Cornwall and Isles of Scilly Primary Care Trust
(Re)Introduction.................................................................................................................................... 2 Critique of Design................................................................................................................................ 4 Summary............................................................................................................................................................ 6 External Partner Contact............................................................................................................8 Critique by Caroline Dunstan.............................................................................................. 10 Next Stage: To Do List...................................................................................................................... 17 Opportunities for Design............................................................................................................. 19 District Nurse Meeting.......................................................................................................................22 Diabetes Drop in Session............................................................................................................ 26 Tributary Design Work...................................................................................................................... 28 Insulin Pen Critique...............................................................................................................................30 Insulin Pen size Deviation............................................................................................................ 35 Conclusion.......................................................................................................................................................36
NHS
(Re) Introduction Last term I undertook a project that saw me design a product for the NHS that aids people with diabetes administer insulin where there might be compounding factors that would require the intervention of a Community Nurse to help out. I met up with the Innovations lead for the NHS South West, Jonathan Barnett, and was given the brief and the issues were outlined. The most common problem that was raised was one of dexterity, and how any diabetic patient suffering a stroke, paralysis, amputation or had a temporarily broken arm could not use a diabetic pen without help. I took these issues away and started working on a sollution based on.the use of one arm only, and outlined an initial concept which was well recieved. I developed a sollution that has been coined the 'pen station'. This is a device that sits on top of a table or desk and acts as a second hand for the person operating the diabetic pen. There are cut-outs all over the pen satation that fit different parts of the pen depending on which function needs to be performed. For instance, there is a section that helps the user remove the lid, another that helps with the replacement of used needles, etc. I followed the processes that need to be performed within the user manual for the Novopen 3, the most popular diabetic pen on the market at that time, and managed to complete all processes with one hand only, which is what was desired.
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NO DECISION ABOUT ME, WITHOUT ME!
Once I had designed a device that I thought fit the bill, I had to get the opinions of those within the industry i.e. Jonathan Barnett and other specialists. Their valued input would forward the design process a step further. I collated some presentaion sheets ready for critique by Jonathan Barnett and other appropriate individuals. See: 'Critique of Presentation 1' This is as far as the project (as of mid level two) was taken given the time period in which we had to operate. The start of this project will involve redesigning based on what was discussed at the meeting with Jonathan Barnett from the tail end of the project from level two.
I shall then take the redesign back to Jonathan Barnett and also to see the Diabetic Specialist Nurse based at Royal County Hospital, Caroline Dunstan. The three of us will mull over the idea, I shall make notes, and I will be able to come away with a better idea of what is required. Hopefully it will involve remodelling our existing concept, but it could involve an entire rethink of the problem. Interesting website http://clinical.diabetesjournals.org/content/26/2/66.full
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Critique of First Concept by Jonathan Barnett
I took the initial ideas for the Pen Station to Jonathan Barnett go gauge his opinion and to see if I was indeed headed in the right direction. His input was important at this stage because it is a project that has been in the pipeline for a couple of years now with himself and Adam Stringer (product design, technical supervisor and researcher at University College Falmouth) looking to solve the issue when it first arose. Their ideas were valuable only or the ammount of time they had been aware of the project.
First meeting went well and Jonathan thought the working through of the initial problem to end sollution was clear and that the thought process had been documented well in sketch and CAD form.
We critiqued the form as I ran Jonathan through each stage of the process from removing the lid of the pen through changing the needle, cartridge, to callibrationg the pen, and the final injection of insulin. At each stage Jonathan had his input and raised some interesting points about the functionality, suggesting ways for improvement. The way a fresh insulin cartridge is removed from its packet was a point of interest because
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On the initial concept I had thought about utilising a natural corner that had presented itself as a means of ripping in to the packaging. This was considered too rough and ready, and although it worked, needed to be more clinical and efficient. It was realized that elderly peolpe would have difficulty removing the little celophane tops on the spare needles. This was an issue that passed me by because even with the use of only one hand , it was an operation that was easy to perform.
An elderly person who's grip is poor would have a much harder time with the fiddly tops. Part of the initial concept includes a large section for removing the lid. This is an aspect that took up a large part of the device's volume and we decided to revise this.
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Summary and Opportunities for (Re)Design The meeting with Jonathan went very well. Important issues were addressed and some key iterations were thought through. Issue 1: Cartridge opener. It was concluded that a 'blade' the shape of the foil that holds the insulin cartridge in place would be best suited to the task. The blade would be angled or curved to aid perforation. When pressure was applied to the cartridge the form of the 'blade' would dispurse the pressure and would glide through. The blade would be as part of the form of the final object, possibly injection moulded. This might add extra angles to the form which might in turn make the moulding process more complex than needs be. Review required upon seeing RP model. See: Presentation sheet 2a - Image 1. Issue 2: Fiddly needle covers. The needles come with fairly large covers on anyway, but a reduction in dexterity, as would be the case in elderly people, people who have suffered a stroke and arthritis would render this a difficult task.
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We discussed the possibility of a large set of tweezers. This could actually be a valid answer, as there are a number of sets of tweezers that are already on the market designd for people with dexterity problems, and also young children still finding their grasp on things. I look at these in my secondary research file. See: Secondary Research File - Dexterity Tweezers Issue 3: Pen lid remover. There was an area on the pen station dedicated to fitting the lid inside so it could be effectively removed. We looked at the job it performed and decided that a part of the pen station existed that could equally perform thre same task. this was the part of the device responsible for holding the pen during callibration/turning operations. This change coincided with the alteration of the cartridge blade. Where the old lid holder stood, now has been replaced with the cartridge blade.
See: Presentation sheet 2 - Image 3.
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Next Step (Inc. External Sources) The next step of the design process is to make these changes happen. I spent quite some time remoulding the form. In fact, I took the extra information I had gained and started from scratch with a new hemisphere, and booleaned in the appropriate shapes. I found the process very interesting, but difficult. I was at a stage with my CAD modeling that, if we required RP models, my CAD form wasn't going to be good enough to use.
I had called upon my friends at Universtiy whom I work closely with for help, but this particular model was being stubourn, and we could not crack it between us. We saw advertised a three day training course in London for the CAD modeling program that we had come to love using, but on which we needed improving. I felt this was a very timely, appropriate course to take, and four of us traveled to London to attend the three day course. This was a chance for me to ask questions about the model that I had made, and get expert advice on how to fix this particular model, and perfom the same tasks in the future.
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The course was Intermediate/Advanced Rhino modeling with CAD (Rhino) expert Phil Cook. Not only has Phil been giving lectures on Rhino for fifteen years, he has been a professional industrial designer for ten years on top of that. We were in good hands. The issue I was having with the model was getting radii to meet at three and four way junctions effectively. I was shown a way of achieving this by Phil on the second day. By the end of the third day, I had completely forgotten what I was told, and felt that asking for the same advise twice would ahve felt like a waste Phil's time, and that I hadn't been paying any attention to him in the first place. This isn't true. I had made notes also, but found these difficult to decipher when the time came. The issue was that we were bombarded with so much information during the seciond half of that day, and all the next, that we were a little saturated. So, when I found myself back in Cornwall, fighting with the model again, I wrote Phil a nice e-mail asking him for a recap on how to perform the operations. See: E-mail correspondence with Phil Cook.
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Critique of First Concept by Diabetic Specialist Nurse, Caroline Dunstan (20.10.2010)
The next level of critique, the person even more qualified to critique the initial concept than Jonathan Barnett, was a lady called Caroline Dunstan. Caroline is the diabetic specialist nurse based at Royal Cornwall Hospital in Truro.
The role of the diabetes specialist nurse (DSN) was first introduced over 60 years ago to educate and support people living with diabetes and their families at all stages of their lives. The role became more common in the 1980s with the introduction of self-monitoring of blood glucose and changes in insulin medications, and in 2007 there were 1,278 DSNs working in the UK. I went with Jonathan Barnett and together we talked through the pros and cons of the pen station, and more importantly, the viability of the project itself. We anticipate other issues to arise at this stage as Caroline is front line consultant and has been invovled in the design critique process before, helping to develope a product that has already gone to market. Her opinion is highly valued. Jonathan opens by introducing us both and outlining the project that is being worked on including it's origins then gets into questions and discussions: Jonathan: First of all, is this a credible solution or are there other problems that we could better tackle with our resources?
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Diabetes Prevelence, UK, 1996: 1.4M People.
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We know the aim is to make the users as independent as possible. Developing a contraption that will accommodate a pen and can do all these operations it's obviously going to be specific to a particular make of pen so if you have several of them, one for each one. Caroline: It might be possible to make one that is generic. They've actually standardise more in the last 18 months. Jonathan: I have some samples which Liam got a hold of, but basically our next step might be to talk to the manufacturers and get them to work with us. Would you be on board with us if we did that, because we need to get a better handle on the issues faced, as we've only done speculative work thus far? Caroline: It is still an issue and will remain an issue untill it is examined. Key areas are: Firstly, the person's physical ability to be able to handle the pen, the dexterity to pick up the pen, attach the needle, change a cartridge, callibrate etc. Fiddly. The second thing is the cognitive ability. One of the particularly difficult things for us, and for them, the main reason why district nurses go in to administer insulin is for cognitive abilities, the patient forgetting to take their dose, or forgetting they've taken it, and taking it again. Diabetes Prevelence, UK, 2010: 2.6M People.
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Caroline: So actually some sort of device which can be time locked so basically patients forgetting they've taken their insulin and taking it twice, or not doing. So basically not being able to remember. What a colleague and I have discussed previously is those pens with the multiple choice inks (red, blue, black, green) and you push down to select the one you want, well having an insulin pen that is like that, but you set 7 doses of insulin, all at a pre-set dose, and you can only take one per day, it's on some kind of time-lock devise. There has to be the technology for that out there. They wouldn't physically be able to give more doses than allowed.
Liam: Yes, and on top of that it could have an alarm that goes off if the dose hasn't been taken. You'd be designing a devise that is set up by a district nurse a week in advance... What used to happen is a nurse would draw up 7 doses for the patient and leave them in the fridge and that was that. Now, there are lots of legal issues with that now, and like we were saying earlier, a patient with dementia could take all the doses in a day, having forgotten what's what (illegal under the (Administration of Medicines Act 1972) Diabetes Prevelence, UK, 2025: 4.1M People.
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Even if the end product costs 30 quid to manufacture, that's still going to be incredibly good value for money given the savings it will generate.
How about taking blood for a C.B.G. (Capillary Blood Glucose) test, how does that work? That's not enough of an issue for us to worry about.
Summary Here we conclude that the patients we're looking to design for in this scenario are friel elderly people who are either cognitively impared, or physically impared, where they would administer once, or at most twice a day.
The figures are alarming and confirm that diabetes is one of the biggest health challenges facing the UK today.
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The selling point for a product like this will be that it can reduce community nurse input, saving time and money for the NHS, which is important now that the govornment has cut NHS spending.
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We proceed to showing the initial design work (from Level 2) to Caroline. Jonathan explains that pushing forward with the project will mean seeking patents and contacting manufacturers of diabetic equipment.
We then explain the pen station to Caroline, and that it was designed for 'one handed' use, not other compounding issues yet. Caroline: Companies are: Novo Nordisc (who are most popular, and who had the first pen on the market), Eli Lilly, Sanosi Aventic. The most like will be Novo Nordisc or Eli Lilly. There a two prodective caps on the needles. How do you propose you remove the second? Liam: Yet to be resolved. Caroline: That helps put the needle on and take it off the pen, fine, but what you're left with then is lump of plastic stuck in the devise. Jonathan: We need some sort of ejection mechanism, very simple, like a see-saw, whereby you push down, and it pops up (gesticulating pushing down with finger and popping up with hand). Area for re-design. See sketch book section - Needle accessability.
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We need to work out a way of performing this task with less than very fine motor functionality. At all stages we need to be able to remove anything we put in. Jonathan: If there was something like a roller for the cartridge where you put the cartridge in a recess, roll over the top and pop it out. The figures can be so small too. Caroline: Novopen 4 has a bulbus magnifyer for the numbers, but it's still small.
Jonathan: There are things for reading books where it scans text and puts it on screen, having something with SatNav sized screen where the numbers appear. Caroline: We encourage 'click counting', but that's flawed. If people have to 'click count' (sometimes as high as 64 units, which has to be done in two hits) they can easily lose count. Jonathan: If you've got something that magnifies the numbers, then good.
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Caroline: Here's a device that can be preset and locked (the optiset pen is almost there, it has a very stiff dial that's dialed up by the nurse, but it is still changable). What you really need is somthing that 'remembers' a dose, and can give no more. Jonathan: Maybe there could be a sleeve that slots over, much like a locking wheelnut, and the carer has the key with no chance of tamper. Caroline: The Rolls Royce would be a digital timelock (as on the devise from Tremorvah, see secondary file and annex)
Diabetic Specialist Nurses in the UK
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Jonathan: Could have a wearable reminding devise that tells them it's time for their dose, even when they're in the bathroom and the pen is in the kitchen.
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Caroline: That's the key for some patients. They're fully dextrous, just need reminding what and when. It still takes district nurse intervention or they're in hospital.
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Time
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TO DO Get information about numbers of diabetics admitted to hospital through misadministration of insulin and why (dimentia) from Caroline. Caroline: If you talk to Nicola Northern (finance officer), she'd be able to give you a breakdown of nurses pay bands and per hour, which you could then decipher potential savings for the NHS. Jonathan: Ok. If you look at the priorities for the Strategic Health Authority, they are (ammongst others), promoting independant living while avoiding needless admisions to hospital and I thinlk one of the reasons they backed this project is that it delivers on both those points.
Caroline: A lot of patients get cross at people invading their space to perform these operations. It messes up their routine and daily lives. The ammount of people we need to see with physical inability to do those things is getting less due to the disposable prefilled pens.
UK, 2010: 21% Elderly (70+) With Type 2 PRIMARY RESEARCH
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Jonathan: So from our perspective, if we had this on the market now, the prefilled pens would be a bit of a competitor because they negate the need to do some of the fiddly stuff. Caroline: You would have to do a cost analysis between a stand alone desk top pen station like you have here, and the prefilled pens to see how much you would save. If you could make that (holding up an Innolet by Novo Nordisc, easyuse insulin pen, see below), with an alarm and a lockng mechanism that could only give the dose when it was needed, you have the perfect devise. They've stopped making insulin cartridges for this one.
This is popular because it's big and chunky and it looks so much easier to use. Jonathan: But if you're a young person with all your faculties, the Novopen 3 and 4 are great and stylish, but they haven't considered others. Liam: How about setting up a user group? Caroline: You'll need to set up a patient engagement exercise, which you'll have a lot of red tape to wade through, but I'll come with you for sure. Thank you very much Caroline and I'll see you soon for some more valuable input.
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Summary and Opportunities for Design
I highlighted the key areas that came up in the meeting with Caroline and Jonathan and some of these are consistent with what was covered in the initial meeting I had with Jonathan Barnett. The point of contact with the needles that are in position within the station is under question. We feel that they are too exposed, that is, if a patient had alzheimers/ dementia, we would ideally like to see them tucked away and shown when needed.
Furthermore, the sockets that have been designed to hold them are in need of a rethink. It was noted that once the needles have been placed on the device by the supporting nurse they would be very fiddly to remove by either the nurse, during a change over period, of by the patient, if they need to for what ever reason. Please see sketchbook, design sheets and RP prototype for workable concpet 1. I will be looking at this as an issue in Major Project stage 2.
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Summary and Opportunities for Design
The main area to look at when designing 'MarkII' of the pen station is inclusion of patients with Alzheimer's and dementia. According to Caroline Dunstan it is this type of compounding issue that requires the most frequent home visits by community nurses. There are some, but not many devices on the market that offer a reminder for people requiring medication on a daily basis. In my secondary research file I have highlighted the important ones and I will look to incorporate some of the technologies and theories they use in further design iterations. Most of them are basically a glorified alarm clock, but there is one that I saw on my visit to Tremorvah Mobility Centre that had some interesting and transferable ideas. I will look to encorporate design for this area more in the 'MarkII' stage.
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I need to get hold of figures for patients admittied to hospital because they have messed up their medication dose due to having Alzheimer;s or Dementia as a compounding issue. This will not only reinforce justification for this project, but will also give a scale of the issue (locally) that can then be used when approach companies or other funding bodies. See Secondary Annex for Diabetes Statistics
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Meeting with District/Community Nurses at FradonVilliage Hall (24.10.2010)
Notes for a monthly meeting of Community/District Nurses to discuss issues in the field and gain feedback from each other. I went to the event with colleagues from UCF who had their own agenda and set of questions to find answers to. I went with the diabetic pen station project, or the idea of it in response to the initial problem that was raised some time ago. I had my own discussion area where groups of three nurses/field specialists came to hear the proposal and gave their detailed experience in reference. After 10-15 minutes, groups changed (much like speed dating!). First group: three community nurses from the Carrick area. Nurse 1: Many patients we go to see have problems with their eyesight. If it had something that counted the clicks and gave an audible feedback, that would be ideal. Liam: Well I haven’t taken into account the other compounding issues that diabetic patients have yet, such as Alzheimer's, which is why I’m here today. Nurse 2: Diabetes can actually cause impairment of vision and even total blindness through the nature of the condition.
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Nurse 1: There’s a man we see who’s very visually impaired. His dexterity is ok, but he can’t see the numbers when calibrating the pen. There’s also a lady who has Parkinson’s disease who would benefit from a device like that. Even though she can use both hands, it would benefit her. Nurse 1: What size is the devise you’ve come up with so far? Liam: It’s about ‘this’ size (holds hands together in an igloo form), organically shaped with recesses for various parts of the pen to fit into to aid the user in performing the necessary task. It could fit in on a tabletop without seeming over sized. Nurse 1: It would be amazing if you could put your finger in it and it would ‘say’ “Your blood sugar level is ...” or say what dose you’re at, like one of those clocks that says what time it is. An audio prompt would be great. Nurse 1: A lot of the people we see are elderly and we wouldn’t give them the insulin because they either wouldn’t remember, but they could also give themselves a full dose on an already low blood sugar level. So, it’s not just the practical side we have to consider but also the cognitive abilities of the people we go to help. PRIMARY RESEARCH
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There’s a guy we visit who can see shapes but there’s no way he’d be able to calibrate the pen. He needs 64 units (2x32) which is a lot and if he lost count mid way, I’d have to track back and it would be a problem if we got it wrong. Could you have something that counts as you click? Strangely, he is quite capable of putting a needle on the pen because it has the protective sheaths on. Taking it off is more of a problem because it involves applying the sheath to a bare needle. Does your devise put the tips on the needles? Liam: Actually it does have a method for re-sheathing the needles that doesn't involve going anywhere near them. Nurse 2: They advise we don’t re-sheath the needles ourselves because we could accidentally get stabbed. Obviously for someone with shaky hands it’s better to have one of those devises to help them do that because people are pricking themselves frequently and it is an issue.
Tested for other complaints Random test
Nurse 1: Fantasy devise: a pen that talks, a CBG (capillary Blood Glucose) machine where you put your finger in and it tells you the reading automatically while cleaning the finger first. Actually that devise would be great for a guy that I was caring for recently who had an accident, broke his arm but was still fully ablebodied. He would have really benefitted from the devise. A lady who we used to see who used to be fully independent, had diabetes for years and years, now we have to see her twice a day.
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Eye complaint Other Medical check-up
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But the real issue was her independence and with a device like that the nurses could go in with her for a while and the lady would dial up her own doses under supervision then after a while the nurses wouldn’t have to go as regularly as twice a day, maybe once a week. For people in care homes it would be massively beneficial because there are already carers there. That would save a huge amount of cash for the NHS. But, there are people who really like the company and play up to their ailment in order to get in contact with us! Have you thought about how you would change the needle? Opportunity for design The lady I see who is a patient with dementia, she could use a devise like that because I still want her to do what she can do and I’ll do what she can’t but I make sure she really can’t do it and just isn’t bothering.
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Awareness of symptoms pre-diagnosis
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E-mails - Nicky Pascoe Hannah Stevens Denise
– Team Leader, District Nurse, Helston. – Community Nurse, Helston – Community Nurse, Helston.
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Information about the type of patients they see.
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Breakdown of patient statistics (age, ability) For follow up to the meeting please see e-mail sent. Highly Aware
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Diabetic Drop-in Session 24.10.2010 Experienced based design (EBD) is an exciting new way of bringing patients and staff together to share the role of improving care and re-designing services. It is being developed by the NHS Institute for Innovation and Improvement as a way of helping frontline NHS teams make the improvements their patients really want. While leading global companies have used similar approaches for years, the ebd approach is very new for the NHS. Where it has been used in the health service, it is having amazing results - delivering the sort of care pathways that leave patients feeling safer, happier and more valued, and making staff feel more positive, rewarded and empowered. See secondary research file: Experienced Based Design
Structured education is a key way of supporting self-care and should be tailored to their individual needs and products play an key roll in helping people, especially those with disabilities, manage their condition safely. (Diabetic Specialist Nurse, 10.12.2010)
2006
2010 Did
Did
Wanted to, but didn't
Wanted to, but didn't
Didin't
Didin't
% Diabetics who attended a self management course
% Diabetics who attended a self management course LIAM WARD
Self-care is the cornerstone of diabetes care. When it comes to managing the condition, it is estimated that about 95% is done by the individual with diabetes. However, many people do not know enough about the key elements of diabetes to help them manage their own condition, and education programmes can help people to feel more in control of their diabetes.
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Many sessions were set up around Cornwall and I was fortunate enough to be able to sit in on a few of them. Caroline Dunstan (Regional Diabetic Speciallist Nurse) and Elizabeth Butland (Trainee Diabetic Speciallist Nurse) set up these drop-in sessions with an aim to improve the experience patients have from initial consultations upon finding out they have diabetes through to follow care and after care. The initial introduction pointed out that all important decisions that effect the services provided are made by those few at the top, managers, executives and the like, who don't live with the condition, or have dealings with people that do. Caroline quoted a very good phrase: No decision about me, without me. This highlights the importance of user led design. It was understood that this was a situation in which I was not granted access to patients for research purposes at these particular sessions. I was allowed to sit at the back and take notes if approprioate. I was, however, able to talk with bith Caroline and Elizabeth extensively regarding the project that I am working on.
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Tributary Ideas In response to the issues that I was looking at (dexterity issues with patients) Elizabeth brought up the issue of being able to calibrate a pen whilst being blind. Because this was flagged as an issue independently from the main group of tasks I had been looking to perform with dexterity problems, I thought about its sollution in a different way. Elizabeth: I would love to see a device that could help a patient calibrate a dose whilst not looking. This would be transferable to all vision problems. You know, something that meant they could only ever dial up that particual dose and not more.
I put some ideas down on paper early on so as not to forget the thinking behind a sollution but didn't focus on it as a main issue to conquer. It is a small device so I did the CAD and made an RP.
It fits well but is a little flimsy. This shall be documented anyhow as it could play an important roll in the development of the pen station Mark II. See sketchbook, CAD sheets and RP.
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I concluded from the drop-in sessions that they were focussed entirely on patient service and quality of their interaction with staff and professionals. INdividuakls were made aware of my presence and asked if they would mind at a later date participating in some user testing. They were fine with this idea.
Even though the sessions were based around quality of service some very intersting phrases came out of it that are worth considering when designing anything in this field.
'...Increase patient confidence with the condition' '...empowering patients to self manage' 'Have you ever been asked what YOU would like from a service or product?' '..like to see more education about the condition' '...not always about treating the ailment directly, but considering the patients themselves (holistically)'
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Eli Lilly: Luxura HD • Precise and accurate dosing in a pen that dials in half-unit increments from 0.5 to 30 units. • Attractive and durable design is easy for children and adolescents to use. • An easy-to-see dosage window and audible clicks • The ability to dial back and forth to correct the dose and help prevent wasted insulin.
Apidra: Solostar he Apidra SoloStar is a disposable insulin pen that is prefilled with rapid-acting insulin glulisine. Ideal to have on your person in case of emergency hyperglycemia.
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Humalog 3: Aventurn Provides a delivery option that may be more acceptable and more convenient to use in comparison with other delivery systems, thus may promote patient compliance, which could help achieve and maintain glycemic control.
NovoNordisc: Innolet Very popular design especially amongst elderly people and those with poor dexterity. Unfortunately production has been ceased.
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Lantus: ClikStar So manage to get myself a ClickSTAR pen yesterday, it’s the new cartridge pen for Lantus. Just wondering if anyone else uses it and what you think of it? My first thoughts are I think I like it a bit better than the autopen24 but still doesn’t match the Novopen. (Sofaraway at diabetessupport.co.uk/forum)
Humalog: Disposable# • Easy use due to ergonomic design. • Half doses available. • compact and lightweight. • Very popular due to form
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Eli Lilly: KwikPen •
Dial-and-dose convenience means there’s no cartridge to change because it comes prefilled with 1 of 3 types of Humalog® insulins, or Humulin® N insulin. Great for those seeking a simple solution.2
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Convenient because it’s lightweight and compact.3
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An easy-to-see dosage window and audible clicks
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The ability to dial back and forth to correct the dose and help prevent wasted insulin.
NovoNordisc: PenMix
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Disposable pen used for set doses only.
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The pen twists to set the dose.
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The plunge is pulled to ready a dose.
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The plunge can only ever be pulled to the dose set via twisting action.
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This revents missdosing amongst patients with dementia.
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It is posible to twist the pen however.
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NovoNordisc: Novopen III & IV •
Easy-to-use
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Simply dial the dose, insert the needle and push the button.
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Highly accurate dosage
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Dial your dose in one-unit increments with a sound mechanical system.
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Reliable
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NovoPen® 3 has a proven track record as one of the most widely used insulin pens in the world.
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Virtually unbreakable
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NovoPen® 3 is built with a tough, high quality metal construction. Flexible
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With the Penfill® 3ml cartridges, you have access to the full range of Novo Nordisk insulins.
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Size Deviation Maximum diameter = 18.23mm
D
Minimum diameter = 15.38 mm
D
If I am to design an object to fit all sizes of pen, that is, to cater to the widest possible user group from young people with diabetes who have merely broken their arm and need a device to help them, to people who use a different pe because it fits their needs better, i.e. Novopen 3 (thin for discretion), I will need to make an apperture for all sizes. The best form will be either a wedge, or a stepped apperture.
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LIAM WARD
Conclussion Through talking to professional care givers and frontline staff it is clear to see that patients dignity and indepentence is in the under pressure from necessary contact time with primary carers. Anything we can do to improve this situation by designing products that help patients manage their medication better at home is beneficial to both all stakeholders: Patient, Staff, NHS. All people with diabetes, whether recently diagnosed or otherwise, should receive the structured education and support they need to enable them to manage their own diabetes. The way in which diabetes care is provided needs to be systematically organised and well resourced to support people with diabetes to effectively self-manage their condition, leading to better outcomes through a patient-centred approach. Any contact time that can be minimized in that equation will serve to strengthen remaining support given. Next, I plan to engage with the my user group to gain first hand experiences of what products and care is available currently, and how it can be improved, taking with me designs to find out how they will be received.
LIAM WARD
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PRIMARY RESEARCH