Patent Publication Number: US-11396418-B2

Title: High efficiency automated pharmaceutical dispenser

Description:
PRIORITY 
     This application is a continuation of U.S. application Ser. No. 14/659,430, filed Apr. 16, 2015, which issued Aug. 27, 2019 as U.S. Pat. No. 10,392,182, which is a continuation of U.S. application Ser. No. 13/454,368, filed Apr. 24, 2012, which issued Mar. 24, 2015 as U.S. Pat. No. 8,989,896, each of which is incorporated by reference in its entirety into this application. 
    
    
     FIELD OF INVENTION 
     This invention relates to automated pharmaceutical dispenser devices such as those that dispense a plurality of different drugs with varying doses used in hospitals, pharmacies and home health care facilities. 
     BACKGROUND 
     The dispensing of pharmaceuticals in hospitals, pharmacies, home healthcare, assisted living and similar facilities is a critical aspect of patient care. Pharmaceuticals are manufactured by numerous drug companies, most using different types of packaging, or packaging that is not uniform in size, drug quantity, labeling, or dosage. These packages can be syringes, ampules, vials, oral suspensions, tubes, jars, blister packs in single or multiple dose sheets, and many bottles of various sizes and shapes. The lack of standardization results in confusion for medical professionals regarding the delivery of proper dose and medication, and it is known to result in a large number of adverse drug reactions caused by errors in the stocking, storage and delivery of prescribed medication. 
     Historically, in a large multi-patient environment, like hospitals that can have hundreds of beds, prescriptions are written by doctors; the prescription is physically or electronically presented to a hospital pharmacy; the pharmacy picks and packs the medicine for physical transfer to a cart or tray for transfer to nurses for delivery to and consumption by patients in their rooms. Nurses are usually responsible for multiple patients located in different rooms or locations within the hospital. Each step in the delivery chain opens opportunities for mistakes in giving patients an improper dosage or improper medication. In reading poor hand writing or inverting numbers on a script, pharmacists may accidently provide the wrong dosage or drug for delivery to a patient. Errors may also occur during transport to the patient&#39;s room or during the administration of the drug by nurses. These errors result in many serious or fatal adverse drug reactions every year and cost our health care system many billions in excess costs annually. 
     Attempts to improve existing packaging, storage, script writing and delivery systems and methods have been made. Systems are known with automated computerized script writing, cross referenced against electronic digital patient medical record, automated storage and dispensing. U.S. Pat. No. 6,757,898 discloses an electronic tracking and patient cross checking system that is a significant improvement over manual systems. Doctors can now place scripts at a patient&#39;s bedside electronically through tablet computer and smart phones that are networked to interface directly with patient records and pharmacies. RFID and barcode systems are known that provide significant improvements in identifying and tracking drug type and dosage as the medication flows from script to patient. Further advances have been made with inventory management, tracking and control, reordering and stock adjustment systems. The security of inventory has also been improved by providing user authorization and authentication with delivery confirmation systems that allow for only dispensing drugs to authorized individuals and tracking the delivery of the dose until confirmation of delivery is provided. 
     Some attempts have been made to establish standardization in bar coding. 21 CFR 201.25 sets out guidelines for the pharmaceutical industry with respect to bar code formats and requirement for certain types of data. However, even with these advancements, there continue to be deficiency with these systems. Because there are no established standards for packaging, handling, tracking, dispensing and delivery of drugs in institutional environments, there remain significant inefficiencies, errors and limitations with existing designs. There is also a significant lack of standardization in the nature and structure of data that is captured and used in managing these functions. Automated dispensing machines have a number of limitations because they are generally designed to handle a variety of package designs or they require a significant amount of manual effort to stock or restock. Current state of the art automated dispensers, in order to handle a variety of medications, also require the manual preparation of individual unit doses of medication so that automated systems can accommodate the package for automated processing. Unit doses must be physically separated and placed in individual bin locations or canisters within the automated dispenser. 
     There are also limitations with respect to inventory monitoring and control of inventory in current pharmaceutical dispensers. In existing systems multiple individuals may have a key or access to secured areas or access point where medication is stored and inventoried. This leaves inventory vulnerable to unauthorized removal or theft. 
     Additionally, many of the known systems are very inefficient in both the unit dose package storage density and in the process of stocking and restocking of pharmaceuticals. In one known system, the McKesson Automation, Inc. system disclosed in U.S. Pat. No. 8,036,773 which is fully incorporated herein by reference, the system is designed to hold unit dose packages of various sizes. However, the McKesson system requires that each unit dose package be individualized or separated from multipack packages and that each separated unit dose package be place in individual carriers in a horizontal plane. The separation of the individual unit dose package is a manual process and requires a significant amount of physical labor to separate and load individual unit dose packages or to otherwise manipulate the unit dose packages to allow accommodation of different package sizes by the system. Alternatively, the user must purchase a standalone separating machine for the purpose of separating unit dose packages, which adds significant cost. 
     Because the system disclosed in U.S. Pat. No. 8,036,773 requires that each individual unit dose package be loaded into a carrier and then multiple carriers are stacked into a storage apparatus, there is a significant amount of unutilized space within the system and the unit dose package density is extremely low, requiring constant manual stocking as described above. Each time the system is stocked there is opportunity for error, and cost is added through manual processing. The loading or stocking procedure is just as lengthy and requires as much operator time as does the dispensing. 
     U.S. Pat. No. 8,090,472 issued to Schifman et al discloses an automated medication dispensing apparatus. This dispenser is similar to the dispenser disclosed in U.S. Pat. No. 8,036,773 in that it uses multiple pharmaceutical storage bins with multiple compartments for holding unit dose packages. The storage bins are stacked and each has an assigned location within a cabinet or enclosure. A robotic arm selects a pharmaceutical by selecting the proper bin location and moving the robotic arm to the bin location to extract the pharmaceutical stored at that location. The same limitations apply, in that there is low storage density, high manual processing and associated increase in error rates. The Schifman dispenser does improve security by including a camera for capturing still or video images of users accessing the apparatus. 
     Pharmaceutical dispensers have also improved by allowing digital communication with computer networks. Many healthcare facilities use integrated medical records management software to assist in patient care and to efficiently make available to clinicians patient information. Doctors can enter prescriptions into mobile computer devices such as tablets and smart phones. These wireless devices can be networked to centralized servers or cloud based databases that can interface with automated pharmaceutical dispensing systems. U.S. Pat. No. 8,090,471 discloses at a conceptual level such a system. These software applications have significantly improved the efficiency of the overall drug delivery process in healthcare facilities by reducing or eliminating mistake in script writing, patient identification. Software is also known for assisting in the management of inventory and access authorization in the automated pharmaceutical dispenser systems. However, these systems cannot improve efficiencies based on the lack of standardization or the limitations of the underlying automated dispenser design. 
     Personal Automated Dispensers 
     As the causes of mortality have shifted over the past one hundred years from acute infectious disease to chronic disease such as cardiovascular disease, cancer, diabetes and other age related diseases, pharmaceutical and biotech companies have developed a plethora of treatments that can be self-administered by patients without hospitalization and only minimal physician oversight. Patients with chronic ailments may often have multiple drugs that are taken at various times during the day. As lifespans increase and populations age, the challenge of managing medication schedules becomes more difficult and for some require assistance. Failure to maintain ones medication schedule can create serious medical problems for the patient. Additionally, some patients may have multiple prescriptions and can be confused about which drug relates to the appropriate schedule of administration, resulting in taking drug A on schedule intended for drug B. Additional problems exist with these patients simply failing to take their medication. 
     A number of personal automated medical dispensing devices are known. E-pill, LLC (www.epill.com/dispenser.html) manufactures a full line of personal dispensers having many of the features of larger systems but scaled to individual users. Many systems are microcontroller based and can have sophisticated user interfaces that allow users to set a number of system functions and features. A key feature of personal dispensers is a medication administration scheduling feature that provides notification to the user or healthcare providers of the time to take medication. Notification can be done via audible indicator, light flash, or wireless communication to a third person when medication is not removed from the dispenser at the appointed time. Although personal automated medical dispensers have improved, many of the same limitations existing with automated dispensers used in institutional venues carry over to personal automated medication dispensers, with some additional limitations. Much of the stocking procedure for personal automated dispensers is carried out manually, resulting in a system that is prone to error. Because of the smaller size of personal drug dispensers, restocking is required more often than larger automated systems, providing for even more opportunity for error. Additionally, many patients may be impaired either physically or cognitively and thus are incapable of properly stocking the dispenser and requiring assistance from a medical professional or family member for restocking. There are similar applications in the retail pharmacy, so called lights out order fulfillment and mail order facilities. 
     SUMMARY OF THE INVENTION 
     In view of the foregoing background, the present invention overcomes the limitations of the prior art by providing for a high efficiency automated pharmaceutical packaging method and dispensing systems for hospital, pharmacy, residential and home healthcare facilities. 
     In one aspect of the current invention, a method is disclosed that provides for ribbon segment packaging of pharmaceutical unit doses in a high-density manner for processing in high efficiency automated pharmaceutical dispensing systems. The invention consists of a means of packaging pharmaceuticals at the point of manufacture or post manufacturing prior to delivery to distribution. Pharmaceuticals are packaged in bands, tapes or ribbons of packaging material within a desirable width that can be wound about a reel or placed in a conduit for easy feeding of the ribbon into a dispenser. This packaging allows for the automated and uniform transport, tracking, storage and dispensing in a highly efficient manner. The packaging is two strips of layered ribbon material with pharmaceuticals packaged between the two bound layers. The bound ribbon with the captured unit dose is wound about a reel with a center core that may incorporate generally circular side supports of such size and configuration as to create an overall package with integrity onto which a continuous ribbon or length of prepackaged drugs can be wound. 
     The ribbon packaging consists of individually sealed segments with each segment having a cavity, and each cavity containing a single unit dose of a drug or pharmaceutical compound. The ribbon segment can also contain individual containers such as a vile, tube, or syringe or in itself being a container for a liquid or gel containing unit doses. Each ribbon segment is sequentially positioned on the ribbon so that there is only one dose per segment within the width of the ribbon package for each unit length, but multiple essentially identical segment lengths sequentially and uniformly spaced on the ribbon. Each side of individual ribbon sections may contain encoded data indicative of relevant information regarding the substance contain, dose, lot or manufacturer&#39;s date code, national drug code information, manufacturer&#39;s information, chain of custody, etc. The data can be essentially any type of data, and it can be encoded in a variety of know means, including single or multidimensional bar code. The data can be read as the ribbon segment passes over a reader to compare against the script to assure the proper medication is provided. 
     Each ribbon reel may be contained in a sealed conduit, cassette or cartridge for easy warehousing, transportation, storage and placement within the dispensing system, and to prevent contamination of the packaged pharmaceutical. Each can also be marked for identification using for example barcodes for type, batch and other data. The cartridge is formed from ridged support panels enclosing a ribbon reel. Standardized packaging may also be a container or box into which a fan-folded ribbon may be placed. In another alternative, each ribbon strip may be fed into a tube or similar conduit restraint system that allows for convenient insertion into the dispenser. 
     The ribbon segments may have holes punched on either or both linear edges to allow the ribbon to be pulled or drawn from the reel. The ribbon can be of essentially any width and length depending on the dispensing application and the pharmaceutical contained within the ribbon. Such means may also be used to move or advance the ribbon products through manufacturing and the several dispensing operations. 
     A presentation head may be incorporated into the conduit, cassette or cartridge for serially presenting or separating each reel ribbon segment. In response to the input from the controller based on a prescription, the presentation head will actively or passively be advanced to feed the ribbon into the automated dispensing device so that the each ribbon segment and its contents would be presented for dispensing in a way where after the dispensing a first ribbon segment, the next ribbon segment will be advanced to the dispensing position and available for a dispensing head. Such a presentation head may have a reader for reading the encoded data on each ribbon segment and that may be identified with human and machine readable elements such that a head can be directly and uniquely associated with a specific reel or cartridge so that the head&#39;s identity data defines the pharmaceutical that is dispensed. 
     In another aspect of the invention, an apparatus is provided that is in communication with at least one computer network and is capable of accepting prescriptions electronically from authorized devices in communication with said network. The apparatus comprises at least one pharmaceutical storage structure with plurality of storage locations that are capable of accepting a plurality of reel cartridges, cassettes or conduits each containing a different pharmaceutical or the same pharmaceutical with different unit doses. The apparatus also comprises a means for accessing and comparing patient medical data stored on the associated computer network against prescribed drugs to prevent improper administration of drugs and adverse drug reactions. The apparatus further comprises dispensing structure having a reader for reading encoded data on ribbon cartridges and segment and that is capable of locating storage locations and dispensing prescribed pharmaceuticals. The apparatus also comprises a printing means for printing encoded data on a container that can be read by a reader and representing patient information, drug and dose information. 
     Another aspect of the invention provides for high density storage and dispensing systems for pharmaceutics that requires fewer manual processes for stocking and restocking. The system has dense and uniform packaging, and no requirement for individual receptacles for each unit dose, eliminating complicated means of accessing individual storage areas that contain a very limited quantity of medications. The storage systems have a small physical foot print in comparison with known systems having the same capacity. 
     In one aspect of the invention methods are disclosed for providing unit dose pharmaceutical packaging for high efficiency transportation, tracking, storage, and distribution and dispensing to patients. 
     In another aspect of the current invention an apparatus is provided for a personal automated pharmaceutical dispenser for individual use that include security, ease of operation and a number of user friendly features. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Embodiments of the present disclosure will be more readily understood by reference to the following figures, in which like reference numbers and designations indicate like elements. 
         FIG. 1A  is a profile view of one embodiment of one aspect of the invention showing a section of the ribbon or tape with segments and cavities with the removable covering. 
         FIG. 1B  is a top view of the tape with segments and cavities and removable covering. 
         FIG. 1C  is a profile view of a single unit dose after being dispensed and removed from the ribbon. 
         FIG. 2A  is a front view schematic representation of a length of continuous ribbon containing unit doses on a minimal carrier comprised of a central core and sufficient side supports to keep the tape manageable when handled outside of a dispenser or other restraint. 
         FIG. 2B  is a front view schematic representation of a length of continuous ribbon containing unit doses on a core supported and protected by circular sides. 
         FIG. 2C  is a front view schematic representation of a carrier which may provide a stand-alone dispensing method, a shipping container, or a structurally independent and uniform cassette that is inserted into a dispenser for automated dispensing. 
         FIG. 2D  is a schematic representation of a length of unit dose ribbon of comparable quantity to a blister pack sheet of unit doses. Also shown is an embodiment of a tube into which a length of unit dose ribbon can be placed. 
         FIG. 2E  is a schematic view of the end of a tube with unit dose packages inserted and mechanical means of both restraining and permitting the advancement of a unit dose out of the end of the tube. 
         FIG. 3A  is a schematic representation of a portion of a dispenser showing 2 reels of unit dose medications being presented at individual locations where the dispensing locations are closer together than the respective dimensions of each reel; also shown is an embodiment of presentation heads with a single unit dose presented according to the present teachings. 
         FIG. 3B  is a schematic representation of a portion of a dispenser with tubes being used rather than reels. The tubes are shown at an angle to the presentation head to demonstrate the advantage of the flexible ribbon packaging and how the density of the presentation heads is independent of the density of the storage media. 
         FIG. 4A  is a front view representation of a unit dose package at the presentation point being constrained by a pair of front stops. 
         FIG. 4B  is a side view of a unit dose package at the presentation point with the upper constraint lifted to allow the unit dose package to be pulled forward by the dispensing head, and a modified embodiment showing the lower presentation platform tilted down on pivot to allow increased access to the unit dose package for dispensing and electronic reading of indicia. 
         FIG. 4C  is a schematic view of a presentation head without a unit dose package present. 
         FIG. 4D  is a side view of the mechanical restraint of a presentation head showing the forward restraints. 
         FIG. 5  is a schematic view of the back of a cabinet typical of a hospital pharmacy application where appropriate lengths of UPD ribbons are contained in tubes, or loaded directly into slots. 
         FIG. 6  represents a profile view of a mechanical system of UPD ribbons rolled onto reels being stored and dispensed in a high density system. 
         FIGS. 7A and 7B  represents a view of a portion of the back of the cabinet of  FIG. 5  with lengths of UDP ribbons either in tubes or independent of tubes in position to be dispensed. 
         FIG. 8 : Represents one embodiment of a complete system with the various components of the system. 
         FIG. 9  is one embodiment of the dispensing head aspect of the present invention of a dispensing head. 
         FIG. 10  depicts a front view of an embodiment of a home or personal dispenser. 
         FIGS. 11A-C  depicts a front, top down and profile view of a single cassette for a home dispenser. 
         FIG. 12  shows a section of the home dispenser stationary presentation head frame without showing the surrounding structure of the dispenser in which it is located. 
         FIG. 13  is a cross sectional view of the dispensing head for the home dispenser. 
         FIGS. 14A-D  is an alternative embodiment of the home dispenser dispensing mechanism. 
         FIG. 15  is a representation of an embodiment having a single presentation head in a presentation head frame. 
         FIG. 16  is a detail of a length of tape of unit dose packages as contained in a dispenser cassette. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     The present invention provides for a high efficiency automated pharmaceutical packaging and dispensing system for hospital, pharmacy, residential and home healthcare facilities. The present invention will now be described more fully with reference to the accompanying drawings, which shows the preferred embodiments of the invention. This invention may, however, be embodied in many different forms and should not be construed as limited to the illustrated embodiments disclosed. Rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the scope of the invention to those skilled in the art. Like numbers refer to like elements throughout. The preferred embodiments of the current invention and methods will now be described in detail, with reference made to  FIGS. 1-16 . 
     Referring now to the drawings, where the showings are for purposes of illustrating the preferred embodiments of the invention-only and not for purposes of limiting the same. 
       FIG. 1A  is a side profile representation of the high-density packaging ribbon segment, or unit dose package (UDP)  10  for pharmaceutical unit doses processed in a high efficiency automated pharmaceutical dispensing systems. The ribbon could also be a band or tape suitable as a packaging material. The ribbon of the preferred embodiment is linear; however, it is contemplated that the ribbon may be multidimensional and composed of multiple columns and rows. Pharmaceuticals are packaged in a ribbon of packaging material of a desirable width. The ribbon can be of essentially any width and length depending on the dispensing application and the pharmaceutical contained within the ribbon. The ribbon  10  is comprised of a flat layer  12  and a cavity layer  14  sealed together along a single length of all sides of the cavity, sufficient to keep the medication contain within the cavity or if preferred air tight, using any appropriate means such as a strong adhesive. The cavity layer may simply be a shrink wrap material that provides sufficient space or volume for the unit dose of the medication being packaged in this specific ribbon. The ribbon comprises a plurality of individual segments  16 , each with a cavity  18  for holding individual unit doses of a pharmaceutical or individual container such as a bottle, vile or syringe containing such pharmaceutical. Each ribbon segment is sequentially positioned on the ribbon so that there is only one dose or cavity per segment within the width of the ribbon package for each segment unit length, but multiple essentially identical segment lengths sequentially and uniformly spaced on the ribbon. The individual segments may be completely sealed or have intentional holes such as in the bottom of the cell to allow for pressure variation, circulation of air, or to assist in the dispensing process by allowing access to the pill or to advance the ribbon to the next segment. It is also contemplated that for ointments or a topical the ribbon may be comprised of a series of individual pouches, similar to ketchup pouches which are strung on a single ribbon length. To use the same ribbon and reel strategy for personal dispensers, it is possible to have a master dispenser feed medication into a second ribbon and reel container directly at the time of prescription filling so that a custom ribbon is created with serially sequential dosages of various drugs are placed in a length of ribbon for dispensing at a home or care facility by a device that is intended for a single patient. 
       FIG. 1B  is a top down view of the flat layer  12  of the ribbon  10 . Each ribbon segment  16  may have sprocket holes  20  or notches  22  or other similar physical features such as embossments on either or both linear edges to that are used as register points and that allow the ribbon to be pulled or drawn from a reel to advance each ribbon segment  16  through the system. Such means may also be used to move or advance the ribbon products through manufacturing or filling and sealing and the several dispensing operations. These notches  22  can be located symmetrically at some distance from the leading edge of the segment so that either end of the ribbon can be the leading end or the notches can be offset or tapered so that only one end of the ribbon can be the leading end and the other the trailing end, the ribbon advancing in only one direction. The ribbon  10  may include perforations  24  or cut and removed space between each segment  16  that extend the width of the ribbon and allow for easy separation of segments. 
     On each segment  16  of the ribbon  10  information  26  is included that may be human or machine readable. The information  26  can represent any information relevant to the particular pharmaceutical, such as name, dose, manufacturer date and lot code, or unit identification of the individual segment on the ribbon reel location. Each side of individual ribbon sections may contain encoded data indicative of relevant information. The data can be essentially any type of data and it can be encoded in a variety of know means, including single or multidimensional bar code. The data can be read as the ribbon segment passes over a reader to compare against the script to assure the proper medication is provided.  FIG. 1C  is a profile view of an individual ribbon segment. 
     The ribbon with individual unit doses packaged within each ribbon segments is further packaged for use in the system. The ribbon packaging allows for the automation and uniform transport, tracking, storage and dispensing in a highly efficient manner. Now with reference to  FIG. 2A , the ribbon  10  is wound about a reel  200  with a center core  210  that allows for the placement of the reel on a sprocket. The reel  200  that may incorporate generally circular side supports  220  of such size and configuration as to create an overall package with integrity onto which a desirable ribbon length of prepackaged individual unit doses of drugs can be wound.  FIG. 2B  is an alternative embodiment showing a ribbon  10  wound about a reel  215  with full circular side supports  216 . The benefit of the full side support is the greater strength of the overall package and the added surface area for display of greater quantities of printed information  217 .  FIG. 2C  shows a ribbon  10  wound about a reel (not shown) contained in cassette or cartridge  225  for easy warehousing, transportation, storage and placement within the dispensing system. The cartridge  225  is preferable in hospital and pharmaceutical applications to increase storage capacity, prevent contamination, and to make restocking of the system more efficient. The cartridge  225  is formed from ridged support panels  230  made from any suitable material and that fully enclose the reel. It is also contemplated that standardized packaging may also be a container or box into which a fan-folded ribbon may be placed. 
       FIG. 2D  presents another alternative embodiment of the ribbon packaging  10  that is preferable in smaller applications such as a home health care environment or for personal dispensers, allowing for smaller quantities and thus greater varieties, (more SKU numbers). Each length of ribbon  10  would approximate the number of UDP&#39;s on a blister card, and thus the minimum order quantity (MOQ) that a hospital would receive in an order. One of the benefits of this design is the dramatic reduction, if not elimination, of an inventory area outside of the dispenser. With the enhanced density and reduction of manual labor required to ‘cingulate’ UPD&#39;s from their parent blister cards, as well as not having to consume time filling loading trays from which a robot picks up UPD&#39;s to place into a dispenser, incoming pharmaceutical inventories can be placed directly into the invention in any available location. 
     Now with reference to  FIGS. 2D and 2E , each ribbon  10  is cut into smaller strip lengths of a set number of unit dose ribbon segments  16  that may be fed into a tube  250  or similar conduit restraint system. The tube  250  shown in  FIG. 2D  and  FIG. 2E  conforms to the general shape of the ribbon&#39;s leading edge front profile, which allows for convenient insertion into the dispenser.  FIG. 2E  shows the ribbon  10  inserted in the tube  250 . The tube  250  may contain ribbon stop restraints  260 , which are engaged by the dispenser to allow the ribbon to advance and prevent the ribbon  10  from slipping from the tube  250 . 
     Referring now to  FIGS. 3A, and 3B , a presentation head  300  may be incorporated into the conduit  301 , reel, cassette or cartridge  303  for serially presenting or separating each reel ribbon segment  310 . One skilled in the art will appreciate that a number of alternative designs can be engineered for achieving the same objective of storing, advancing and presenting the ribbon.  FIGS. 4A, 4B, 4C, and 4D  show different views of the presentation head. The presentation head  400  will feed or position each ribbon segment  410  into the automated dispensing device so that the each ribbon segment and its contents would be presented for dispensing in a way where after the dispensing a first ribbon segment, the next ribbon segment will be advanced to the dispensing position and available for a dispensing head. The dispensing head  400  may incorporate an optical target or alignment sensor  420  at its leading end for ensuring the proper alignment of a picking head (not show). 
     The upper arm portion  430  of the dispensing head preferably has a central open space  431  that allows a reader to have visibility access of the ribbon as it proceeds through the presenting head into the dispenser head. The presentation head  400  may be associated with a reader (not shown) for reading the encoded data on each ribbon segment which may be identified with human and machine readable elements such that a dispensing head can be directly and uniquely associated with a specific reel or cartridge so that the head&#39;s identity data defines the pharmaceutical that is dispensed. The reader reads data from the ribbon surface and communicates this data to the system. 
     The upper arm  430  preferably hinged at the rear and contains a spring  440  or other mechanically created load at a hinged location  445  to keep the upper arm  430  in a closed position unless the ribbon segment is pulled through the head. A front register  435  and a back register  436  will limit the advancement or prevent backward movement of the ribbon as it is pulled through the dispensing head by closing on the register notch located between each ribbon segment. As the ribbon is pulled through the dispensing head the upper arm  430  raises until a register notch is reach and the spring  440  tension forces the upper arm  430  to close at the register notch. 
     Now referring to  FIG. 5 , the system includes a dispensing cabinet  500 . The cabinet can be of any shape and size, but is preferably structured to accommodate the particular application and environment where the system is used. In one embodiment shown is  FIG. 5 , the cabinet  500  is a seventy two inch by thirty six inch box enclosed on the top, bottom and sides. The cabinet has a series of dividers  510  running vertically and spaced 1.5 inches apart. Each divider  510  has a plurality of grooves  520  on each side of the divider and spaced 1.5 inches. This configuration provides for 1,152 slotted locations. If each slot will have a location address and is loaded with ribbons containing twenty four segments the total contents of the cabinet will be 27,648. However, if a reel containing a ribbon with two hundred segments is used the total content can be increased to 230,400 unit doses. Thus the storage density advantage of the ribbon and reel configuration is apparent. 
       FIG. 6  demonstrates one configuration for installing multiple reels  610  into the cabinet  600 . Each reel  610  is placed in a slot conforming to the size of the reel. Multiple reel slots are structured in a drawer  630  that can be pulled open to replace a reel. The ribbon of each reel is fed through feed slots  620  within the cabinet. 
       FIG. 7  shows the slots configuration of one column within the cabinet  700 . Referring to  7 A, in an embodiment where ribbons  715  are fed directly though the vertical slot  710 . Lateral extensions  720  fit into grooves  730  of the slots. Each slot location is provided an address or coordinate that allows for identification of the location. The address data can be represented as bar code or other data associated  750  with the slot location or associated with a sensor that is triggered when inserting a ribbon. Additionally, a user may input other data such as drug type, dose, quantity, etc. An indicator light  760  is also provided at each slot location, which is illuminated when restocking. 
     Now, referring to  7 B, in an embodiment where a conduit or tube  740  holds the ribbon  715 , the conduit is formed to include lateral extensions  745  that fit into grooves  731  of the slots. A clip or other means such as a door, pin, slide is used for preventing the conduit from slipping from the slot. 
     Now referring to  FIG. 8 , illustrated is the overall configuration of the preferred embodiment of the system  800 . The system is comprised of storage cabinet  810  having a dispensing face  812  and an inventory loading face  814 . Doors  815  are provided for securing inventory internal to the cabinet and for gaining access to a plurality of conduit slots  817  running the length through the cabinet  810 . A plurality of presentation heads  840  extend from the slots  817  on the dispensing face side  812  of the cabinet. For illustration purpose only, not every slot  817  of  FIG. 8  includes a presentation head. 
     The cabinet will have a user interface  820 , which one of skill in the art will appreciate could include many conventional known types of interfaces and may include a keyboard, display, wired or wireless communications interface with other devices. In the preferred embodiment the user interface  820  is microcontroller based and controlled by a software application. The user interface  820  allows users to access the various functions and reports of the system. Additionally, the user interface  820  may be connected to a modem or other wired or wireless communications interface (not show) that will provide communications with a computer network or the Internet (also not shown) and will allow for remote access to, data exchange with and control of the system. 
     The system  800  includes a data reader  825 . In the preferred embodiment the reader  825  is a single or multi-dimensional bar code reader that allows users to scan data from individual conduits  844  packaged with ribbons  845  of unit doses prior to insertion into the cabinet slot  817 . The data reader  825  can also be used to read data on individual unit dose packages or at each individual slot location  817 . By reading data from the conduit  844  and slot location  817  at the time of stocking inventory into the system the system can track the location of pharmaceuticals of various doses and verify and cross check against patient data or drug interaction data when filling a prescription to ensure there are no errors in drug type or dose. The captured data can also be used to generate a large variety of reports, for inventory management and for system access monitoring. 
     A dispensing head support frame  830  is interfaced with the cabinet  810  and provides a rigid structure for moving the dispensing head  835  in the X and Y coordinates. The dispensing head support frame  830  includes two upright beams  834  and a cross beam  832 , which adds support and provides for a mounting location for the dispensing head  835 . The cross beam  832  can be raised and lowered on the Y axis using a mechanical motor means within the upright supports such as a motor driving a belt, drive shaft, linkage system or similar system. The dispensing head  835  can be moved along the X axis using a similar means within the cross beam  832 . There are many know means for mechanically moving a load along the X and Y axis. It will be appreciated by one skilled in the art that any of these means can be used to move the dispensing head along the X and Y axis. 
     When the dispensing head support frame  830  is mounted to the cabinet  810 , the dispensing head  835  is movable along the X and Y axes and as it moves from one slot location to the next will interface with the presentation heads  840  located at a plurality of slot location within the storage cabinet  810 . The dispensing head  835  will be mapped to the proper slot location based on a grid address system and software that is loaded into a system microcontroller within the user interface, ensuring that proper location is located and unit dose packages are picked. As the system accepts a prescription from authorized users, which can be digitally communicated to the system via linked computer network. The system can cross check against patient records to verify that the unit dose is appropriate for the particular patient&#39;s physical data and condition. The system also can use a look up table to make sure there will be no adverse drug interactions based on the patient&#39;s current prescriptions. 
       855  shows a temporary collection device for collecting all the doses required to fill a specific prescription for a single patient. This allows the dispensing head  835  to travel to all required drug locations in the system to dispense the required medications for a single patient before returning to a home or discharge position.  850  is a conduit for receiving the doses from the collection tube  855  and transferring them to a distribution sorting device  860  where each patient&#39;s completed prescription is placed in a unique container where a printer prints a label and the container will be transported to the patient for administering. 
     Briefly described, this process includes the picking head  835  being moved to each presentation head  840  required and picking a UPD for each medication required. These UPD&#39;s are held in the temporary collection device  855  which is attached to  835  as it moves until the picking process for a single patient is completed. The dispensing head  835  then moves to a position approximate to  850  into which  855  transfers the UPD&#39;s to complete the patient prescription.  860  then advances a new pocket opening which is labeled appropriately and into which the UPD&#39;s are placed. The pocket is then unsealed. In a hospital scenario, the dispenser is programmed to pick the medications according to the delivery order in which they will be administered. By creating a continuous strip or bandolier of labeled and sealed pouches connected and perforated between in the order in which they will be distributed, accuracy, security and savings of space is achieved. 
     Referring now to  FIG. 9 , the dispensing head  900  is mounted to the dispensing head support frame cross beam  905 . Head  900  is moved in the Y direction on upright beams  910  and the X direction on cross beam  905 . Once in the proper XY position to access a presentation head according to the prescription, the dispensing head slides into position in the Z direction with the presentation head  920  and an optical sensor  925  detecting a mark or target on the presentation head  920  to allow for proper alignment of the presentation head  920  and the dispensing head  900 . A presentation head opener  930  having a wedged shape slides under the opening pins  941  on upper arm portions  935  of the presentation head and lifts the upper arm against the spring tension at the hinge as the dispenser head move forward. A reader  940  moves over the open portion of the upper arm and scans the data  942  on the ribbon segment  945  made available for dispensing, confirming the type of drug, dose, segment number, and other relevant information. A cutter  950  grabs, extracts, cuts and separates the ribbon segment  945 , which drops into a collector  955  having an attached chute  960 . A front register  943  prevents multiple ribbon segments from advancing and a back register  944  prevents the ribbon from retracting. As the dispensing head  900  retreats from the presentation head  920  the upper arm  935  will move to the closed position as a result of tension caused by the hinge spring  946 . 
     Again referring to  FIG. 8 , once the ribbon segment has been separated from the ribbon it falls through a chute  850  attached to the dispensing head collector  855  to a packaging table  860  where the prescription is prepared for delivery to the patients. Within the packaging table  860  will be a bagger for placing individual ribbon segment unit doses for a specified prescription. The bagger may be on a roll, each bag drawn for each prescription. A printer a bar code label and seals it to the bag to properly identify the contents and associated with the proper prescription. A conveyor delivers the packaged script to a collection area. 
     It will be understood by those skilled in the art that the system may be configurable with a variety of different such cabinet types, pick and pack mechanisms and packaging processes. For example a tower or column with multiple bin locations around the circumference of the tower and multiple stacked layers rotating on a carousel for easy presentation of the presentation head to a picking head. Another configuration may have multiple towers surrounding a single dispensing head. Yet another configuration may be a personal and small venue application.  FIG. 10  shows such a configuration. 
     With reference to  FIG. 10 , an embodiment for a personal pharmaceutical dispenser  1000  is provided. The personal configuration has the same components of the hospital version, including the door  1010 , a user interface  1020 , a dispensing head  1030 , presentation heads  1040 , and medication slot positions  1050 . The process is essentially the same as in the larger hospital application without the requirement of any Y movement. The dispensing head  1030  moves by a drive shaft  1035  and aligns with the presentation head  1040  for extracting, cutting and separating the ribbon segment unit doses. 
     Now with reference to  FIGS. 11A, 11B and 11C . Depicted are multiple views of a single cassette  1110  for a home dispenser.  FIG. 11A  is a top down view showing the single cassette  1110 , which may be made of cardboard, pressboard, plastic or other suitable materials. A label  1120  is provided to show the contents of the cassette  1110 . A similar label  1130  is provided on the tape. 
       FIG. 11B  is a front view of a cassette  1110  showing the leading edge of tape leader  1160  extending through opening  1150 . UPD cavity  1170  is shown as it will pass through opening  1150 . The label  1140  may contain information regarding the contents of  1110  in a different location that is still visible when the cassette  1110  is placed in the home dispenser. 
       FIG. 11C  is a cut-away view of cassette  1110 . The cassette  1110  provides the enclosure to restrain a length of tape  1165  containing enough medication of a single type for a period of time, typically up to 31 doses for daily use for an entire month. A larger cassette could be used to contain sufficient UDP&#39;s for multiple doses per day or a longer period of time.  1110  also provides the structure and protection required for transporting, mailing, handling and dispensing the UDP&#39;s from the reel contained therein, although for confidentiality and security this cassette may be placed in an envelope or other carrier. The cassette  1110  may be refillable, recyclable or disposable. 
     A label  1120  is affixed to the cassette  1110  at or prior to the filling of the cassette  1110  with the ribbon  1165 . The label  1120  has either or both human and machine readable information regarding the contents of the cassette  1110 , including but not limited to the drug type, name, UDC, patient, time of day to be administered, quantity, physical characteristics, routing, filling and manufacturing information. In general, the label  1120  contains the information read by dispenser at the time of installation and at the time of dispensing for quality control and gathering dispensing information. The label  1130  contains information pertaining to the contents of reel  1165  and is on a leader length of tape prior to the first UDP in cassette  1110 . During the prescription filling sequence, the ribbon  1165  is cut from a larger master roll. At this time it is advantageous to label the otherwise unidentified length of tape as to its origin and destination. Even though each individual UDP pocket may be labeled as to its contents ( FIG. 1B, 60 ), additional information such as patient specific information for whom the prescription is being filled is practical to act similar to a ‘router’ in a manufacturing production line and as a means of identifying each individual prescription along the fulfillment path in creating a ‘chain of custody’ verification. This label  1130  can also have an adhesive on the back and provide a level of security and tamper resistance by ensuring that one or more doses have not been surreptitiously cut from the tape length  1165  during handling. 
     The tape length  1165  may be wrapped around a core  1166  with or without reel support sides  1167 , or spiraled without a core, fan-folded or otherwise configured within  1110 . 
       FIG. 12  shows a section of the home dispenser&#39;s stationary presentation head frame  1260 , without showing the surrounding structure of the dispenser. Individual presentation heads  1270  are designed and configured so as to accept UDPs  1250  in a manner that the UDP  1250  is supported, registered and held in place for the dispensing process so that the label  1240  on the ribbon&#39;s cover  1230  is exposed prior to being detached from the tape length. Cassettes  1210  are shown as placed in the dispenser in any order, sequence or location so that labels  1220  can be read during the programming and dispensing processes. Each unit dose package  1250  is held from moving forward and maintained in dispensing position by detail  1251  registering in the head  1270 . Combined use of forward advancement registration detail  1252  and drive engagement detail  1253  during the dispensing process advances pocket  1250  beyond the head  1270  and positions the next UDP  1250  on tape length  1165  in the presentation head  1270  and the first (dispensed) pocket  1250  is able to be separated from tape length  1165  at and assisted by connecting detail  1254 . During the dispensing process, label  1240  is read by the dispensing head to verify proper medication information. 
       FIG. 13  is a cross sectional view of the dispensing head  1300  of the home dispenser. The dispensing head  1300  moves along guide rods  1322  on bearings  1321  to the proper position aligned with dispenser carrier cassette  1301 . The alignment with the proper cassette is verified by optical reader  1306  reading a label on the cassette  1301 . The optical reader  1307  verifies and records a label on the UDP before UDP advance arm  1312  is extended by controller  1313  to engage and slide pocket  1304  from presentation head  1305  to the temporary staging area  1314 . At this time, upper and lower blades  1308 ,  1310  are controlled by blade drives  1309  and  1311  to sever the connection between the ribbon segments. The dispensed UDP segments now slides down collection guide  1315  into temporary collection cup  1317  where it resides with other dispensed UDP segments until all doses are dispensed for the current dispensing time. 
     After all doses are similarly dispensed, the dispensing head  1300  returns to its home position in dispenser. A cup bottom  1317  is released by control  1319  on hinge  1318  and the contents of UDP&#39;s are delivered into stationary collection tray  1320  where the patient or his care giver can access them in the area assessable to the patient. 
     Now with reference to  FIGS. 14A, 14B, 14C and 14D ,  FIG. 14A  shows an alternative embodiment for dispensing the required medications. In this alternative, the UDP&#39;s are opened and the medications separated and collected in a common area with the packaging being collected for further processing such as disposal, compacting, recycling. The purpose is to provide medications ready for consumption without requiring that the patient open individual unit dose packaging. This method is more in line with the current methods of opening a container that contains a month&#39;s supply of bulk or unwrapped dosages. 
     The doses are packaged and delivered in the same manner as described above to the point of dispensing. During dispensing as described in  FIG. 13 , the unit dose  1401  is cut from the ribbon  1400  by blades  1402  and  1403  and held on temporary staging area  1412 . An opening cutter  1404  is extended by controller  1405  to pierce and separate the leading and side edges of UDP cover  1406  from UDP cavity  1407 . Once opened, the UDP segment  1401  is still held by staging area  1412  and rotated to allow opened segment  1408  to fall to one side of separator  1409  and into collection area  1410  while empty UDP cavity  1407  and cover  1406  are deposited to the other side of separator  1409  from where they are retrieved and further processed. Both collection area  1410  and disposal collection area  1411  may be attached to dispensing head  1300  and their contents deposited into accessible areas such as stationary collection tray  1302 . 
     Now referring to  FIG. 15 , shown is a representation of an embodiment of a single presentation head  1502  in presentation head frame  1501 . The forward advancement limit  1503  protrudes above UPD flange support  1506  in a manner that it is able to catch in the forward advancement limit of the UDP and register the UDP in the proper position for dispensing. The forward advance limit  1503  is spring loaded so that it is capable of being pushed flush with  1506  during the dispensing operation, typically by the UDP advance bar. Similarly  1504  is spring loaded so that it retracts into the flange support  1506  as the ribbon is drawn forward and lifts back into position as the forward advancement limit detail of the UDP moves beyond reverse limit  1504 .  1505  is a relief feature that enables  1312  or other such mechanism clear access to the sprocket holes in the ribbon length. 
     Now referring to  FIG. 16 , shown is a length of ribbon  1601  of unit dose package segments  1602  as contained in a dispenser cassette.  1603  is the pocket portion of the lower tape containing the medication dose.  1604  is an open area removed from the ribbon for easier separation of contiguous cavities at the time of dispensing.  1606  is the forward advancement register which engages with the forward advance limit  1503  to keep a UDP in the dispenser head from retreating back into the cassette. A reverse advancement registration  1605  is shown which engages with reverse limit  1504  in the presentation head.  1607  is the remaining structure of the ribbon that connects one UDP segment with the next UDP segment. 
     While the above description has pointed out novel features of the present disclosure as applied to various embodiments, the skilled person will understand that various omissions, substitutions, permutations, and changes in the form and details of the present teachings may be made without departing from the scope of the present teachings. 
     Each practical and novel combination of the elements and alternatives described hereinabove, and each practical combination of equivalents to such elements, is contemplated as an embodiment of the present teachings. Because many more element combinations are contemplated as embodiments of the present teachings than can reasonably be explicitly enumerated herein, the scope of the present teachings is properly defined by the appended claims rather than by the foregoing description. All variations coming within the meaning and range of equivalency of the various claim elements are embraced within the scope of the corresponding claim. Each claim set forth below is intended to encompass any apparatus or method that differs only insubstantially from the literal language of such claim, as long as such apparatus or method is not, in fact, an embodiment of the prior art. To this end, each described element in each claim should be construed as broadly as possible, and moreover should be understood to encompass any equivalent to such element insofar as possible without also encompassing the prior art.