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Packaging The Kilmer Innovations in Packaging group programmes


■Aseptic presentation: It may seem straightforward, even unquestionable, but there are considerable differences between different countries’, companies’ and healthcare systems’ understandings of aseptic presentation. Even the concept of the ‘sterile barrier’ has not been universally adopted – let alone some of the practical tools for maintaining sterility. The KIIP group is looking to improve the quality and availability of evidence and guidance on the best approaches, and drive consistency in how they are applied.


■The last 100 yards: “We know what happens in the last mile and know pretty well how to test our devices against those hazards,” explained Rod Patch at his Engineering Week presentation. “It is when it arrives at the destination that we have low knowledge.” Alongside Bix and Lee’s work on how packages are used when patients are brought in by ambulance, Patch emphasised the need to work more closely with the individuals in healthcare systems who decide how devices and packages are stored and transferred.


■Let’s speed things up: This isn’t about the speed at which packages travel, but how quickly the industry innovates. The KIIP group believes knowledge-sharing can make a considerable difference here. A range of companies have already worked out ways to tackle different problems, but they often keep those approaches to themselves, which might just make things more difficult for end-users who have to juggle a range of different solutions from different providers. As Patch put it, the KIIP group is aiming to “unravel” shareable solutions from proprietary information. The goal is to improve and standardise industry practice while encouraging companies to work together on areas that still need solving. For instance, the ‘Wicked stability’ project is leveraging pre- existing knowledge to accelerate the process of proving a packaging system is stable for a new application.


■Sustainability: Like aseptic presentation, packaging sustainability is also more complicated than it initially appears. Certainly, this programme focuses on material use and the environmental impacts of production and disposal, but Bix contextualises it more generally with reference to the UN definition of “meeting the needs of the present without compromising the ability of future generations to meet their own needs”.


“They use one hand to hold the bars, or to hold the patient, because there is a lot of vibration.” As Bix sees it, these ambulance crews are compensating for inappropriate packaging. “They have solved the problem and overcome the design deficits, without even realising that they are problem-solving,” she says. “Our design is not considering their context. They’re bumping along the road, trying to stabilise their patient, and our design doesn’t take one-handed use into account.”


“When you’re managing a really complex regime, particularly if it involves multiple drugs, the information you might need is very specific, rather than the ‘one-size-fits-all’ that is usually available.”


Laura Bix


Rather than attempt to force the paramedics to act ‘correctly’ – which clearly wouldn’t work: even if they did, they might be putting patients at risk – engineers need to design packages that fit the intended use. “We could have one side sticky, so it’s held on the wall and can be opened easily,” Lee suggests. “Or IV


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packaging that could be hooked on.” Or, indeed, they could design packaging that is safer to open with teeth. Whichever it is, the solution needs to accommodate current practice rather than assume that the practice has to change.


Box of confusion


By putting that level of attention on how a whole range of different users interact with medical packages, Bix’s team is also developing strategies for mitigating ‘lookalike’ or ‘soundalike’ mix-ups, and for preventing unintentional exposure in children.


While labelling looks less exciting than what goes on in the back of an ambulance, it can be equally important – and is only becoming more so as healthcare decentralises. The last 100 yards are increasingly those inside a patient’s home, and, as Bix explains, “When you’re managing a really complex regime, particularly if it involves multiple drugs, the information you might need is very specific, rather than the ‘one-size-fits-all’ that is usually available.” Information about latex is a particular issue, because if products do not specifically carry a label saying they are ‘latex-free’, patients worry. Bix and her colleagues are exploring ways to more efficiently transmit the most important information on device labels – notably the product name, sterility status and whether or not it contains latex – using strategies including AI and augmented reality (AR). One direction for the research could be the development of an app that calculates risk levels associated with a user taking particular medicines and projects them over packages using AR technology.


One student on the project conducted a risk assessment to establish how far each of the ten main elements on a label were associated with the likelihood of someone making a mistake in the way a product is used. He sorted these by importance and redesigned the labels prioritising high-risk information. Products with the new labels proved significantly less likely to be associated with mistakes than those with the standard commercial ones. “As we see more and more serious conditions being moved to home health settings, it’s not beyond the realm of possibility to see dialysis machines and similar equipment in the home,” concludes Bix. “We have to make these things easier to do. We don’t think about packaging as part of the solution to these big problems like medication error or healthcare-associated infection, but it plays a silent and ubiquitous role in the system, and it’s a ripe area for innovation and solutions that are meaningful and impactful in terms of lives.” ●


Medical Device Developments / www.nsmedicaldevices.com


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