Why is checking the flow of medicine through the needle becoming less of a habit for injector users?
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THAY Medical has been focusing for quite a while now on combination products and their use, in reality, for comparison and for validation with a number of user groups of patients, healthcare professionals and caregivers. In the main, the single and multi-dose injection systems are very usable, with very high rates of success to deliver an injection of a prescribed dose into part of the body. This is reflective of good, thorough design effort on the behalf of injection device manufacturers, but also reflective of experience, training and the creation of safe habits by users.
Introduction
When evaluating many of these combination products, we have observed though some particular trends in use that are becoming a little worrying for us because they show a gap between what device manufacturers and pharmaceutical organizations want users to do and what users are actually doing in real life. Obviously, both users, device manufacturers and pharmaceutical organizations want is safe use, efficient use and precise use.
Our insights
What is being observed as a gap is the individual risk assessment of users to omit specific tasks, or to alter the tasks that are being instructed by the pharmaceutical organizations. An example is that of disposing of a used needle. The used needle is a biohazard, a risk to other people as well as the user, and we still observe users, patients and family caregivers, dispose into trash bins instead of specific sharps containers. Typically, this is done with the needle encased within the outer needle cap, so the risk of needlestick is minimal, but we have observed occasions of users just disposing exposed used needles in the trash regardless, which is a risk. The root cause often is not that they do not know they should dispose of the used needle in a sharps container, it is just that they take a personal decision based on risk to perform this task on what is most convenient to themselves at that time. Often, they have not got a sharps container to hand, they have not purchased one, their current one is full etc. Sometimes though it feels like these users are just not thinking through their actions.
Another is the task focused on priming the needle or checking the flow through the needle. This is frequently a missed part of the administration. It is always instructed as a task to perform to ensure safe delivery of the prescribed dose, especially with more viscous medicines where a blocked needle may be more prevalent and replacement of that needle is required. When analyzing root causes, it appears that a mental model of “if it is blocked, I will find out when I inject” is becoming more frequent. Additionally, perspectives around “it’s an extra task, it’s unnecessary as I have never had a blocked needle” and other responses we do hear. Are users becoming lazier or really are they taking their own risk decisions and omitting tasks to make the administration quicker?
Conclusion
It is an interesting question. Do instructions need to change to reflect the habits of the user or do they stick to what is responsible, clinically, legally and morally? It is the role of human factors engineering to determine what is the ideal bridge to the gap between user habits and pharmaceutical organization responsibility. We do see this happening though with wording in instructions being more precise, additional instructions that aid the user, more illustrations to aid safety and more warnings. All help to ensure safety as far as possible, but as we see, when users take responsibility into their own hands (literally), then they are making their own risk-based decisions that could result in unsafe use. It is not easy to stop this from happening, but it is a gap we are bridging more effectively every day.
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Who wrote this insight?
Our Author today was: Greg Thay, Founder, Principal Human Factors Consultant.
Greg is our founder and principal - leading THAY Medical with thirty years of experience in medical devices, pharmaceutical and diagnostic products and AI. Greg has a passion for quality in healthcare. His strong belief is that we are all end-users of medical products and that we should all have the highest standards of looking after each other, regardless what we do in life individually. This belief leads Greg to focus the THAY Medical team to deliver each collaboration time after time, exceeding expectations and assisting to develop cutting-edge, innovative and usable medical products. Often the most successful products are the most usable ones!
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