  72  of the storage unit  66  and, if so, then the process is returned to the pick dose step  400 . If no further packages  16  are required from that bin  72  of the storage unit  66 , then a determination  410  is made whether all four orders are complete on the transfer stations  64  of the pick device  62 . If not, then the pick device  62  is moved to the next grid bin position  398  for a subsequent medication/supplement. If all four orders are complete, then the pick device moves to a clear position  412 . Then the most recent two medications/supplements picked from the storage unit  66  are emptied  414  into the transfer nest. Then a determination  416  is made whether the designated transfer station  64  is empty and if not, then the process is returned to the empty step  414 . If the transfer stations  64  are empty, then the pick device is moved  418  to the designated transfer station  64  after which the load is pushed  420  into the transfer stations  64  and then the pick status order is updated  422  and the process returns to the order acceptance step  394  for subsequent order processing. 
         [0097]    Referring to  FIG. 29 , the operation of the camera station  41  is depicted. The camera station  41  scans the bar codes  24  on the packages  16  in the carriers  32  on the conveyor  30  and the FEC or control  240  compares the data collected from the camera scan with the data assigned to the conveyor carrier  32 . The operation of the camera station  41  begins with a determination  424  of whether the conveyor  30  and the associated carriers  32  are appropriately positioned at the camera station  41 . If not, then this process is delayed until such time as the carriers  32  carrying the associated order are at the camera station  41 . If so, then the carriers are scanned  426  and then the scanned information is transferred  428  to the FEC or control  240 . A comparison  430  is then made between the data for the order in the FEC or control  240  and the data retrieved from the camera station  41 . If the data from the camera station  41  matches  432  that in the FEC or control  240  for the respective prescription order, then a determination  434  is made whether that order is an urgent or stat order. If so, the bag is appropriately marked  436  as a stat order. If the data scanned from the camera station is not approved because it does not correspond to the associated data in the FEC or control  240 , then a determination  438  is made whether to approve the short fill order and, if so, the bag is marked  440  appropriately. If the approval of the short fill order is not accepted, then the bag is marked  442  as an exception. Whether the bag is a stat, short fill or an exception, the status of the bag is sent at  444  to the FEC or control  240  as an update. If a determination is made that the bag satisfies the order appropriately  446 , then the bag status is copied at  448  to the conveyor carrier and the work is completed  450 . If the bag is determined to be inadequate and the consecutive fault limit having been reached  452 , a fault indicator is issued  454 . 
         [0098]    The printing operation and bagging operation of embodiments of the dispensing system  10  according to this invention are shown in  FIGS. 30 and 31 , respectively. The bagging process is triggered by a valid bar code data being present at the packaging or bagger station  26 . The print process is triggered by a valid data being assigned to the first conveyor carrier  32  processed past the camera station  41 . The bag printing process operates asynchronously until a fault occurs which allows the dispensing system  10  to resolve print and bag feed errors with minimal impact on overall throughput. 
         [0099]    Referring to  FIG. 30 , the operation of the printer according to one embodiment of the dispensing system  10  of this invention is described. Initially, the conveyor carrier  32  advances  456  from the camera station  41  and the bag data is assigned  458  to that conveyor carrier  32 . If not, then the process begins once again. If so, a determination  460  is made whether the bag needs to be printed and, if not, then the bag data assignment step  458  is repeated. If a bag needs to be printed, then a request at  462  for information regarding the print string must be received from the FEC or control  240 . Once that information is received, then the bag is printed  464  and the process returns to the initial step  456  for further operation. If the bag is not printed, then the determination  466  is made whether the time-out limit has been reached for printing of the bag and, if so, then a fault is issued  468 . If not, then a subsequent request for the print string from the FEC  420  is issued at  462  until such time as the bag is printed successfully or a fault is issued. 
         [0100]    The operation of the packaging or bagger station  26  according to one embodiment of the dispensing system  10  of this invention is described in  FIG. 31  and begins with the bagger assembly presenting a bag  470 . Then, the bagger signals at  472  the dispenser to read a bar code included on the bag. After the dispenser reads the bar code  474 , a determination is made at  476  whether the bar code matches the bag number associated with the order to be put into the bag. If not, then a determination  478  is made whether to retry the bagger operation and to start a recovery process  480 . If a recovery process is initiated, a bag is discarded at the fill station  482  and a new bag is printed  484  and, a determination is made at  486  whether the new bag is ready to be filled. If not, then that bag is discarded  482  and a subsequent bag is printed. If the bag is ready to be filled, then the process begins once again at the initial bagging operation step  470 . 
         [0101]    If the retry limit has not been reached after a mismatch is identified between the bar code on the bag and that of the prescription order at step  478 , then the process begins once again at the initial step  470 . If the bag bar code does match the information with the order, then the bag is filled  488  and a determination is made  490  whether the bag was filled successfully. If the bag fill was unsuccessful, then a fault signal is issued  492 . If the bag was successfully filled, then the bag is sealed  494  and the next step is copying  496  the conveyor carrier data onto the bag and the bag is then moved  498  to a transfer position for ultimate delivery to the LTC facility. 
         [0102]    From the above disclosure of the general principles of this invention and the preceding detailed description of at least one embodiment, those skilled in the art will readily comprehend the various modifications to which this invention is susceptible. Therefore, we desire to be limited only by the scope of the following claims and equivalents thereof.