Abstract:
This invention relates to a process and a device for automatically delivering and retrieving singular medication from a plurality of containers or product blister packages, storing and recording medication transactions for each patient, and the crushing of designated medications. This invention also relates to medication control, delivery, consumption verification and monitoring within institutional entities.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     This application claims the benefit of U.S. Provisional application No. 61/066,524, filed Feb. 21, 2008. 
    
    
     BACKGROUND OF THE INVENTION 
     This invention relates to a process and a device for automatically retrieving singular medication from a plurality of containers or packaged product packs, storing and recording medication transactions for each patient, and the crushing of designated medications. This invention also relates to medication control, dispensing/delivery, consumption verification and monitoring within institutional entities. 
     Institutional entities such as correctional systems, nursing homes, assisted living centers and hospitals require the accurate administration of medications to a plurality of patients. This process can be time intensive with numerous opportunities for human error. The documentation of medication administration is often done manually, and is a tedious, inaccurate process that can be difficult to monitor. Maintaining an accurate inventory of medications, physical security, and accountability of controlled medications often requires additional personnel. Additionally, the linking of the delivery process and the billing process for medication is often inconsistent, and can be further complicated by inaccurate documentation and/or human error. 
     Another problem arises in the institutional environment when medication is left with the patient. The potential exists for abuse and/or theft of patient retained medication and patient compliance with dosage instructions is difficult to oversee and track. And again, problems related to theft and patient compliance are further compounded by the same inaccuracies and human error previously mentioned. 
     Secure institutions must ensure the accurate distribution and consumption of single pills by their patients. However, the labor costs associated with tracking a single pill exceed the costs associated with tracking a blister package. Thus, the preferred approach for dispensing a single pill is a blister package. However, current systems do not provide a mechanical system suitable for selecting a single blister package of medication from the pharmacy or medication room, and subsequently dispensing a single dosage from the blister pack by mechanical means is lacking. Additionally, secure institutional environments typically lack an autonomous and/or biometric system for positive patient identification, patient medication receipt, and medication consumption verification. Still further, there is an absence of a real-time feedback loop for administrative personnel to monitor strict patient compliance with the medication protocol. 
     In some institutions, medical/pharmacy personnel encounter safety hazards during the deliver of medications to the patient. The problems can be worse in a prison environment where medication may become currency. In these situations, an automated medication facility and/or cart having the ability to deliver and dispense the correct medication to a single patient or a series of patients would be preferred. Such a capability in this environment requires both security and electronic controls. Additionally, verification of patient consumption with real-time feedback or notification will be important. Thus, security, consumption control, verification, feedback and communications are essential to ensure that medication dispersement is not circumvented for other purposes. 
     In an institutional environment, mass medication delivery will improve operating efficiency and reduce costs. However, identification of a particular patient and their specific dose(s) can present a challenge. In many instances, the patient is unaware of the possible drug interactions or the side affects of the particular medication they are taking. An autonomous system that positively identifies the patient, selects the right medication, delivers the medication, verifies positive patient consumption and provides real-time feedback with the administrative medical/pharmacy personnel is highly desired. Additionally, institutions will benefit from an autonomous system that can provide real-time drug information to an institutional patient in a hardcopy form simultaneously with dispensing of the medication. 
     Medication inventory control for institutional entities is another distinct challenge. With a large number of medications ordered and dispensed daily, it is preferred to have a real-time medication inventory tracking and re-supply linked with the medication dispensing/delivery function. It is also highly desirable to have the ability to automatically track inventory on-hand, inventory re-supplying/reordering, pharmacy/medication room delivery, patient delivery, patient information sheets, and drug interaction sheets. Because of the large number of personnel involved in the medication delivery process, there are additional concerns about the accountability, security, and tracking of medication. Often, there is a breakdown and/or a complete lack of medication security and tracking. 
     The present invention, as described herein, solves the aforementioned problems and deficiencies. 
     SUMMARY OF THE INVENTION 
     In a one embodiment, the current invention provides an automated medication delivery system comprising a storage facility, a controller, at least one input station, a retrieval device, a cup, a cup slot, and a med card slot. 
     The storage facility has a plurality of storage bins. The storage bins are sized for storing a med card. 
     The controller is in electronic communication with a computer. The controller is attached to the storage facility and adapted to provide control of the storage facility. 
     At least one input station incorporated with the storage facility and in electronic communication with the controller is provided. The input station includes an input port, a positive identification device, and a display device. The input port is positioned on a side of the storage facility for entering a user&#39;s personal identification data. The display device provides a menu depicting at least one medication associated with a patient and currently available for dispensing. 
     The retrieval device is positioned inside of the storage facility and is capable of retrieving the med cards from the storage bins. 
     The punchout system is positioned inside of the storage facility and is adapted to receive the med cards from the retrieval device. The punchout system includes a punch and a tray. The tray is sized to hold the med card and has a plurality of holes thereon. The holes are compatible with a plurality of pills positioned on the med card. 
     The cup is positioned on a conveyor that is positioned inside of the storage facility. The cup is positioned below the hole of the punch out and is adapted to receive one of a plurality of the pills from the med card. 
     The cup slot is positioned in the side of the storage facility. The cup slot is adapted to receive the cup. The med card slot is positioned in the side of the storage facility. The med card slot is adapted to dispense the med card. 
     In another embodiment, an automated medication delivery system is provided. The automated medication delivery system comprises: a facility, a controller, a barcode scanner, an input station, a retrieval device, a dispensing device, and a positive consumption device. 
     The facility includes a secure interior and a plurality of storage bins positioned within the secure interior. The storage bins are sized to store a med card. 
     The controller is in electronic communication with a computer. The controller is attached to the facility and is adapted to control the facility. The controller stores information associated with each of the med cards. 
     The barcode scanner is positioned within the facility and is capable of scanning the med cards before insertion into the storage bins and after removal from the storage bins. The barcode scanner is in electronic communication with the controller. 
     At least one input station incorporated with the storage facility and in electronic communication with the controller is provided. The input station includes an input port, a positive identification device, and a display device. The input port is positioned on a side of the storage facility for entering a user&#39;s personal identification data. The display device displays a menu of at least one medication associated with a patient and that is available for dispensing. 
     The retrieval device is in electronic communication with the controller and is positioned within the facility. The retrieval device includes: a track, an elevation rod, a picker arm, and a retriever. The elevation rod is movably mounted in the track. The picker arm is moveably mounted on the elevation rod. The retriever is attached to the picker aim. 
     The dispensing device is positioned within the facility. The dispensing device includes: a punchout system, a cup, a first conveyor, a second conveyor, an anti-contamination film, a pill crusher, a cup sweeper, a med card sweeper, at least one cup dispensing slot, and at least one med card dispensing slot. The punch out is positioned inside of the facility and is in electronic communication with the controller. The punchout system is adapted to receive the med card from the retrieval device. The punchout system includes a punch and a tray. The tray is sized to hold the med card. The tray has a plurality of holes thereon. The holes are compatible with a plurality of pills positioned on the med card. The cup is positioned below the holes and is sized to receive one of the plurality of pills. The first conveyor has the cup positioned thereon. The second conveyor is positioned to receive the med card. The anti-contamination film is mounted on and stretched between a first and a second spool. The pill crusher has a crusher head and is positioned between the first and second spools. The anti-contamination film is positioned between the crusher head and an interior of the cup. The cup sweeper is positioned to move the cup from the first conveyor. The med card sweeper is positioned to move the med card from said second conveyor. The cup dispensing slot is positioned to receive the cup from the cup sweeper. The med card dispensing slot is positioned to receive the med card from the med card sweeper. 
     The positive consumption feedback device is in electronic communication with the controller. The positive consumption feedback device includes a video camera, a microphone, a recorder, and an audio/video communications link. The video camera is positioned on the side of the facility. The recorder is capable of recording video from the video camera and audio from the microphone. The audio/video communications link is with a separate location. The audio/video communications link provides real-time video and audio to the separate location. 
     In yet another embodiment, the current invention provides a mobile automated medication delivery system comprising: a cart, a plurality of storage bins, a controller, a wireless communications device, at least one input station, a retrieval device, a punchout system, a cup, a cup slot, and a med card slot. 
     The cart has a plurality of storage bins internally positioned within it. At least one med card carrying a plurality of medications positioned within at least one storage bin is provided. 
     The controller is in electronic communication with a computer and attached to the cart. The controller is adapted to provide control of the cart. 
     The wireless communications device provides electronic communication for the controller. The controller is in electronic communication with a remote central control facility. 
     The input station is incorporated with the cart and is in electronic communication with the controller. The input station includes an input port, a positive identification device, and a display device. The input port is positioned on a side of the cart and is for entering a user&#39;s personal identification data. The display device displays a menu of at least one medication associated with a patient and is available for dispensing. 
     The retrieval device is positioned inside of the cart and is capable of retrieving the med cards from the storage bins. 
     The punchout system is positioned inside of the cart and is adapted to receive the med card from the retrieval device. The punchout system includes a punch device and a tray. The tray is sized to hold the med card. The tray has a plurality of holes thereon that are compatible with a plurality of pills positioned on the med card. 
     The cup is positioned on a conveyor that is positioned inside of the cart. The cup is positioned below the holes of the punch out and is adapted to receive a pill from the med card. 
     The cup slot is positioned in the side of the cart. The cup slot is adapted to dispense the cup. The med card slot is positioned in the side of said cart. The med card slot is adapted to dispense the med card. 
     In yet another embodiment, a method for dispensing medication in a secure facility is provided. The method comprises the steps of:
         (a) a requestor logging on to an automated medication delivery system;   (b) identifying said requestor through a security protocol, said security protocol including:
           i. said requestor entering a unique identifier associated with said requestor;   ii. said requestor entering a security password/personal identification number;   iii. comparing said entries by said requestor with a database in a controller electronically connected to and communicating with said automated medication delivery system;   
           (c) displaying at least one medication available for a patient from a list of available medications for said patient, said list of available medications stored in a patient database;   (d) selecting at least one medication from said list;   (e) directing said controller to retrieve said medication from a storage bin located in said automated medication delivery system;   (f) scanning said selected medication with a barcode reader;   (g) verifying said scanned medication matches said selected medication;   (h) dispensing said medication according to a pre-selected protocol;   (i) printing a receipt for said patient, said receipt having information regarding said medication; and   j) updating said patient database.       

     Numerous objects and advantages of the invention will become apparent as the following detailed description of the preferred embodiments is read in conjunction with the drawings which illustrate such embodiments. 
    
    
     
       DRAWINGS 
         FIG. 1  is a front perspective view of the automated medication delivery system. 
         FIG. 2  is a back perspective view of the automated medication delivery system. 
         FIG. 3  is a back perspective view of the automated medication delivery system with the walls removed. 
         FIG. 4  is an elevation view of the automated medication delivery system. 
         FIG. 5  is a top view of the automated medication delivery system. 
         FIG. 6  is a back perspective view of the storage bins and retrieval device. 
         FIG. 7  is a perspective view of the retrieval device. 
         FIG. 8  is a perspective view of the retrieval device extracting a med card using a clamp. 
         FIG. 9  is a perspective view of the retrieval device extracting a med card using a spatula. 
         FIG. 10  is a top view of a med card. 
         FIG. 11  is a perspective view of a tray. 
         FIG. 12  is an elevation view of a punchout system. 
         FIG. 13  is a front perspective view of the mobile automated medication delivery system. 
         FIG. 14  is a back perspective view of the interior of the mobile automated medication delivery system. 
         FIG. 15  is flow chart of a patient refill request method. 
         FIGS. 16A and 16B  depict the flow chart of a staff member login and retrieval of a patient&#39;s medication. 
         FIG. 17  is a flow chart of the method for loading the automated medication delivery system. 
         FIG. 18  is a flow chart of the filling of the prescription for the med cards. 
     
    
    
     DETAILED DESCRIPTION 
     As described herein, the preferred embodiments of the current invention provide a method and apparatus related to automatically storing and delivering medications within an institutional facility. The method and apparatus maintains the security of the medication and ensures patient compliance with the medicine protocol. 
     Referring to the drawings and specifically to  FIGS. 1-14 , the automated medication delivery system is illustrated and generally designated by the numeral  10 .  FIG. 1  represents a front perspective view of automated medication delivery system  10 . 
     Referring to  FIGS. 1-5 , automated medication delivery system  10  includes a storage facility  12 . Storage facility  12  is a secure area having a single access door  14 . Access door  14  is positioned within inner side wall  16  of storage facility  12  providing access to storage bins  24 . Preferably, a plurality of storage bins  24  are positioned along inner side wall  16  and outer side wall  26 , aligned in at least two rows. 
     Each of storage bins  24  are sized to accept med card  28 , shown in  FIG. 10  and described herein. Preferably, storage bins  24  are vertically and laterally aligned to form a plurality of storage bins  24 . As shown in  FIG. 5 , access panel tray  30  is positioned next to bin end  32  of storage bins  24 . 
     Automated medication delivery system  10  also includes a barcode scanner  34 . Barcode scanner  34  is positioned near access panel tray  30  or near bin end  33 . Preferably, barcode scanner  34  is positioned to provide a sufficient field of view to read barcode  36  of med card  28 . It may be desirable to have at least two barcode scanners  34 , with one positioned in each location. 
     Controller  38  is positioned within storage facility  12  as shown in  FIG. 5 . Controller  38  may be positioned in any location as long as it is electronically connectable to numerous components of automated medication delivery system  10  as identified herein. Controller  38  is in electronic communication with a computer  40 . Controller  38  provides functional control for all of automated medication delivery system  10 . For example, controller  38  receives input, provides output and real-time feedback to all systems. Some of the major systems include barcode scanner  34 , retrieval device  42 , dispensing device  44 , first input station  46 , positive control feedback device  48 , and cart  50 . 
     Computer  40  is preferably incorporated into controller  38 . However, for security reasons computer  40  may be separated from controller  38 . 
     With reference to  FIGS. 1 and 5 , first input station  46  includes input port  52 , at least one positive identification device  54 , and display device  56 . In the preferred embodiment, input port  52  is a keyboard, as shown in  FIG. 1 ; however, input port  52  maybe any device suitable for entering personal identification data into controller  38 . Positive identification device  54  is preferably a biometric device such as finger print reader, retinal scanner, or voice identification device. Display device  56  is a visual display interacting with the requestor. Preferably, display device  56  is a touchscreen device. In one alternative, when display device  56  is a touch screen display device, input port  52  is integrated with display device  56 . First input station  46  elements, input port  52 , positive identification device  54 , and display device  56 , are in electronic communication with controller  38 . 
     Additionally, first input station  46 , input port  52  and display device  56  may be used to submit live queries or respond to medical/pharmacy personnel or security personnel. 
     Retrieval device  42  is preferably positioned between storage bins  24  and in electronic communication with controller  38 . As shown in  FIGS. 3-9 , retrieval device  42  includes track  58 , elevation rod  60 , picker arm  62 , and retriever  64 . Track  58  permits lateral movement of elevation rod  60  between storage bins  24 . Track  58  supports elevation rod  60  between upper component  66  and lower component  68   
     Elevation rod  60  carries a rotatable collar  70  supporting picker arm  62 . Elevation rod  60  provides vertical movement of between storage bins  24  for picker arm  62 , while rotatable collar  70  allows picker arm  62  to rotate 360 degrees about elevation rod  60 . Picker arm  62  is able to laterally move within rotatable collar  70 . 
     Each picker arm end  72  and  74  carries a retriever  64 . In one preferred embodiment depicted in  FIGS. 6-8 , retriever  64  carries clamping device  76 . In an alternative embodiment depicted in  FIG. 9  retriever  64  carries spatula shaped device  78 . 
     Dispensing device  44  is shown in  FIGS. 3-5  and  11 . Dispensing device  44  includes punchout system  80 , cup  82 , first conveyor  84 , second conveyor  86 , anti-contamination film  88 , pill crusher  90 , cup sweeper  92 , med card sweeper  94 , first cup dispensing slot  96 , second cup dispensing slot  98 , first med card dispensing slot  100 , second med card dispensing slot  102 , a distribution conveyor  104 , and water dispenser  106 . 
     Punchout system  80  includes punch  108  and tray  110 , and is adapted to extract medication from med card  28 . A plurality of holes  112  are disposed through tray  110  and positioned above catch  114 . Catch  114  has catch opening  116 . 
     With reference to  FIG. 10 , med card  28  has blisters  118  containing pills  120 . Positioning of med card  28  in tray  110  aligns blisters  118  with holes  112 . Extraction of pills  120  is provided by positioning of punch  108  over any one of blisters  118 . 
     With reference to  FIGS. 3 and 4 , cup feeder  122  is positioned at first conveyor first end  124 . Cup feeder  122  provides a continuous supply of individual cups  82  to conveyor  84 . First conveyor  84  is adapted to convey cup  82  to first cup dispensing slot  96  positioned through outer side wall  26  or second cup dispensing slot  98  positioned through first end wall  126  at first conveyor second end  128 . 
     Anti-contamination film  88  is positioned between and crusher head  134  of pill crusher  90  and an interior of cup  82 . Anti-contamination film  88  is carried by first spool  130  and second spool  132 . First spool  130  and second spool  132  are adapted to release a portion of anti-contamination film  88  when crusher head  134  is positioned within the interior of cup  82 , and to retract anti-contamination film  88  when crusher head  134  is not in use. First spool  130  and second spool  132  are adapted to move anti-contamination film  88  after every crushing event. Preferably, pill crusher  90  moves in an upward and downward direction for crushing pill  120 . Pill crusher  90 , first spool  130 , and second spool  132  are in electronic communication with controller  38 . 
     Second conveyor  86 , shown in  FIGS. 3-5 , receives a complete med card  28 . Second conveyor  86  has a second conveyor first end  138  adapted to receive med card  28  from retrieval device  42 . Second conveyor  86  is adapted to convey med card  28  to first med card dispensing slot  100 , or second med card dispensing slot  102 . First med card dispensing slot  100  is positioned through outer side wall  26 . Second med card dispensing slot  102  is shown positioned through first end wall  126  at second conveyor second end  140 . 
     Sweep structure  142  supports cup sweeper  92  and med card sweeper  94 . Cup sweeper  92  is positioned to move cup  82  from first conveyor  84  to first cup dispensing slot  96 . Med card sweeper  94  is positioned to move med card  28  from second conveyor  86  to first med card dispensing slot  100 . 
     When requested, first conveyor  84  conveys a plurality of cups  82  through second cup dispensing slot  98  to distribution conveyor  104 . Distribution conveyor  104  is shown wrapping around first end wall  126  and onto inner side wall  16 . Distribution conveyor  104  is positioned within a secure portion of storage facility  12 . 
     Positive consumption feedback device  48  is shown in  FIG. 1 . Positive consumption feedback device  48  ensures compliance with medical protocols by providing a video camera  144 , microphone  146 , recorder  148  and audio/video communications link  150  to permit monitoring of patients using automated medication delivery system  10 . Additionally, window  152  permits direct human oversight by facility staff standing in or outside of window  152 . Although video camera  144 , microphone  146 , recorder  148  and audio/video communications link  150  can be positioned almost anywhere. In one embodiment, window  152  has video camera  144  and microphone  146  positioned above it. Audio/video communications link  150  provides a signal to recorder  148  co-located with controller  38 . 
     Dispensing device  44  optionally includes a water dispenser  106 . Water dispenser  106  is adapted to provide water to cup  82  while upon first conveyor  84 , as seen in  FIG. 12 . 
     In the preferred embodiment, a printer  158  prepares a receipt for the medication. In one embodiment, printer  158  prepares a receipt near input port  52 . The receipt optionally includes additional information regarding the medication dispensed. Another embodiment has an additional printer near first cup dispensing slot  96  for dispensing a receipt with cup  82 . Preferably, another printer  158  is positioned to deposit a receipt with cup  82  exiting second cup dispensing slot  98 . Additionally, a portable printer (not shown) may be near window  152  for a staff member to manually present to the patient. 
     As depicted in  FIG. 10 , med card  28  carries a barcode  36 . Additional information is also preferably printed on med card  28 . The preferred information includes identification of the medication, date of issue, number of refills, prescribing medical professional, dosage, administration protocol, warnings, and housing unit, or room of the patient. Other information can be added as desired. Preferably, database  160  stores all information for access by computer  40  through controller  38 . 
     Servicing of retrieval device  42 , dispensing device  44 , barcode scanner  34 , controller  38 , first input station  46 , or any other equipment with medication room  196  is done by qualified personnel. This includes refilling cup feeder  122 , picking up dropped med cards  28 , or cleaning spills. 
     In the preferred embodiment, cart  50  is a mobile extension of automated medication delivery system  10 .  FIGS. 13 and 14  show cart  50  carried by wheels  162 . However, cart  50  may use any convenient type of conveyance suitable for movement through the intended environment. Additionally, cart  50  may have powered wheels  162  for autonomous operations or robotic operations. 
     Cart  50  preferably uses a rechargeable battery as a power source (not shown) and includes a suitable charger (not shown) connectable to a standard wall outlet. 
     Cart  50  has a plurality of internal storage bins  24  sized to store med card  28 . In the preferred embodiment, security is provided by access panels  164  that are only openable by the facility staff members with the proper access clearance. 
     Cart  50  further includes a wireless communication system suitable for communicating with controller  38 . When operating in an autonomous mode or robotic mode, cart  50  is entirely controlled by controller  38 . In this situation, controller  38  is a remote central control facility. A typical wireless communication system will include an antenna  166  and communications device  168  positioned within or on cart  50 . Additionally, cart  50  has an on-board computer  170  for local control functions. 
     In the preferred embodiment, cart  50  has a remote input station  172 , a remote retrieval device  174 , a remote punchout  176 , a cup  178 , a remote cup dispensing slot  180 , and a remote med card slot  182 . Each of these is similar to the ones found in storage facility  12 . 
     Additionally, remote input station  172  includes the same elements as found in input station  46 . Remote input station  172  has input port  52 , positive identification device  54 , and display device  56 . On remote input station  172 , input port  52  is shown as a keyboard in  FIG. 13 . As before, input port  52  is suitable for entering personal identification data into cart  50  and controller  38 . Display device  56  is a visual display interacting with the requestor. Preferably, display device  56  is a touchscreen device. In one alternative, when display device  56  is a touch screen display device, input port  52  is integrated with display device  56 . Remote input station  172  is in electronic communication with on-board computer  170  and in wireless electronic communication with controller  38 . 
     Remote retrieval device  174  also includes the same elements found in retrieval device  42 . Remote retrieval device  174  is shown in  FIGS. 13 and 14  as being positioned near and providing access to storage bin  24 . Remote retrieval device  174  is in electronic communication with on-board computer  170  and in wireless electronic communication with controller  38 . 
       FIGS. 13 and 14  show remote retrieval device  174  with track  58 , elevation rod  60 , picker arm  62 , and retriever  64 . Elevation rod  60  is movably positioned on track  58 . Within cart  50 , track  58  is shown with an upper component  66  and a lower component  68 . Track  58  is designed to move elevation rod  60  laterally between storage bins  24 . 
     Cart  50  uses picker arm  62 , which is shown positioned on elevation rod  60 . Elevation rod  60  is designed to move picker arm  62  vertically between storage bins  24 . Picker arm  62  is mounted on rotatable collar  70 . Rotatable collar  70  allows picker arm  62  to rotate 360 degrees about elevation rod  60 . Picker arm  62  is able to laterally move within rotatable collar  70 . Picker arm  62  in cart  50  also employs either clamping device  76  or spatula shaped device  78  as retriever  64 . Within cart  50 , retriever  64  is attached to at least end  72 . Preferably, retriever  64  is attached to both ends  72  and  74  of picker arm  62 . 
     Cart  50  employs a variation of dispensing device  44 . As shown in  FIG. 14 , cart  50  uses punchout system  80 , which includes punch  108  (not shown in  FIG. 14 ) and tray  110 . Tray  110  has a plurality of holes  110  disposed through it with catch  114  positioned below tray holes  112  of tray  110 . Catch  114  has catch opening  116 . 
     Cart conveyor  184  is adapted to convey a pill  120  extracted by punchout system  80  to remote cup dispensing slot  180 . Remote cup dispensing slot  180  is shown positioned through outer side wall  26 . Remote cup dispensing slot  180  is sufficiently large enough to allow access to pill  120  on cart conveyor  184 . 
     Although not shown in  FIG. 14 , cart  50 , an alternative embodiment includes a pill crusher  90 . In this alternative embodiment, pill crusher  90 , first spool  130 , second spool  132 , crusher head and anti-contamination film  88  are similarly configured as in storage facility  12 . In cart  50 , pill crusher  90 , first spool  130 , second spool  132 , crusher head and anti-contamination film  88  are positioned between tray  110  and cart cup dispensing slot  180 . Pill crusher  90 , first spool  130  and second spool  132  are in electronic communication with on-board computer and in wireless electronic communication with controller  38 . 
     In the alternative embodiment using pill crusher  90 , cup feeder  122  is also used. In this alternative embodiment, cart conveyor  184  receives cups from cup feeder  122  which is positioned at cart conveyor first end  186 . Cup feeder  122  provides a continuous supply of individual cups  82  to cart conveyor  184 . Cart conveyor  84  conveys pill  120  positioned within cup  82  to remote cup dispensing slot  180 . Remote cup dispensing slot  180  is also sufficiently large enough to allow access to cup  82  on cart conveyor  184 . 
     As shown in  FIG. 14 , cart  50  uses cart shelf  188  to receive a complete med card  28 . Cart shelf  188  is positioned adjacent to remote med card slot  182 . Remote retrieval device  174  positions med card  28  sufficiently within remote med card slot  182  for a requestor to extract med card  28 . 
     An alternative positive consumption feedback device  48  including video camera  144 , microphone  146 , recorder  148  and audio/video communications link  150  is optionally integrated with cart  50 . Video camera  144 , microphone  146 , recorder  148  and audio/video communications link  150  are positioned near remote input station  172  for ease of use. Audio/video communications link  150  provides a signal to on-board computer  170  and wirelessly communicates with recorder  148  via controller  38 . 
     In one alternative embodiment, cart  50  includes printer  158 . Typically, printer  158  will be located near remote input station  172  for ease of use. 
     Having described the preferred embodiments of the apparatus of the current invention, the following discussion will focus on the preferred methods for automatically delivering medication using the automated medication delivery system  10 . The following detailed discussion will break the method into six sub-methods, as shown in  FIGS. 15-18 . The first sub-method begins with the actual prescription process. The method includes the following steps, which are shown in  FIG. 18 :
         a. A physician writes a prescription for medication(s) for a patient;   b. the prescription is transmitted to a pharmacy via computer or facsimile;   c. the pharmacy fills the prescription into med cards  28  having blisters  118 ;   d. the pharmacy records patient information and medicine information into database  160 , and associates that information with barcode  36  that is printed on med card  28 ;   e. the patient information and prescription information are printed onto med card  28 ;   f. the pharmacy ships med cards  28  to facility via approved, overnight shipping agent; and   g. the staff receives, inspects, records anomalies and loads medicine cards loaded into automated medication delivery system  10 .       

     The second sub-method highlights the loading process and is shown in  FIG. 17 . In this sub-method, the medical staff preferably inputs med card  28  into storage facility  12 . The group of med cards  28  is received from the pharmacy. Each med card  28  has all of the pertinent patient information already printed upon it, along with barcode  36  that associates the patient information and medication. 
     The staff member, or members, enters medication room  196  through access door  14  with med cards  28  received from the pharmacy. Each med card  28  is inspected by at least one staff member for completeness, accuracy and any missing medications. All missing medications on med card  28  are identified by individual blisters  118 . The information is entered into terminal  194 , which is in electronic communication with controller  38  and database  160 . 
     The staff member places the inspected med card  28  onto access panel tray  30 . In one embodiment, controller  38  engages barcode scanner  34  to record barcode  36  while med card  28  is upon access panel tray  30 . In another embodiment, controller engages barcode scanner  34  after removing med card  28  from access panel tray  30 . In an alternative embodiment, the staff member directly places med card  28  into storage bin  24  and engages controller  38 , automatically or through terminal  194 , to use retrieval device  42  to remove, scan and store it. 
     Controller  38  next engages retrieval device  42  using retriever  64  to pick up the scanned med card  28 . Controller  38  assigns med card  28  to an empty storage bin  24  and moves retrieval device  42  to insert med card  28  therein. 
     The third sub-method highlights the patient request process. This process is similar to the fourth sub-method shown in  FIGS. 16A and 16B . The third sub-method is demonstrated through an example operation of storage facility  12 . In the example, the facility is a prison or large institutional hospital. 
     A patient approaches the first input station  46 . Using input port  52  and display device  56 , the patient proceeds to login by entering a unique number assigned to them, along with a personal identification number. Positive identification device  54  in this instance is a finger print biometric device. The patient places their finger on positive identification device  54  for verification of their identity. A receipt is printed and dispensed to the patient using printer  158 . 
     Once the patient&#39;s identity is verified, a menu of at least one medication associated with that patient is shown on display device  56 . The menu indicates all medication available for dispensing at that time. Using first input station  46 , the patient makes a request for the medication by selecting the medication desired. If several medications are available, the menu allows the patient to select all dispensable medications. 
     Upon receipt of the request, controller  38  identifies the specific storage bin  24  containing the patient&#39;s med card  28 . Controller  38  also identifies that the medication is not a “keep on person” medication and that the medication must be crushed. As known to those skilled in the art, institutions identify certain medications as “keep on person” medications when those medications must remain with the patient. For example, a patient with severe asthma may need to carry their medication with them at all times in the event of an asthma attack. 
     Controller  38  moves picker arm  62  vertically and laterally to position retriever  64  immediately adjacent to the specific storage bin  24  containing the patient&#39;s med card  28 . Controller  38  extends picker arm  62  through rotatable collar  70  until retriever  64  clamps med card  28 . Controller  38  next retracts picker arm  62  to a neutral position. 
     Controller  38  moves picker arm  62  vertically and laterally to position retriever  64  adjacent to barcode scanner  34 . Controller  38  again extends picker arm  62  through rotatable collar  70  to scan barcode  36  on med card  28 . Picker arm  62  is again retracted to a neutral position. Depending upon the particular location of storage bin  24 , rotatable collar  70  may have rotated picker arm  62  one or more times to scan barcode  36 . 
     Controller  38  moves picker arm  62  vertically and laterally until med card  28  is aligned with tray  110 . Once aligned, controller  38  extends picker arm  62  through rotatable collar  70  to place med card  28  onto tray  110 . Since tray  110  is sized to accept med card  110 , blisters  118  are aligned with holes  112 . Depending upon the particular location of storage bin  24 , rotatable collar  70  may have rotated picker arm  62  one or more times to align med card  28  with tray  110 . Picker arm  62  may optionally release med card  28 . In the preferred embodiment, picker arm  62  retains med card  28  until after punchout system  80  is through with the extraction process of pill  120 . 
     Controller  38  operates punchout system  80  once med card  28  is positioned on tray  110 . Controller  38  memory contains the location of all remaining pills  120  in med card  28 . Preferably, controller  38  moves punch  108  to a position over blister  118  containing pill  120 . Alternatively, picker arm  62  and retriever  64  release med card  28 , allowing tray  110  to move and position blister  118  under punch  108 . Controller  38  moves punch  108  in a downward direction to push pill  120  through blister  118 . Pill  120  falls through hole  112  into catch  114  and out catch opening  116 . Since catch  114  is funnel shaped, it does not matter which pill  120  is extracted. 
     Controller  38  has previously released cup  82  from cup feeder  122  at first conveyor first end  124 . Controller  38  positions cup  82  under catch opening  116  by moving cup  82  on first conveyor  84 . 
     Once pill  120  is extracted, controller moves picker arm  62  back to a neutral position on rotatable collar  70 . This movement removes med card  28  from tray  110 . Preferably, controller  38  moves picker arm  62  to replace med card  28  in the same storage bin  24 . 
     Once pill  120  is in cup  82 , controller  38  moves first conveyor  84  to position it under pill crusher  90 . Controller  38  moves crusher head  134  in a downward motion until it enters interior  136  of cup  82  and engages pill  120 . Pill  120  is crushed by crusher head  134 . Anti-contamination film  88  protects crusher head  134 . Crusher head is moved upward to a neutral position. Once in the neutral position, controller  38  causes first spool  130  and second spool  132  to rotate and remove the contaminated portion of anti-contamination film  88  from near crusher head  134 . 
     Controller  38  engages first conveyor  84  to move cup  82  to a position in front of first cup dispensing slot  96 . Once positioned, controller moves cup sweeper  92  to push cup  82  into first cup dispensing slot  96 . Printer  158  produces a receipt and deposits the receipt in or near cup  82  while cup  82  is in first cup dispensing slot  96 . The patient is now able to access their medication. 
     Controller  38  updates database  160  with the details of the transaction to include the specific pill extracted from med card  28 . 
     If the patient is to receive “keep on person” medication, controller  38  directs delivery of med card  28  to second conveyor first end  138 . Once med card  28  is on second conveyor  86 , controller  38  moves second conveyor  86  until med card  28  is positioned in front of first med card dispensing slot  100 . Once there, controller  38  engages med card sweeper  92  to push med card  28  into first med card dispensing slot  100 . Printer  158  produces a receipt and deposits the receipt with med card  28  while med card  28  is in first med card dispensing slot  100 . The receipt may contain additional information about the medication to include drug interaction warnings and side effects. The patient is now able to access their medication. 
     The fourth sub-method is for a staff member to request medication for a group of patients, an entire housing unit or an entire wing. The fourth sub-method is shown in  FIGS. 16A and 16B . 
     In some situations, patients are unable to come to a central medication distribution site. Thus, facility staff member may need to retrieve all of the medication for a particular room, housing unit, or wing. In that situation, the staff member approaches a second input station (not shown) and logins using a second input port (not shown), a second display device (not shown), and a second positive identification device (not shown). Second input station is preferably positioned in near inner side wall  16  or first end wall  126 . Second input station is also in electronic communication with controller  38 . 
     After the staff member enters their unique identifying number and personal identification number, they may be required to further provide positive identification by a finger print scanner, retinal scanner, or voice identification device. Once the staff member&#39;s identity is verified by controller  38 , they will have a different set of menu options presented to them. Preferably, the staff member is able to select an individual patient, a group of patients, an entire housing unit or wing, and/or a combination thereof. From that grouping, the staff member selects the medication to be dispensed at that time. Controller  38  has the medical records of the patients on file and is able to determine which medication must be dispensed. 
     Controller  38  repeats most of the process used for the individual patient identified in the third sub-method, but it does not use cup sweeper  92  or med card sweeper  94 . Instead, controller  38  uses first conveyor  84  to deliver all of the medication in cups  82  through second cup dispensing slot  98 . Printer  158  prints the patient information for each cup  82 . At that point, controller  38  moves cups  82  on distribution conveyor  104 . The staff member removes cups  82  from distribution conveyor  104 . A safety check device  190  provides feedback to controller  38  to prevent cups  82  from falling off of distribution conveyor  104 . 
     Additionally, controller  38  uses second conveyor  86  to deliver all med cards  28  that are “keep on person” medications to second med card dispensing slot  102 . The med cards  28  are delivered to catch basket  192 . The staff member removes all med cards  28  from catch basket  192 . 
     The fourth sub-method highlights the staff request process. The method includes the following steps shown in  FIGS. 16A and 16B :
         a. The staff member logs into the second input port with appropriate identifier;   b. the staff member selects the option to retrieve all medication for a particular patient, group of patients, housing unit or wing;   c. controller  38  identifies if any of the medication is “keep on person” (KOP) medication   d. if any of the medication is a KOP medication, controller  38  directs retrieval device  42  to use picker arm  62  and retriever  64  to retrieve med card  28 :
           i. barcode  36  on med card  28  is scanned and verified that medication is correct for patient;   ii. the entire med card  28  is passed through second med card dispensing slot  102  to catch basket  192 ;   iii. database  160  is electronically updated;   
           e. If none of medication is a KOP, controller  38  directs retrieval device  42  using picker arm  62  and retriever  64  to retrieve med card  28 :
           i. retrieval device  42  using picker arm  62  moves med card  28  to punchout system  80 ;   ii. barcode  36  on med card  28  is scanned to verify the correct medication is being dispensed for the correct patient;   iii. med card  28  is positioned to allow the next individual pill  120  to be punched out, extracted, from blister  118  on med card  28 ;   iv. individual pill  120  is punched out and falls into cup  82 ;   v. database  160 , medication administration records, are electronically updated;   vi. database  160  information on med card  28  is updated to determine where next punchout should occur on med card  28 ;   vii. controller  38  directs retrieval device  42  using picker arm  62  to return med card  28  to its storage bin  24 ;   viii. cup  82  is moved on first conveyor to pill crusher  90  station;   ix. controller  38  identifies if pill  120  is to be crushed; if so, pill(s)  120  are crushed using crusher head  134 ; otherwise cup  82  is further conveyed to second cup dispersing slot  98 ; and   x. printer  158  prints a receipt showing the medication retrieved; the receipt is placed on or in cup  82 .   
               

     The fifth sub-method relates to a patient&#39;s refill request of medication or a staff member&#39;s request for a refill of a medication for a patient. This sub-method is shown in  FIG. 15 . Controller  38  will display all medications needing refills as part of the original display. If the patient or staff member is only requesting a refill, they may go through the same login process and select that particular option. The fifth sub-method is further outlined in the following steps:
         a. The patient or staff member logs into first input station using their unique identifying number, personal identification number, and presenting a positive identification;   b. the positive identification is made through fingerprint scan, retinal scan, or voice identification;   c. the medication(s) the patient is authorized to refill is shown on display device  56 ;   d. the patient or staff member identifies any or all medications to be refilled;   e. if the medication is selected for refill, the refill order is automatically sent to the pharmacy and the medical staff is notified that a refill order was transmitted; and   f. if the refill order was rejected by the patient or staff member, the medical staff notified that refill order was rejected.       

     The sixth sub-method relates to the mobility of automated medication delivery system  10 . As shown below, cart  50  is used to deliver medication within a facility. Cart  50  may be pushed by a staff member. Alternatively, cart  50  may be semi-autonomous and move through the facility with a staff member. In still another alternative, cart  50  operates autonomously without a staff member. In all situations, cart  50  is in wireless electronic communication with controller  38  and facility staff. 
     Cart  50  is loaded with med cards  28  by an authorized staff member. In a secure environment, a staff member opens secure access panels  164  to have access to storage bins  24 . The staff member uses a remote barcode scanner (not shown) to scan barcode  36  and record the information in on-board computer  170  and controller  38 . The remote barcode scanner is mounted within cart  50 , and is in electronic communication with on-board computer  170  and controller  38 . 
     The staff member places med card  28  inside of cart  50  under remote barcode scanner. Remote barcode scanner triggers remote retrieval device  174  to collect med card  28 . Remote retrieval device  174  selects an empty storage bin  24  and moves med card  28  to that storage bin  24 . On-board computer  170  is performing local control of remote barcode scanner and remote retrieval device  174 . The particular med card  28  information and storage bin  24  information are locally stored and transmitted to controller  38 . The med card  28  information is compared with database  160  by controller  38 . Any anomalies are identified to the on-board computer  170 , which has remote retrieval device  174  remove med card  28 . Once all anomalies are resolved, the med card  28  having trouble is reloaded. After all med cards  28  are loaded, secure access panels  164  are secured. 
     Once cart  50  is loaded, on-board computer  170  directs it to deliver the medication. Preferably, cart  50  delivers medication to a single room or patient. However, cart  50  can be programmed to deliver medication to a location with several patients. 
     When the patient accesses cart  50 , they use remote input station  172  to login. Using input port  52  and display device  56 , the patient proceeds to login by entering a unique number assigned to them, along with a personal identification number. Preferably, the patient further verifies their identity using positive identification device  54 . Positive identification device  54  is preferably a biometric device, as described above. 
     Since, the need for cart  50  implies a higher security area to be serviced, on-board computer  170  records the entire transaction using video camera  144  mounted near remote input station  172 . Additionally, the date, time and all other pertinent information is recorded. The recording is wirelessly transmitted to controller  38 . 
     Once the patient&#39;s identity is verified, a menu of at least one medication associated with that patient is shown on display device  56 . The menu indicates all medication available for dispensing at that time. Using remote input station  172 , the patient makes a request for the medication by selecting the medication desired. If several medications are available, the menu allows the patient to select all dispensable medications. 
     Upon receipt of the request, on-board computer  170  identifies the specific storage bin  24  containing the patient&#39;s med card  28 . On-board computer  170  also identifies if the medication is a “keep on person” medication, an individual dosage, and if that individual dosage should be crushed. 
     Within cart  50 , on-board computer  170  engages remote retrieval device  174 . Picker arm  62  is moved vertically and laterally to position retriever  64  immediately adjacent to the specific storage bin  24  containing the patient&#39;s med card  28 . On-board computer  170  extends picker arm  62  through rotatable collar  70  until retriever  64  retrieves med card  28 . On-board computer  170  next retracts picker arm  62  to a neutral position. 
     On-board computer  170  next moves picker arm  62  vertically and laterally to position retriever  64  adjacent to barcode scanner  34 . On-board computer  170  again extends picker arm  62  through rotatable collar  70  to scan barcode  36  on med card  28 . Picker arm  62  is again retracted to a neutral position. Depending upon the particular location of storage bin  24 , rotatable collar  70  may have rotated picker arm  62  one or more times to scan barcode  36 . 
     Once med card  28  is scanned, on-board computer  170  moves picker arm  62  vertically and laterally until med card  28  is aligned with tray  110 . Once aligned, on-board computer  170  extends picker arm  62  through rotatable collar  70  to place med card  28  onto tray  110 . Since tray  110  is sized to accept med card  110 , blisters  118  are aligned with holes  112 . Depending upon the particular location of storage bin  24 , rotatable collar  70  may have rotated picker arm  62  one or more times to align med card  28  with tray  110 . Picker arm  62  may optionally release med card  28 . In the preferred embodiment, picker arm  62  retains med card  28  until after punchout system  80  is through with the extraction process of pill  120 . 
     On-board computer  170  operates punchout system  80  once med card  28  is positioned on tray  110 . On-board computer  170  memory contains the location of all remaining pills  120  in med card  28 . Preferably, on-board computer  170  moves punch  108  to a position over blister  118  containing pill  120 , Alternatively, picker arm  62  and retriever  64  release med card  28 , allowing tray  110  to move and position blister  118  under punch  108 . On-board computer  170  moves punch  108  in a downward direction to push pill  120  through blister  118 . Pill  120  falls through hole  112  into catch  114  and out catch opening  116 . Since catch  114  is funnel shaped, it does not matter which pill  120  is extracted, 
     If an alternative embodiment utilizing pill crusher  90  is used, cup  82  is internally positioned. In this alternative embodiment, on-board computer  170  has previously released cup  82  from cup feeder  122  at cart conveyor first end  186 . On-board computer  170  positions cup  82  under catch opening  116  by moving cup  82  on cart conveyor  184 . 
     Once pill  120  is extracted, controller moves picker arm  62  back to a neutral position on rotatable collar  70 . This movement removes med card  28  from tray  110 . Preferably, on-board computer  170  moves picker arm  62  to replace med card  28  in the same storage bin  24 . 
     Once pill  120  is in cup  82 , on-board computer  170  moves first conveyor  84  to position it under pill crusher  90 . If pill  120  is to be crushed, on-board computer  170  moves crusher head  134  in a downward motion until it enters interior  136  of cup  82  and engages pill  120 . Pill  120  is crushed by crusher head  134 . Anti-contamination film  88  protects crusher head  134 . Crusher head is moved upward to a neutral position. Once in the neutral position, on-board computer  170  causes first spool  130  and second spool  132  to rotate and remove the contaminated portion of anti-contamination film  88  from near crusher head  134 . 
     If pill  120  is not be crushed, or after being crushed, on-board computer  170  engages first conveyor  84  to move cup  82  to a position in front of remote cup dispensing slot  180 . Once positioned, printer  158  produces a receipt and deposits the receipt in or near cup  82  while cup  82  is in remote cup dispensing slot  180 . The patient is now able to access their medication. 
     If the alternative embodiment is not used having pill crusher  90  receiving cup  82  from cup feeder  122 , cart conveyor  184  receives pill  120  and positions it in front of remote cup dispensing slot  180 . 
     In yet another embodiment, using pill crusher  90  and not cup feeder  122 , the patient selects cup  82  from external cup feeder  198 , removes pill  120  from cart conveyor  184 , inserts pill  120  into cup  82  and places cup  82  under pill crusher  90 . On-board computer  170  knows to detect if cup  82  is positioned under crusher  90  through a detector (not shown). Once cup  82  is in position, pill crusher  90  engages and crushes pill  120 . After the crushing event, the patient removes cup  82  with pill  120  in it. 
     On-board computer  170  updates database  160  via controller  38  with the details of the transaction to include the specific pill extracted from med card  28 . 
     If the patient was to receive “keep on person” medication, controller would have delivered med card  28  to cart shelf  188 . Remote retrieval device  174  pushes med card  28  out remote med card dispensing slot  182  a sufficient distance so that the patient may grab med card  28 . Printer  158  produces a receipt for the patient. The receipt may contain additional information about the medication to include drug interaction warnings and side effects. The patient is now able to access their medication. 
     An automated update of the entire transaction is recorded by on-board computer  170  and transmitted to database  160  via controller  38 . 
     Therefore, it will be seen that the apparatus and method of the present invention are well adapted to carry out the ends and advantages mentioned, as well as those inherent therein. While a presently preferred embodiment of the apparatus and method have been described for the purposes of this disclosure, numerous changes in the arrangement and construction of parts in the apparatus, and steps in the method, may be made and executed by those skilled in the art. All such changes are encompassed within the scope and spirit of the appended claims.