Tag Archives: Instructions for use

Pain in the arm

Whilst visiting a local pharmacy recently, I came across a notice that free flu jabs were available for qualifying NHS patients. This seemed like a much simpler way to get immunised than visiting my GP to find an appointment, then returning for the vaccination at some point in the future, particularly with the nightmare that is parking in our local town.

All I had to do was complete a simple form and, being in one of the groups that qualify for a free immunisation, I was able to have the jab right there and then. No waiting, no return visit.

So far, so good. The whole process of receiving the injection was (relatively) painless and the pharmacist friendly and competent, but several things struck me as unusual.

Imuvac IFU folded smallerFirstly, I was given the (Instructions for Use) IFU to take away, and encouraged to read it by the pharmacist. This was the first time in 7 years that I’d been provided with any information about the drug product I had been dosed with, let alone side-effects. Perhaps I should have been firm in asking previously, but that’s a topic for another time perhaps.

While in the pharmacy, I found the IFU was difficult to open. Luckily, I have full use of my hands, fingers and eyes, unlike many of the target patient population, yet it was still a challenge. As seems typical for pharmaceutical products, the IFU was on very thin paper, and folded in a way that seemed to actively combat attempts to open or re-fold. Bizarrely, the IFU was glued down, making it hard to actually unfold. Having been involved in packaging line qualification in a previous life, I appreciate all these features were probably there to aid assembly of the final product (pre-filled syringe, IFU and carton). I am, however, curious to know what was done with users to ensure they were able to use the IFU.

Imuvac IFU smallerFinally, having wrestled with the IFU to get it open to read, finding the key information took some searching. Hidden in amongst prescribing information were a few paragraphs that were of use to me, as the patient. Although there were some key steps required before injecting the drug, the pharmacist didn’t appear to once refer to the information about administering the drug.

Yes, I did read through the IFU, and have retained it in case I experienced any side-effects. However, I am perhaps unusual in doing so and persevering with finding the relevant information. Surely we can do better, and we should do better, we should chose to develop IFUs that are usable, readable by, and impart relevant information clearly to, the users and patients.

Of course, if the manufacturer of the vaccine in question would like to discuss developing a more effective IFU, I’d be happy to talk with them 🙂

93% of asthma patients can’t use their inhalers!

How often do you see people on tv use an asthma inhaler, only to exhale or start talking straight away? Instruction leaflets typically ask the user to hold their breath for at least 5 seconds before breathing out, yet I can count on the fingers of one hand, how many times I’ve seen this portrayed accurately.

If media portrayal is so inaccurate, it’s no surprise that most asthma patients don’t really know how to use their devices. Recent research found that only 7% of them use inhalers correctly, getting the full benefit of their prescribed medication.

It matters, because repeated under dosing results in poor management of the condition, often leading to people being put on stronger inhalers than they actually need. Dr Samantha Walker, director of research and policy at Asthma UK, said in a recent BBC interview, “This is also hugely wasteful – asthma-prescribing is one of the most expensive areas of cost for the NHS, costing almost £1bn annually.”

Tyical instruction leafletMuch reliance is placed upon the patient reading, and keeping hold of, their instruction leaflet. But, we know that 60 percent of users won’t ever look at that leaflet, let alone refer to it later on. Training, particularly during an annual visit to the asthma clinic, is often relied upon to “fix” poor technique. How effective can a 5 minute session be for unlearning habits that have been reinforced over many months?

Guidance from FDA includes a hierarchy of ways to mitigate device risks. At the top sits design changes, designing out use errors or reducing their occurrence, training and then instruction leaflets sit at the bottom.

Poor inhaler technique can, at least in part, be mitigated through the design changes incorporated into breath actuated inhalers and capsule inhalers. So perhaps the changes being called for recently by UK healthcare charities should extend to use of appropriate alternative devices, to improve disease management and reduce long-term costs to the health service.

It’s not just asthma patients that struggle. Studies in the US show that just 16% of people prescribed adrenalin auto-injectors used them properly. People often didn’t hold the injector in place for at least 10 seconds or didn’t push down forcefully enough to allow the adrenalin in. Auvi-Q is a great example of a device that seeks to address these problems. It talks the user through each step, even counting up to 10 for them whilst they’re injecting.

Instructions, what are they good for?

Absolutely nothing, if no one reads them.

The view of many people when they encounter a new gadget and its instructions is “Do I have to read all that?“, “which bit do I need to look at?”  These are typical of the comments we heard during a recent lengthy usability study; even the people who professed to read instructions thoroughly only skimmed through them.  They blanched when the multi-lingual/multi-model user manual appeared.  When presented with these tomes, the frustration and despair of users is palpable.

Instructions are synonymous with restaurant menus; people only want to dip in and out, their eyes scanning and concentrating on the interesting bits.  Once the reader feels they’ve gleaned enough information from the quick perusal, they’re ready to start using the gadget.

Now, I’m no angel when it comes to following instructions.  I often only glance at information and then have to go back to the instructions when I can’t even switch a device on.  I’m not alone.  People seem happier tinkering and poking, figuring out how to do something manually, believing they have downloaded the basics with their cursory scan of the information. Continue reading