1. Medical Ergonomics and Drug Delivery Systems D. John Doyle MD PhD FRCPC March 2003

2. Drug Delivery Ergonomics Concerned with the safe and efficient delivery of drugs from supplier to consumer.

3. Drug Delivery Ergonomics u Suppliers: drug distributor, warehouse, drug store, pharmacy storage area, medicine cabinet, hospital satellite pharmacy, medical offices, clinics etc.. u Consumers: patients (IV, IM etc.), hospitals, clinics, medical offices, narcotics cabinet etc...

4. Top Ten Drug Ergonomic Principles u Package labeling u Special markings u Product identifiability u Generic name u Trade name u Drug dose (tablets) u Concentration and volume (liquids) u Product strength label predominance u Safety against cuts (ampules and vials) u Address special needs

5. Drug Ergonomic Principles 1 Package labeling should be clear and unambiguous, with sufficiently large fonts and good print contrast Package labeling should be clear and unambiguous, with sufficiently large fonts and good print contrast

6. Drug Ergonomic Principles 2 Special instructions or warnings should be highlighted and prominently displayed on the packaging. Special instructions or warnings should be highlighted and prominently displayed on the packaging. –“may be sedating; avoid heavy machinery or cars” –“shake well before use” –“The trade name of this product has confused individuals - be sure you have the right product” –“not suitable for Olympic athletes”

7. Drug Ergonomic Principles 3 Product Identifiability u Tablets should have unique markings to allow product recognition. u All products should have a product code u All products should have a lot number u All products should have an expiratory date u All products should indicate the suggested route of administration

8. Drug Ergonomic Principles 4 The generic name of the drug should be prominently displayed on the drug label The generic name of the drug should be prominently displayed on the drug label

9. Drug Ergonomic Principles 5 The drug brand name, if displayed, should not expected to result in the drug being misidentified. ( Note: not all drugs will have a brand name (e.g. atropine); co-labeling of drugs with both the brand name and the scientific name is encouraged.) The drug brand name, if displayed, should not expected to result in the drug being misidentified. ( Note: not all drugs will have a brand name (e.g. atropine); co-labeling of drugs with both the brand name and the scientific name is encouraged.)

10. Drug Ergonomic Principles 6 For tablets and other oral dosage forms, the dose of each tablet should be clearly stated (but not necessarily as tablet markings). For tablets and other oral dosage forms, the dose of each tablet should be clearly stated (but not necessarily as tablet markings). Tablets should be marked with a unique identifier. Tablets should be marked with a unique identifier.

11. Drug Ergonomic Principles 7 Labels for drugs in liquid form should clearly indicate the concentration and volume. Labels for drugs in liquid form should clearly indicate the concentration and volume.

12. Drug Ergonomic Principles 8 The strength of the product should have predominance over the number of units in the package. The strength of the product should have predominance over the number of units in the package.

13. Drug Ergonomic Principles 9 The drug packaging should not present a safety hazard to users. The drug packaging should not present a safety hazard to users. (e.g., glass ampoules that totally disintegrate when opened) (e.g., glass ampoules that totally disintegrate when opened)

14. Drug Ergonomic Principles 10 Address special needs issues –Child-proof containers –Limited vision patients –Patients with arthritis

15. Additional Suggestions u Label adhesives should be colorless u Bar codes, if used, should not interfere with label legibility u There should be a high level of contrast between the print and its background (don’t use transparent glass as the print background)

16. Violations of Sound Drug Ergonomic Principles u Hard to read drug ample labels (ambulance letter; case reports) u Unlabelled syringes u Difficult to find generic drug name u Confusing brand names (line extension practices)

17. Line Extention u AIM: Build on a well-known drug names to achieve instant recognition for newly launched products u Benadryl ALLERGY FORMULA is diphenhydramine u Benadryl DECONGESTANT/ALLERGY formulation has added pseudophedrine u Violation of Ergonomic Principle Five

18. Challenges Awaiting u Disseminate information about ergonomic principles of drug delivery u Support research into further reducing drug errors u Internet accessible anonymous central reporting for drug error incidents, with links to other interest groups u Elimination of confusing brand names

19. Drug Ergonomic Principles The End