From: Improving the safety of disposable auto-injection devices: a systematic review of use errors
Category | Subcategory | References |
---|---|---|
Activation | a) failure to release the safety lock | |
b) failure to push the button (at all, or with enough force) | (Fujioka et al., 2015; Callis Duffin et al., 2016; Robinson et al., 2014; Matfin et al., 2015; Demary et al., 2014; Salter et al., 2014; Brown et al., 2013) | |
c) failure to press the device against the injection site (at all, or with enough force) | (Sicherer et al., 2000; Salter et al., 2014; Brown et al., 2013; Guerlain et al., 2010a; Umasunthar et al., 2015; Bakirtas et al., 2011; Mehr et al., 2007; Arga et al., 2011; Topal et al., 2013; Edwards et al., 2013; Saleh-Langenberg et al., 2017; Hanna et al., 2016; Raffa et al., 2017) | |
d) duration of device-site contact too short | (Schmid et al., 2013) | |
e) unintentional activation | (Rohrer et al., 2013) | |
Compliance with procedures | a) attempt to disassemble device | (Guerlain et al., 2010a) |
b) incorrect handling | ||
c) incorrect storage | (Sicherer et al., 2000; Schiff et al., 2016; Domańska et al., 2017) | |
d) failure to call the emergency medical services after the injection | ||
e) failure to massage the injection site after the injection | (Salter et al., 2014; Brown et al., 2013; Saleh-Langenberg et al., 2017) | |
f) failure to refer to the instructions for use (IFU) | (Jeannerot et al., 2016) | |
Disposal | a) incorrect device disposal | |
b) incorrect needle disposal | ||
Dosage | a) incorrect dose setting | (Stauder et al., 2014; Fujioka et al., 2015; Rohrer et al., 2013; Jeannerot et al., 2016; Lange et al., 2014; Schertz et al., 2011; Pfützner et al., 2012; Mahony et al., 2015; Saunders et al., 2012) |
b) dose misinterpretation/miscalculation | (Stauder et al., 2014; Fujioka et al., 2015; Jeannerot et al., 2016; Mahony et al., 2015) | |
c) failure to check the dose prior to injection | (Stauder et al., 2014; Schertz et al., 2011; Saunders et al., 2012) | |
d) failure to visually check the administered dose | (Phillips et al., 2011; Hudry et al., 2017; Schertz et al., 2011; Saunders et al., 2012) | |
Hygiene | a) failure to disinfect the injection site | (Schiff et al., 2016; Domańska et al., 2017; Jeannerot et al., 2016; Pfützner et al., 2012) |
b) failure to wash hands | (Schiff et al., 2016) | |
c) touching the tip | (Salter et al., 2014; Guerlain et al., 2010a; Topal et al., 2013) | |
Injection | a) incorrect duration of injection | (Stauder et al., 2014; Lange et al., 2015; Sicherer et al., 2000; Phillips et al., 2011; Robinson et al., 2014; Matfin et al., 2015; Demary et al., 2014; Salter et al., 2014; Brown et al., 2013; Guerlain et al., 2010a; Umasunthar et al., 2015; Bakirtas et al., 2011; Mehr et al., 2007; Arga et al., 2011; Topal et al., 2013; Saleh-Langenberg et al., 2017; Raffa et al., 2017; Hudry et al., 2017; Schiff et al., 2016; Domańska et al., 2017; Lange et al., 2014; Schertz et al., 2011; Saunders et al., 2012; Pachon et al., 2014; Sheikh et al., 2016; Hanna et al., 2016; Guerlain et al., 2010b; Varunok et al., 2011) |
b) incorrect pinching/folding of skin for injection | ||
c) significant movement of the device during injection | (Guerlain et al., 2010a) | |
d) performance of several injections with same needle/device | ||
e) incorrect injection site | (Stauder et al., 2014; Sicherer et al., 2000; Salter et al., 2014; Brown et al., 2013; Guerlain et al., 2010a; Bakirtas et al., 2011; Mehr et al., 2007; Arga et al., 2011; Topal et al., 2013; Saleh-Langenberg et al., 2017; Schmid et al., 2013; Schiff et al., 2016; Domańska et al., 2017) | |
Needle removal | a) incorrect removal from device | (Fujioka et al., 2015; Jeannerot et al., 2016; Schertz et al., 2011; Saunders et al., 2012) |
b) incorrect removal from skin | ||
Device orientation | a) device held upside-down | (Lange et al., 2015; Sicherer et al., 2000; Robinson et al., 2014; Matfin et al., 2015; Salter et al., 2014; Umasunthar et al., 2015; Bakirtas et al., 2011; Mehr et al., 2007; Arga et al., 2011; Topal et al., 2013; Schmid et al., 2013; Hudry et al., 2017; Domańska et al., 2017; Guerlain et al., 2010b; Saleh-Langenberg et al., 2017; Hanna et al., 2016; Andre et al., 2017) |
b) device held at the wrong angle | (Phillips et al., 2011) | |
Preparation | a) incorrect needle attachment | (Stauder et al., 2014; Fujioka et al., 2015; Phillips et al., 2011; Lange et al., 2014; Schertz et al., 2011; Pfützner et al., 2012; Pfützner et al., 2010) |
b) incorrect priming (flow and air bubble checking/removal) | (Stauder et al., 2014; Fujioka et al., 2015; Jeannerot et al., 2016; Lange et al., 2014; Schertz et al., 2011) | |
c) incorrect device selection | ||
d) failure to check device integrity | (Hudry et al., 2017; Schiff et al., 2016; Schertz et al., 2011; Saunders et al., 2012) | |
e) failure to check product validity | (Sicherer et al., 2000; Schmid et al., 2013; Hudry et al., 2017; Schiff et al., 2016) | |
f) tampering with the device | (Andre et al., 2017) | |
Protective/safety cap | a) incorrect cap removal | (Phillips et al., 2011; Brown et al., 2013; Saleh-Langenberg et al., 2017) |
b) incorrect needle capping after the injection | (Phillips et al., 2011; Hudry et al., 2017; Jeannerot et al., 2016; Schertz et al., 2011; Mahony et al., 2015; Saunders et al., 2012) | |
c) cap not removed | (Fujioka et al., 2015; Sicherer et al., 2000; Robinson et al., 2014; Matfin et al., 2015; Salter et al., 2014; Guerlain et al., 2010a; Umasunthar et al., 2015; Bakirtas et al., 2011; Mehr et al., 2007; Arga et al., 2011; Schmid et al., 2013; Rohrer et al., 2013; Hudry et al., 2017; Lange et al., 2014; Schertz et al., 2011; Guerlain et al., 2010b; Brown et al., 2013; Topal et al., 2013; Hanna et al., 2016; Andre et al., 2017) | |
d) cap removed in the wrong order |