Johnson & Johnson Chief Medical Officer Highlights Unit Dose Packaging’s Role in Preventing Accidental Ingestion
Dr. Ed Kuffner: “Every day in the U.S., we have about 150 children—about four busloads of kids—coming into emergency departments because of accidental unsupervised ingestions… Packaging innovations can reduce these risks.”
Applying pressure to the Packlock blister card and creating the rectangular prism is required to open up a space between the backing of the card, allowing the user to push a pill into the space and have the pill drop down.
Healthcare Packaging talked with Dr. Ed Kuffner, chief medical officer at Johnson & Johnson Consumer Health, where he leads a global team of medical and safety professionals. Throughout his career, Ed has been passionate about patient safety and has worked with a broad range of internal and external stakeholders to tackle complex public health issues such as preventing medication errors, accidental unsupervised ingestions, misuse, abuse, and overdose.
[Editor’s note: Answers have been edited for brevity]
HCP: How did your experience lead to your involvement in the unit dose packaging community?
Dr. Ed Kuffner, chief medical officer at Johnson & Johnson Consumer Health.EK: I'm an emergency physician and a medical toxicologist. I've worked in different emergency departments over my career and at a poison center. Both in the ER and at the poison center, I've unfortunately cared for many children whose illnesses and injuries may have been prevented. I've treated young kids who've gotten sick after getting into medicines when they were not kept appropriately out of their reach or kids who suffered medication errors when given an incorrect dose by a caregiver. When you're in that setting and a kid needs to be admitted to the hospital, or even the ICU, it's heartbreaking for all parties involved. It's hard for me as a clinician, it's hard for the staff, and it's certainly tough on the kids and their families. So, for me today as the chief medical officer for Johnson & Johnson's (J&J) Consumer Health business, we have doctors, nurses, and pharmacists working together to keep all the users of our products safe, especially young kids.
HCP: What led to J&J choosing a unit dose technology focus for its recent Packaging Design QuickFire Challenge?
EK: Last year, we worked with a variety of people within the company—R&D, our safety team, and Johnson & Johnson Innovation—and launched a QuickFire Challengewhich sought to crowdsource potentially groundbreaking ideas to improve unit dose packaging.
Some may ask, “Why would you launch a challenge like this?” Unit dose packaging really has the ability to help prevent accidental unsupervised ingestions, which is when kids get into medicine when it's not appropriately kept out of their reach. Having worked in the ER and at the poison center, some people may be surprised at the number of kids who come into emergency departments: every day in the U.S., we have about 150 children—about four busloads of kids—coming into emergency departments because of accidental unsupervised ingestions and many more will have parents or caregivers call the poison centers. (For more: Trends in Emergency Department Visits for Unsupervised Pediatric Medication Exposures, 2004-2013.)
Packaging innovations, like unit dose packaging, can reduce these risks. You have adults who are trying to use medicines appropriately—many who may have limited dexterity with their hands, people who may have arthritis and they may have difficulty or struggle when they're just trying to use medicines appropriately. If they can't get into the packages easily, that may compromise their health if they consequently decide not to take the medicine. If people feel it's too difficult to access, they may take their medicines out of a child-resistant package and put it in another type of container which isn’t as safe. That's where kids can get into trouble. On top of that, all of us—as individuals, as companies—we want to become more environmentally friendly. I think we all have a job to do in protecting the planet.
At the end of the day, if we can make the packaging a little bit easier for people, we can hopefully enhance adherence and help people to take medicines more appropriately. Thinking about all these different aspects, we wanted to stimulate innovation and hopefully make packages that are child-resistant, senior-friendly, environmentally friendly, and that potentially increase medication adherence. One way of doing that was through the QuickFire Challenge, where we try to inspire innovators. We offered $100,000 in grant funding and our awardee, IDEEWISS AG, is a Swiss company with a unique packaging design called Packlock.
HCP: What stuck out to you about IDEEWEISS AG’s Packlock in terms of protective features beyond a traditional blister card?
EK: Different blister cards have different backings which help control the amount of force that's needed to push a tablet through the backing.
If you have a backing that's easy to push the pill through, even young children can access that medicine relatively easily.
If you have backings that are stronger or you use other technologies like a bend-and-peel technology, it gets more difficult for young children to self-access, but it also gets more difficult for the older patients, those with arthritis and other people trying to use the products appropriately.
Applying pressure to the Packlock blister card and creating the rectangular prism is required to open up a space between the backing of the card, allowing the user to push a pill into the space and have the pill drop down.
Packlock’s design offers a two-step mechanism in order to access the pill via the blister card. We know that two-step mechanisms really can help prevent accidental unsupervised ingestions because they're a little more cognitively difficult for kids to figure out. What Packlock created is a blister card, which when you put some pressure on the card, creates a rectangular prism. Applying pressure and creating the rectangular prism is required to open up a space between the backing of the card.
This allows the user to push a pill into the space and have the pill drop down. We think this design will both help protect kids and hopefully make it easier for adults to appropriately access medicines.
Another positive about Packlock’s innovation is that it uses a relatively traditional type of blister card design. We think that the cards could be produced on packaging lines used to produce blisters today, with only minor modifications, making it easier to implement.
HCP: What do you feel is the intersection of child-resistant, user friendly, non-recloseable designs with sustainability? For so long, these concepts seemed at odds with each other, at least at face value.
EK: There are many different considerations. We've talked about some of them: it's all in striking the right balance between preventing accidental unsupervised ingestions, encouraging adherence, and not overburdening adult users of these products. In addition, we want to try to prevent medication errors, protect the environment, and also be able to manufacture these at a reasonable cost. At the end of the day, if you don't produce a package that really delights patients and consumers, people aren't going to use it and you really defeated the purpose of the innovation.
It's not easy to strike that right balance. This is where I try to use my position as the chief medical officer within J&J's Consumer Health business to advocate for the safety and wellbeing of patients and consumers, and try to prevent those curious young kids, which we all love, from becoming patients. I try to encourage and motivate the R&D teams to innovate and make sure we're striking that right balance. It’s a constant balancing act, but with innovations like Packlock, new designs, and new technologies, I think we're really moving in the right direction.
HCP: What innovations are you excited about in terms of drug delivery that boosts patient adherence?
EK: We've seen a lot of new innovations recently, and we’ll continue to see more. It's an exciting time. When I think of some of the innovations that excite me personally, it's technologies that allow us to deliver more sustained release or a longer duration option. A number of years ago, sustained release meant 24 hours, or over a couple of days. Now we actually have the ability to deliver sustained release medicines that are released over months and are starting to get to years. It makes it much more convenient for patients. When they don't have to dose as frequently, we know that this improves adherence and that improves outcomes.
Certain technologies like microneedle technologies have the potential to deliver medicines in new settings with less pain. I think that's really going to help patients and consumers.
As we start to get more data on genomics and personalized drug regimens, I think that will also spark innovation in how we work to deliver medicines not just to the broad population, but in ways that help individuals.
And even today, coming out of the pandemic, we've seen a big rise in telemedicine. We've seen people using technologies more that allow healthcare providers in health systems to monitor remotely. I think these types of technologies will continue to push the boundaries and create new opportunities for different drug delivery options. There's a lot coming in the future.
HCP: Parent, caregiver, and clinician burnout has made a lot of headlines lately, and people are on their phones a lot. We're all fairly distracted compared to 10 or 20 years ago. Is that causing issues that designers should be factoring in? On the positive side of that, patients are more educated, connected, and knowledgeable.
EK: You highlight a lot of the considerations when I look at preventing medication errors or accidental unsupervised ingestions. I look at it like a continuous journey that we're all on together: patients, healthcare professionals, industry, healthcare systems, regulators, and consumer advocacy groups.
For me, it's always about digging deep into the root causes of medication errors and accidental unsupervised ingestions. The more we understand the root causes, the more that we can innovate, design technologies, and implement new packaging and techniques to try to address them.
When new products come onto the market, let's understand what's going on with those products. When we start expanding into new categories, it's an opportunity to take a step back and dig deep again and ask if really understand what's happening with the product and packaging?
I'll give a couple of examples:
The legalization of THC based products. When companies started to formulate and market them in appealing food-based forms, that created risks, not just for the users, but for kids when it relates to accidental unsupervised ingestions.
We're seeing expansion in natural products and supplements. I think there's an opportunity for all of us. How do we further refine how these supplements are dosed? Can we put additional measures in place to protect children like adding dosing devices and child-resistant packaging like we have on more traditional over the counter or prescription medicines?
I think digital tools have the ability to help make dosing much more accurate to prevent medication errors. How do we better educate patients, consumers, and caregivers about these things?
With all these new advances, I'm optimistic that new technologies and digital solutions could help us reduce medication errors and accidental unsupervised ingestions.
HCP: Do you have any tips for packaging engineers who are designing or updating unit dose packaging and drug delivery devices?
EK: I know I’ve said, and I’ll say it again: it’s all about striking the right balance in making it easier for the users so they can access medicines, safer for the kids so that they don't get into it, and being environmentally friendly.
I would encourage packaging engineers to always think beyond the brief. When you get that brief from R&D which is primarily focused on sustainability, I would say, how in the same re-design process could we delight users and further enhance the safety by preventing accidental unsupervised ingestions or medication errors and find that win-win.
If a packaging brief says to focus on decreasing costs—which is certainly something people are interested in, as a packaging engineer, can you also find a way to funnel some of those savings back into upgrading the packaging in other ways — like adding or upgrading the child-resistant feature? Sometimes that means pushing your business partners to look at ways to simplify across the portfolio. For me, it's really about these win-win type of situations.
One other aspect is how do we find more ways to co-create with patients, consumers, and healthcare professionals and put prototypes in their hands? Even skilled and experienced packaging designers and safety experts who’ve worked in this area for many years learn—when you co-create and put products and prototypes in the hands of patients and consumers, it helps you dig deeper into their experiences. Oftentimes, I'm even surprised. I think working together with patients and consumers, you can really unlock some of the insights that may be overlooked if we don't partner in that way.
Dr. Kuffner is passionate about preventing medication errors in children. As he explains, “Whether you're a packaging engineer, a toxicologist, or a packaging expert, at the end of the day, there is information that we can communicate to our friends, family, and loved ones that could help keep all of us—especially kids—safe.”
Always read and follow the labeling information on healthcare products that you're taking yourself or giving someone as a caregiver.
The concept of keeping the medicine high and out of sight of children is really important, not just during storage but after every use. Dr. Kuffner explains, “A big risk area is when caregivers, who appropriately store medicines high and out of sight, take them out because somebody in the family may be sick. They use them and then don't put them back. Oftentimes that's when kids get into them.”
Never give adult medicines to kids. There are pediatric medicines and adult medicines, and when you give adult medicines to children, you create increased risk.
Always use the dosing device that comes with the product, especially with pediatric liquid medicines. “Don't use household spoons, they're notoriously inaccurate,” he says.
For people carrying their medicines in purses or backpacks: don’t leave bags on the ground when visiting a household or environment where there may be young kids, because it's relatively common for curious young kids to get into them. “If you're one of those people who carries your medicines around, which many people need to do, be hyper aware when you're entering new environments where kids are around.”
Don’t hesitate to call. Dr. Kuffner has encountered people, even in the emergency department, who say they didn’t want to call the poison center and bother a healthcare professional. He notes, “As healthcare professionals, we want to hear from patients. If you have a question, a concern, or you're unsure, reach out and contact a healthcare professional. In the U.S., we are fortunate to have a wonderful poison center system, and the poison centers are there for you 24/7. We have healthcare professionals on the ready to help you— they can give fantastic advice and they're happy to do it.”
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Dr. Ed Kuffner, chief medical officer at Johnson & Johnson Consumer Health.
