PATIENT COMPLIANCE - PharmXpert Academy

Drug Delivery, Drug Packaging, Labelling & Dispensingembossing of units or text that is too small), mistakes couldbe made even if the care-giver thoroughly understandsthe dosing instructions. These difficulties can be furtherexacerbated by the context undergirding the interaction,such as the lighting of the environment and the condition,location and behaviour of the child, which have the potentialto add stress to the difficulty.A specific combination of events may conspire to confusethe user, inducing them to dose a child with the moreconcentrated infant product using the wrong dosing device,ultimately resulting in a medication error. For instance,different standard syringes might be available to the user,with no markings identifying their respective drug product.As such, a child could receive the right drug at the right dosebut in the wrong concentration because of an identificationproblem related to the packaging and dosing device.Inconsistencies in the measuring devices for children’sliquid oral dosages that are likely to lead to care-giverconfusion are documented. 10 In fact, largely as the result ofnumerous, documented, unintentional overdoses involvingliquid oral formulations, both the industry 20 and the US Foodand Drug Administration (FDA) have released guidancesregarding the inclusion, markings and abbreviationsappropriate to these devices. 21Epinephrine InjectionEpinephrine is generally administered parenterally; typicallyin the form of an injection used to treat life-threateningallergic reactions caused by insect bites, foods, medications,latex, and other causes. 22 It is packaged in varied forms,which include a single-dose pre-filled automatic injectiondevice that is applied in a “swing and stab motion” intothe thigh. Patients and their care-givers are instructed toadminister epinephrine at the early signs of a serious allergicreaction (as indicated by swelling redness, etc.).Users of epinephrine injections have a wide range ofabilities, as they include children to older adults, and the drugmay be self-administered or administered by a care-giver(e.g. healthcare professional, parent, teacher, babysitter,etc.). Care-givers, in particular, may or may not be familiarwith the appropriate use of the device that delivers the drug.Given the critical context of use (time is of the essence ina potentially life-threatening situation) and the variedexperience levels of those likely to administer the drug, clearand simple directions regarding this product are paramount.This product will always be used under a high level ofstress and rush induced by the emergency nature of theneed for it. Other characteristics of the context of use areincredibly varied and will likely include: outdoors, indoors,public places, homes, schools, vehicles, etc. A usage scenariocan be conjured for literally any place.The set of tasks include carrying the device (some usersmay actually “holster” this drug to themselves due to thetime-critical nature of its use), identifying the needle tip,removing its safety feature, holding the device in the rightposition, and administering the drug successfully (which inand of itself has a series of steps). These steps may lookeasy to replicate, but the combination of poorly designeddevices, untrained users, limited time for reasoning, and astressful context complicate the process, making clear andstraightforward design requisite for success, with potentiallife-threatening implications resulting from poor designs.ConclusionsA majority of efforts regarding the design and evaluationand drugs is devoted to understanding the chemical aspectsof the packaged product so that it is assured to be safe andefficacious throughout its stated shelf life. Yet, in virtuallyevery instance of healthcare, there are people (be they thepatient themselves or a care-giver – trained or untrained)who must interact with the packaged product such thatit is administered safely and effectively. As a result, thesafety of patients is partially dependent on a system ofphysical components such as packaging, measuring devices,www.JforPC.comJournal For Patient Compliance Strategies to enhance Health Outcomes 51