GB2296468A - Medical record and administration system including medication packs - Google Patents

Abstract

The system provides instructions for and the recording of the administration of medication and packs for containing said medication. The system includes a master record (2, Fig 1) containing the patient's details and a medication record 12 (Fig 2) to record the administration of medication. The medication record 12 includes modules 16 recording the types of medication. The medication record 50 (Fig 8) may be integral with a medication pack having medication compartments 66. The system also includes a blister pack (Figs 9A - 9G) containing medication arranged on a support. <IMAGE>

Description

Medication Recording Means The invention which is the subject of this application relates to a means for recording the provision of medication administered to and by patients and of ensuring that the correct medication is provided to the patient at the correct times and in the correct sequence.

At the present time there is considerable growth in the provision of establishments which offer care for patients.

Typically, but not exclusively, said establishments care for elderly patients, many, if not all, of whom require various medication to be administered on a regular basis. When a considerable number of persons are housed in one establishment the provision of the correct medication and correct dosages to the correct patient by their carers is an important concern and can cause problems given the considerable quantities of different medications kept in the establishment at any one time and that the medications can be given by unqualified persons. Similar requirements are also created for persons who live in their own home but who are part of the "community care" programme.

One known means of attempting to avoid the risk of wrong medication dosages being given to patients is to form a pack for each patient containing the medication for that patient for a period of time. One known form of pack typically comprises a plurality of sealed compartments, each compartment containing the medications which should be given at any one time. Hence, for example, if a patient receives three types of medication each day in the following manner; one medication three times during the day, one medication twice during the day and one medication once, there will be provided in the pack three separate sealed compartments for each day, one compartment containing one of each of the three medications, one compartment containing two of the three medications and a third compartment containing one of the medications.Thus when the carer administers medication they break into one of the compartments of the pack and give the patient the medication which has been placed in that compartment.

While the system is known to work there are several disadvantages. A major disadvantage is that the packing of the various types of medication in the correct compartments for each patient is extremely time consuming and is wasteful in terms of the packaging material required to be used and the bulk which the packages take up. Furthermore the system is inflexible. If, for example, a doctor alters the medication dosage for the patient during the course of treatment the carer must return the patient's medication package to the pharmacist who has to break into the sealed compartments, dispose of that package and then prepare a new package with the new medication dosages entered into the compartments and the new package returned to the patient carer.When one considers that this can happen more than once in any medication course it is clear to see that this is a major disadvantage and problem. A further disadvantage is that there is no proper record kept in a ssocation with the pack to allow the person administering dosages to indicate that the medication has been given. Thus the provision of the correct dosage is reliant upon the proper medication being placed in the compartments of the package.

The aim of the present invention is to ensure that an accurate and flexible system for the monitoring and recording of the provision of medication is provided as this is an important feature and a statutory requirement and to provide the same in a manner whereby the system is easy to use and flexible to allow alterations in the medication dosages, or indeed the medication, to be taken into account during a course of treatment with minimum effect to the system.

The present invention provides a system for recording and controlling dosages of medication to at least one patient over a period of time, said system comprising at least a first master record containing the patient's details and a medication record for completion by medical staff to record the administration of medication.

Typically the medication record is printed on paper or card and comprises a series of modules thereon. In addition to the modules, space is left for the completion of patient details and start dates for the administration of the medication.

In one embodiment each module comprises space for the insertion of the medication details, dosage times during the day, the amount of medication provided by the pharmacist and received by the patient carer and a plurality of grids, each grid split into a number of columns such that each column represents a day, hour, month or otherwise designated time period. The module can be provided with a number of grids related to the duration of a course of medication or the batch of the certain medication held in store and the rows of the grid are used to indicate the number of times the medication is administered in the time period represented by the column.

In addition to the medication record, there can preferably be provided any of, or any combination of: Warning slips, a carers index guide listing the patient details; a treatment record for use in recording the administration of medical ointments, dressings and such like; a "balance to follow" record wherein if a full quantity of medication is not delivered due to bulk or unavailability a record is kept that the remaining amount of the quantity is still to follow; transit bag labels of three types namely, medication sent to home, return medication labels and controlled drug labels indicating that the same should be held in a secure cabinet; repeat prescription records or a labelling function for applying labels to the medication container which can be cross referenced to the record cards; patient assessment cards so that nurses can be aware from the card, the patients details.

Preferably the labels for the forms can be generated using computer software.

In a further feature of the invention spaces are provided on at least the medication record, but preferably all of the record forms, to allow a label to be completed with details of the patient and/or medication as appropriate, by adhering a label with the required information printed thereon in the space provided. With regard to medication details the labels to be applied are generated at the same time as the label for the medication container and hence the information on the record and the container is identical thereby easing cross referencing of information. Typically each module of a medication record, when completed, includes a label with the medication details and a label indicating the time and number of doses of the medication per day. The remaining details are then completed by the carer as the medication dosages are given to the patient and hence by the end of the course or the designated time given on the medication record module, a complete medication record is completed.

In a further feature of the invention overlay sheets are provided which allow the layout of the record to which they are to be applied to be varied. One example of the use of the overlay sheet, is to allow the number of and/or size of grids in a medication record module to be altered to suit a particular type of medication or a particular dosage schedule or, when medication is to be provided on a "when required" basis as opposed to a set schedule the overlay sheet can be applied to alter the module for this purpose. Overlay sheets can also be provided for use when additional medical supplies are provided hence allowing information relating to the same to be added to the medication record; to indicate changes in medication returns; dosage times; or to highlight changes in dosage schedules; instructions to stop the dosage, or other alterations.

Furthermore the overlay sheets can be used to adapt the system to differing types of prepackaged medication systems and can be used to increase the portability of the system wherein, for example, a different chemist or hospital can send an overlay which can be applied to the medication records of a patient who is normally supplied by another hospital or chemist. Alternatively, the home where the patient resides can send a supply of overlays to an "emergency" chemist or hospital for the same to be applied when necessary in emergency or the overlays can be used to simply blank out areas and allow the same to be re used.

The system can also be used in relation to prepacked medication systems wherein the pack is prepacked at the manufacturer or the pharmacy according to individual patient scripts which are also incorporated in the medication record system thereby ensuring that the package can be traced and checked for accuracy. Indeed it is now known that there is a commitment to provide unit packaging for dispensing items by the pharmaceutical industry and it is envisaged that these packs could be for set time periods and be made into a similar form as conventional packs.

In a further aspect of the invention there is provided a pack for containing a plurality of medication types therein, said pack containing a plurality of compartments, said compartments filled with one or a plurality of medications and provided in a regulated manner equated to the times for administration of the dosage and wherein the pack further includes a record card for completion by the person administering the medication to indicate the administration of the medication.

In one embodiment the record card is provided as an additional part of the pack and can be fitted to a pack of standard conventional design and, in one preferred form the record card includes a portion which is provided to be trapped between the layers of the sheet material which when adhered together form the pack.

In an alternative embodiment the record card is provided as an integral part of the pack.

Typically the compartments of the pack are defined by the indented portions on a sheet which is provided as part of the pack in a manner such that said indents are separate thereby preventing the passage of medication between said compartments.

In whichever the form the record card allows the pack to be provided with a record card which includes a series of modular areas, each of said areas including a portion for the indication that a medication dosage has been given, and when given, and a space for the adhesion thereto of a label giving details of the medication to which the module relates.

In a yet further aspect of the invention there is provided a pack for containing medications in any of the recognised forms such as, for example, tablets and/or capsules and/or liquid form, in compartments therein wherein said pack includes a blister pack containing said medication in the blister compartments formed therein, said blister pack mounted on a support with at least the blister compartments of the pack protruding through at least one aperture in the support to allow the medication therein to be accessed.

In one embodiment the pack is formed of a sheet of card and the blister compartments protrude through an aperture or apertures in the card. Typically the card also has medication dosage and/or patient details applied thereto, typically in the form of labels prepared as per the system described previously.

In one embodiment the card acts as the support of the blister pack and is provided with an aperture of a size linked to the size of the blister pack to be mounted therein. In an alternative embodiment, when the pack is required to be adaptable so that a number of different sized blister packs can be mounted if required, the card is provided with a number of weakened lines formed therein, and said weakened lines are provided to allow the material within said line to be removed to form an aperture of the required size for a particular blister pack size.

In one embodiment the support sheet is hingedly movable in relation to a second sheet which, when the sheets are in a closed position acts to protect the compartments from damage.

In one form the support sheet is L shaped and two sides of the blister pack are supported.

In an alternative embodiment an inner layer is provided which acts to support the blister pack when the said layer is trapped between, or attached to one, outer sheet of material to form the pack.

Typically the outer sheet or sheets is formed of a more rigid material than the inner layer.

In one embodiment the inner layer is of a form to cut an aperture therein to size or, alternatively, a series of weakened lines are provided on the layer for the selective pushing out of the material within a selected line to form an aperture therein. In whichever form, this arrangement allows the aperture in the outer sheets to be a standard size.

In a further embodiment the inner sheet is formed from two Lshaped sheets which are movable in relation thereto to form the required size of aperture for the required blister pack and are then joined together with the blister pack held in the required position.

The invention therefore provides a comprehensive records system whereby the medication dosage is both recorded and controlled by the system but at the same time the system is sufficiently flexible to allow the same to be altered to take into account alterations in medication and dosage during a course while ensuring the safety and wellbeing of the patient treated. The medication record includes all the statutory requirements for medication quantities, returns and patient treatment details and also allows the system as a whole to be universal in application such that it can be adapted for use in relation to any container, bottle, medication pack, ointment tubes or suchlike and, with the provision of stand alone software, existing pharmacist record systems can be adopted.The invention further provides a pack which can be adapted to be used as part of the system of the invention and furthermore a means whereby a blister pack which is manufactured under factory conditions can be mounted in a form which allows the pack to take a conventional form and be part of this and other systems without affecting the integrity of the blister pack or warranty of the blister pack manufacturer.

This therefore prevents the need for the pharmacist to break open the blister packs and repackage the same as is the current system but simply place the blister pack, unopened, in the adaptor pack as described above.

Specific features of the invention are now described with reference to the accompanying drawings wherein; Figure 1 illustrates a patient record; Figure 2 illustrates a medication record according to the invention; Figure 3A illustrates a medication administration record Figure 3B illustrates a combined medication record; Figure 4A illustrates a "balance to follow" form; Figure 4B illustrates a repeat prescription form; Figure 4C illustrates the labels according to the invention applied to medication container; Figure 4D illustrates a transit bag label; Figures 4E-4F illustrate Non medicinal supply record sheet; Figure 5 illustrates a range of overlay cards for use in the system; Figures 6A and 6B illustrate a record card for attachment to a pack for medication; Figure 7 illustrates a pack for medication;; Figure 8 illustrates a record card of Figures 6A and 6B attached and provided as part of the pack of Figure 7.

Figure 9A-9G illustrate a pack according to a further aspect of the invention; Figure 10 illustrates the protocol of the system to be followed for a patient in a residential home; and Figure 11 illustrates the protocol to be followed by the pharmacy in relation to the resident according to the system of the invention.

Referring firstly to Figure 1 there is shown a patient record 2 according to the invention. The record shows the details of the patient including a name and address section 4, a medical history section 6 and a section for the entering of current medication details 8. A form 10 containing similar information is also provided to the pharmacy which is to supply the new medication.

Figure 2 illustrates a medication record 12 according to the invention. The record includes a first section 14 for the application of a label, not shown, which has patient details thereon. The record 12 includes a number of modules 16, each module including information relating to one particular type of medication. The module includes a section 18 for the attachment of a label including details relating to a medication printed thereon, a space 20 for the attachment of a dose time label, i.e. morning, evenings and a series of grids 22.

In this case the grids shown in modules 16a-16e are for the recording of the administration of one dosage of medication per day. The module also includes space for recording the amount of medication received in total and the amount of medication returned at the end of the course and confirmation that the same has been checked. Thus when completed the medication record comprises a form which acts as a base and has, in predesignated areas thereof, two and possibly three ply sheet thickness by the application of labels containing patient and medication details and hence a full and accurate record can be formed.

Figure 3A illustrates a medication administration record 24 of a type for use when medication is not administered at set times but on a "when required" basis. In this case the form again includes a space for the attachment of patients details and a number of modules 26. In this case each module includes a space 18 for the attachment of medication details and a number of boxes 28. Each box is divided into sections for indicating the date, and the times of administering the dosage of the medication due on that date.

Figure 3B illustrates a combined medication record card which, on one side includes modules of the type for use as shown in Figure 3A and on the other side a nursing treatment record which is provided for use by both resident and visit ing members of the medical team.

Figure 4A illustrates a form for use when a full medication batch is not supplied. These forms are called "balance to follow" cards 36 which indicate to the carer that a further quantity of the course of medication is to follow and the location of the further quantity. Once again the form includes a series of modules , one module for each medication and each module includes a space for the application of medication details therein. Figure 4B illustrates a repeat prescription order form 32, which can be used for repeat medication courses and the details are again provided in each module. The form can be updated by the issue of overlay sheets and the use of warning sheets to indicate the change of medication use.

Figure 4C illustrates the manner in which the labels applied to the modules on the medication record forms are reproduced and applied to the container 31 for the medication and, as the labels are created at the same time and applied at the same time then the labelling between the various parts of the system can be ensured to be accurate and thereby eliminate the possibility of confusing medication containers and the medication record forms. Figure 4D illustrates a label 30 for application to the container for the medication. The label carries the same information as appears on a label attached to a module of the medication record thus allowing the medication in the containers to be linked to the medication record.

Figures 4E and 4F illustrate a form which can be used as part of the system and in a similar manner thereto but for non medicinal supplies.

Figure 5 illustrates a series of overlay sheets 38 which can be attached, typically by adhesive, to appropriate locations on modules on the forms to alter the information which the module carries. This can be to take into account alterations in the medication dosage times or to alter the module when a course of medication is started after the date of initiation of the medication record.

To utilise the invention, when a patient is accepted into a nursing home or other care establishment or a community care programme is set up, the patient record sheet is completed with the relevant details. The details are relayed to the pharmacist supplying the medication to the establishment and the details are input onto their records which act as a master record. At the commencement of the course of medication the details of the medication are printed onto a number of labels, one of which is attached to a designated module on the medication record form, another is attached to the medication container and the medication container(s) for that patient are then collated in a sealed bag with transit labels attached indicating the medication enclosed and the same passed to the care establishment. Thus an integrated record system is created which allows the accurate record system which ensures that the identical details can be applied to all the appropriate locations for each medication to be administered.

The care establishment then has all the medication for a patient and a medication record for that patient which indicates all the medication to be taken, when each medication should be administered and a means by which the person who gives the medication can record that this has been done by entering the details on the relevant module on the medication record. Thus the dosages of medication can be controlled and recorded and the medication record provides both instructions and record keeping facilities.

If alterations to the dosages of a medication are instructed by a doctor during a course of administration, the new instructions can be prepared on an overlay sheet 38 and the overlay sheet adhered to the medication record to an unused area of the card, the previous instructions being negated by a warning sticker and the new instructions and record being used instead of the original. The original record does however still exist as a permanent record on the patients overall record of medication.

The remaining record cards provided can be used to allow reordering of medications, the provision of further parts of a batch of medication or other processes in providing the required medication.

Figures 6A and 6B illustrate another form of medication record according to the system of the invention and, in this case the medication record is in the form of a card 50 which has printed on one side general instructions 52 and a space for the attachment of patient details 54 and on the other side a series of modules 56 are provided, each of said modules for completion with the details relating to one medication, namely, by filling in the grid 58 with details of when dosages of the medication are administered by the carer and by applying a label with details of the medication and instructions for dosage onto the space 60. Thus each module includes details relating to the medication and a record of when the dosages are provided.

The record card 50 also includes a portion 62 which allows the card 50 to be permanently attached to the pack 64 which is shown in Figure 7. The pack includes a series of compartments 66 which are typically formed by a series of indents in a plastic sheet and, in these compartments are retained the necessary medications which are to be administered by the carer at designated times during the course of medication.

The designated times are indicated to the carer by the printing 68 as indicated. The medications required for the patient are loaded into the appropriate compartments by the pharmacist and then the compartments are sealed to form a sandwich arrangement which is described in more detail in Figure 8.

The sandwich arrangement comprises, from the front of the pack the compartments 66 which pass through apertures provided in a card layer 70 with remainder of the plastic sheet in which the compartments are formed attached to the card layer 70 by adhesive. Once the appropriate medication 74 is placed into the appropriate compartments the openings of the same are closed by a layer of foil 76 which prevents unauthorised opening of the compartments without the same being indicated.

The foil is also adhered to a backing card 78 which has a number of apertures equal to the number of compartments.

Thus, to remove the medication a pressing action on the front of the compartment 66 causes the foil behind the compartment to break and the medication can be removed through the appropriate aperture in the backing card 78. The present invention provides for a medication record to be an integral part of the pack by trapping the portion 62 of the card 50 in the sandwich arrangement of the pack as shown such that the remainder of the card is disposed over the front of the compartments for ready reference and marking of records. Thus a pack with a medication record is provided wherein the medication record cannot be separated from the medication pack and this represents a considerable improvement in the conventional use of packs with separate medication records which can be become lost or may not be completed or may be used with the wrong packs.

Referring now to Figures 9A-9G there is shown a pack in various forms according to another aspect of the invention.

The pack 90, in a first embodiment as shown in Figure 9A, is formed from a support layer 92 which has an aperture 94 formed therein and attached thereto is a blister pack ( not shown) of conventional form which is attached to the support such that the blister compartments on the blister pack protrude through the aperture to allow the same to be used in a conventional manner. Figure 9B illustrates the manner in which the support layer 96 in a blank form is provided with a plurality of weakened lines 98, each of which define an area of the layer which, if the weakened line selected is pressed can be removed from the layer to form the aperture 94 of required size for the reception of the blister pack. Thus the layer 92 can be adapted to receive blister packs of different size.

Figure 9C illustrates the support layers 92 and 96 attached o a further sheet 100 in a hingedly movable manner to form a folder type pack. The additional sheet 100 can be used as a medication record related to the medication located in the blister pack in the support layer.

Figures 9D and 9E illustrate an alternative embodiment of the pack wherein the same includes an inner layer 102 which can again have weakened lines 104 provided therein to allow the correct sized aperture for the blister pack located therein to be selected. The inner layer 102 acts to support the blister pack located thereon and is then attached to an outer layer of more rigid material or is trapped between two outer layers to form the pack. The advantage of this is that the aperture in the outer layers can be of a standard size and only the aperture size of the inner layer need be selected.

Figures 9F and 9G illustrate yet further embodiments of the invention wherein Figure 9F illustrates the way in which the inner layer is provided from two L-shaped pieces 106, 108 and the relative positions of the same when the pack is formed determines the size of the aperture 110 for the reception of the blister pack therein. Figure 9G illustrates a pack wherein the blister pack has two of its side located in a support layer which is L- shaped 112 thereby allowing blister packs of many sizes to be held therein.

The main advantage of the pack shown in Figures 9A-9G is that the same allow blister packs which are manufactured under factory conditions to be provided as part of standard sized medication administration packs and as part of the administration system without the need for the integrity of the blister packs to be affected and, furthermore, the pack of the invention allows the various sizes of the blister packs produced to be supported in the packs by simple alteration of the pack support layer.

Thus the present invention provides a means whereby the provision of medicines to patients can be controlled and recorded without the need for inconvenient and inflexible packaging processes. An example of the setting up of the system in relation to a new resident admitted to a home is shown in Figures 10 and 11 wherein in Figure 10 there is shown in a schematic form the steps required to be taken by the home in relation to medication for a resident. In Figure 11 there is shown in schematic form the steps required to be taken by the pharmacy in relation to a patient according to the system of the invention and it should be noted that the steps described and wording in both of theses diagrams form part of the disclosure of this invention and the description of the same. The security and consistency of giving medication can be maintained by the provision of the recording system while ensuring that the system is sufficiently flexible to allow alterations to the type and form of medication to be taken into account. The invention nevertheless can accommodate prepacked medication packages of whichever type in tandem with other dosage presentations should the prescriber or nurse require these facilities.

Claims (34)

1. A system for recording and controlling dosages of medication administered to at least one patient over a period of time, said system comprising at least a first master record containing the patient's details and a medication record for completion by medical staff to record the administration of medication and to form a complete record of medication administered over the period of time and wherein at least the medication record includes at least one module to which is applied a record carrying details of the medication to which the module is to relate.

2. A system according to claim 1 wherein the master and medication record includes a plurality of modules printed thereon.

3. A system according to claim 2 wherein space is left for the completion of patient details and start dates for the administration of the medication detailed on the records.

4. A system according to any preceding claim wherein each module comprises space for the insertion of details of any, or any combination of, the medication, administration of medication times, the amount of medication provided by the pharmacist and received by the patient carer and a plurality of grids, each grid split into columns such that each column represents a day, hour, week or other of the week.

5. A system according to claim 4 wherein each module is provided with a number of grids related to the duration of a course of medication or the batch of the certain medication held in store and the size of each grid is dependent upon the number of dosages of medication to be given each day.

6. A system according to claim 1 wherein the system includes further, any of or any combination of, warning slips, a carers index guide listing the patient details, a treatment record for use in recording the administration of medical ointments and,or dressings.

7. A system according to any of the preceding claims which includes a record for use in indicating if a full quantity of medication delivered and, if not, when the remainder is due.

8. A system according to any of the preceding claims wherein the system includes the use of transit bag labels for use in indicating medication sent to home, the return of medication and controlled drug labels indicating that the same should be held in a secure cabinet.

9. A system according to any of the preceding claims wherein the system records and/or label are computer generated.

10 A system according to any of the preceding claims wherein predesignated spaces are left on at least the medication records and said spaces are completed with details of the patient and/or medication as appropriate, by adhering a label with the required information printed thereon in the space provided.

11. A system according to claim 10 wherein the labels to be applied are generated at the same time as a label for the container for the medication and hence the information on the record and the container is identical.

12. A system according to claim 10 wherein each module of a medication record, when completed, includes a label with the medication details and a label indicating the time and number of doses of the medication per day and a portion for completion by the carer as the medication dosages are given to the patient.

13. A system according to any of the preceding claims wherein overlay sheets are provided to allow the layout of the record to which they are to be applied to be varied.

14. A system according to claim 13 wherein the provision of the overlay allows the number of and/or size of grids in a medication record module to be altered to suit a particular type of medication or a particular dosage schedule or, when medication is required but not on a regular basis to indicate this.

15. A pack for containing a plurality of medication types therein, said pack containing a plurality of compartments, said compartments filled with one, or a plurality of medications, and provided in a regulated manner equated to the times for administration of the dosage and wherein the pack further includes a record card for completion by the person administering the medication to indicate the administration of the medication.

16. A pack according to claim 15 wherein the record card is provided as an additional part of the pack.

17. A pack according to claim 16 wherein the pack is one of standard conventional design to which is attached the record card.

18. A pack according to claim 17 wherein the record card includes a portion which is provided to be trapped between the layers of sheet material which form the pack.

19. A pack according to claim 15 wherein the record card is provided as an integral part of the pack.

20. A pack according to claims 15-19 wherein the compartments of the pack are defined by the indented portions on a sheet which is provided as part of the pack in a manner such that said indents are separate thereby preventing the passage of medication between said compartments.

21. A pack according to any of claims 15-19 wherein the record card includes a series of modular areas, each of said areas including a portion for the indication that a medication dosage has been given, and when given, and a space for the adhesion thereto of a label giving details of the medication to which the module relates.

22. A pack for containing a plurality of medications in any known form in compartments therein wherein said pack includes a blister pack containing said medication in the blister compartments formed therein, said blister pack mounted on a support layer with at least the blister compartments of the pack protruding to allow the medication therein to be accessed.

23. A pack according to claim 22 wherein the medication is packed in the compartments of the blister pack under factory conditions and is not required to be opened until medication is to be administered.

24. A pack according to claim 22 wherein the support layer is a sheet of card with an aperture through which the compartments of the blister pack protrude.

25. A pack according to any of claims 22-24 wherein the support layer, in a blank form, is provided with at least one weakened line formed therein, said weakened line defining an area which, when the weakened line is broken, is removed to form an aperture in the support layer.

26. A pack according to claim 24 wherein the support layer is hingedly movable in relation to a second sheet which, when the same are in a closed position acts to protect the compartments from damage.

27. A pack according to any of claims 22-26 wherein the support layer is L shaped and two sides of the blister pack are supported.

28. A pack according to claim 22 wherein the pack includes an inner layer which acts to support the blister pack and said layer is trapped between, or attached to one, outer sheet of material to form the pack.

29. A pack according to claim 28 wherein the outer sheet or sheets is formed of a more rigid material than the inner layer.

30. A pack according to claim 28 wherein the inner layer has in a blank form at least one weakened line formed therein, said weakened line defining an area which, when the weakened line is broken, is removed to form an aperture in the support layer.

31. A pack according to claim 28 wherein the inner sheet is formed from two L-shaped sheets which are movable in relation thereto to form the required size of aperture for the required blister pack and are then joined together with the blister pack held in the required position.

32. A pack according to any of the claim 22-32 wherein pack support layer and/or outer sheets has medication dosage and/or patient details applied thereto.

33. A pack as hereinbefore described with reference to the accompanying drawings.

34. A system as hereinbefore described with reference to the accompanying drawings.