Layer 1

Xrayser: Let's make auto-injectors more patient-friendly

“The manufacturer expects the patient to fit the device, instead of making a device patient-friendly”

Manufacturers should learn from malfunctioning medical devices to make them more user-friendly and avoid wastage, argues Xrayser

In this disposable world of cheap commodities, people often don’t return anything that stops working as it’s usually quicker and cheaper to simply buy a new item. And often if something doesn’t work it’s because I’m doing something wrong.

Therefore when patients return a medically prescribed device, my first thought is that their use or technique isn’t correct. Usually, that’s the case. Common examples of returned devices are metered dose inhalers caked in powder that haven’t been rinsed for years; blood glucose test strips inserted the wrong way round; or ‘faulty’ insulin pens that won’t deliver a dose because the needle has been jammed on so awkwardly that its internal part is bent over.

So, when a patient brought her housebound husband’s dry powder inhaler back saying “it’s faulty – he needs a new one”, I was frustrated. The counter showed 30 out of 60 doses and the ready indictor was green, but she assured me that it wouldn’t activate.

The design of dry powder inhalers is such that it’s pretty much impossible to test them without inhaling a dose, but as this patient had been using them for over 18 months without a problem I presumed it was indeed faulty and supplied a replacement.

A few days after messaging the manufacturer to report the fault, I received a call from their medical information department to say that they would not be replacing the device. Instead they told me the patient’s usage was wrong, so they’d email a copy of the patient information leaflet.

“Hang on,” said I, “this patient has been using the device without a problem for almost two years, and this particular one for at least 30 doses. Are you telling me that it’s not stopped working?”

“Oh no,” came the reply, “the device will have stopped working but the patient has caused this by not using it correctly, and as it can’t be cleaned (the way conventional metered dose inhalers can be), it’s useless and we won’t replace it.”

How does that work, then? There’s obviously a design flaw that means the device is prone to clogging up, but the manufacturer didn’t seem to want to take responsibility. As so often is the case, it expects the patient to fit the device, instead of making a device designed to be patient-friendly, as evidenced by the leaflet they sent with six pages of instructions!

Of course, they could go the way of Bausch & Lomb’s Emerade adrenaline auto-injector pens. In November 2019, the manufacturer identified that if patients kept them too warm they might fail to activate, and so it recalled them from pharmacies.

Has all common sense been lost? Neither the inhalers nor Emerade auto-injectors need be recalled. Instead, they should be subject to patient alerts and then have their manufacturing process corrected as soon as possible. If, as seems inevitable, all these devices will end up in landfill as yet more plastic waste then they should at least be of some practical benefit to patients first.

A long-running C+D contributor, the identity of Xrayser remains a mystery, but his irreverent views are known by all. Tweet him @Xrayser


C A, Community pharmacist

Hmmm... a dry powder inhaler with 60 doses and a green indicator?

It's wasn't a Genuair device was it? Possibly an Eklira...

I've found plenty of patients have problems getting enough "puff" to activate them if they are poorly or badly educated on the technique.


Yo Palumeri, Community pharmacist

the perennial problem with dry powder inhalers - I never replace now due to patient incorrect storage or abuse. Ask the patient to get another Rx and send " faulty" item to the manufacturer for a report and tell patient if found faulty I will replace.

If the manufacturer doesn't play  ball just report MHRA as faulty medicine and see what happens

100% agree with this. I use the yellow card system if I think the device is genuinely faulty, I don't bother speaking to the manufacturer anymore.

Kevin Western, Community pharmacist

Ah... you are suffering from the common misconception that medicines are for treating patients rather than being  a product designed to attract sales to create profit. 

They dont have to satisfy the "purchaser" - the prescriber, unless he/she happens to suffer and use it themselves


Job of the week

General Practice Pharmacist
Armagh, Dungannon, Newry
Up to £40,894