Issue:April 2015

ADVANCED DELIVERY DEVICES – Self-Administration Device Training: Incorporating New Technologies to Reduce Device Errors

As self-administration with drug delivery devices continues to grow, more patients are being introduced to injection devices, such as prefilled syringes, autoinjectors, and injection pens. Patients using these devices are required to inject subcutaneously, which involves injecting into the fatty tissue the lies between the skin and muscle. Common injection sites for these products include the top of the thigh, the stomach, or the back of the upper arm. Unlike healthcare professionals, who receive professional training on the safe and effective use of injection devices, patients often have limited or no experience with injectable devices. This can lead to a great deal of challenges, including user errors, anxiety, and avoidance behaviors. Addressing these issues helps build patient confidence and support patients in the autonomous use of drug delivery devices.

The patient’s first 30 days, commonly called “onboarding,” is the time when patients are first introduced and trained on their injection device. This often includes in-office training by nurses or other healthcare professionals. While this training is important and beneficial to patients, variability and environmental conditions can adversely affect this training and cause inconsistencies within patient groups. After receiving in-office training, patients return home and are expected to adhere to a prescribed treatment and self-inject.

A number of cognitive, environmental, device, and emotional factors affect the safe and effective use of drug delivery devices by patients. Imbalances among these factors can result in user errors, injuries, and adverse events. The root cause of these errors can be tied to ineffective training and awareness of administration techniques, procedures, or sequences. Examples of barriers to effective use include the following:

Cognitive: The psychological impact of diagnosis, combined with new medical terminology and jargon may block the patient’s ability to remember new information.

Physical: Mobility, age, and dexterity impairments associated with specific therapeutic categories make it physically challenging to use the device. The lack of experience and education with medical devices also leads to onboarding challenges for patients that are naïve to self-administration.

Emotional: Fear and anxiety associated with self-injecting that often leads to avoidance behaviors. There is also a social component to this human factor as the social needs of the patient, including family and medical support systems, may also impact treatment.

To reduce user errors and build patient confidence, device training tools have been developed to support patients in learning their drug delivery devices. These devices are customized to the needs of specific patient populations and delivery platforms to accurately mimic device characteristics and build adherent behaviors in patients. Currently, marketed training devices use mechanical reset and multisensory technologies (visual, auditory, and tactile) to complement HCP training and create consistent training experiences for all patients. Neurological research suggests multimodal recognition and processing increases the retention and recall of multisensory stimuli. As a result, trainers incorporating these technologies can benefit through the improved recall of training and handling requirements. Common errors that can be addressed through device training include the following:

  • Injection into an unapproved injection site

  • Failure to remove device cap before actuating the device

  • Insertion angle of needle or positioning of the device on the injection site

  • Proper sequence to prepare or unlock safety mechanisms

  • Recapping of the device, damaging the needle or actuating the device

  • Premature or out of sequence actuation of the device

  • Proper hold time to receive a full dose

Throughout the past few years, patients and healthcare providers have benefited through innovative training technologies like multisensory devices. Recent improvements to this technology include the addition of sensors to detect errors and teach patients how to correct them in real-time. These technologies can be incorporated into packaging, training devices, or wireless platforms to enrich the patient experience through adaptive and engaging support programs. Based on a recent user study performed by Michelle Johnston of Word of Mouth Marketing and analyzed by Dr. Shashank Rao of Auburn University, new patients who received device training reduced their anxiety by 14% and increased their confidence by 86%. Of those, a talking error correction training device was preferred in 84% of participants, and more importantly, when observed; talking error correction participants had significantly fewer errors of all tested training methods.

At its core, the ultimate goal of device training is to improve the patient experience and create value for HCPs and industry stakeholders. Improved training technologies like error correcting and wireless features allow brands to engage patients and provide personalized training content based on individual patient needs and performance. As new brands continue to launch and augment markets, brands will continue looking for strategies to differentiate themselves from competitors. In the modern era of patient-centric care, those able to provide a superior product and educational experience to patients will be competitively positioned and benefit from the loyalty established by patients and HCPs.

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Craig Baker is Executive Vice President at Noble, where he is responsible for the company’s international development efforts, focused on providing patient-centric educational and onboarding solutions for commercial, brand management, and device development teams. Having joined Noble shortly after it was founded in 1994, he has been active in the growth of Noble’s infrastructure, which more recently, includes growth in engineering and manufacturing. Areas of expertise include patient onboarding, device training, and product development. Mr. Baker has a Bachelor’s from the University of Iowa and a Master’s from the University of South Carolina.