#MEQAPI – Tweetchat June 14-2018 3:00ET #WrapRage: Getting a Grip on Rx

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.

Accessibility goes beyond simply being able to see a physician or pay for a prescription. After all, what use is seeing a physician, getting a diagnosis, and filling a prescription, if one can’t get the pill bottle open or liberate the tablet from the seemingly indestructible blister pack?

For many people with chronic diseases, the child-proof bottles, blister packs, and other packaging systems can present very real barriers to access. This may be especially so when flares or acute episodes make dexterity, visual acuity, or coordination problematic. As one person put it “.. do you really want me using a knife during a migraine?”.


I can’t use the fold-n-peel (which never peels) kind of blister pack when I have a migraine. My migraine medicine is packaged in a fold-n-peel blister pack. Clumsiness is a common problem with migraines. Using a sharp object to slice it open is a bad idea but it’s what i do!

I am blessed with a 6’2″ adequately-muscled body with above average grip strength, but at times I have experienced #WrapRage and resorted to brute force and tool-enhanced violence to get at a tiny pill lurking in a blister pack. If, I have wondered aloud, I need a dissection knife and locking forceps to break through the blister pack defenses, what on earth will it be like when I am 8o, and have weakened grip, less dexterity, reduced visual acuity, and more likely to gouge a trough in my hand than get at the pill?

Tools to Defeat Blister Packs

There is a sense that child-safety features are understandable, but surely there are ways to achieve acceptable security without burdening the patient with barrier to access at the time and place of need? In the same vein, it is often rather obvious that the medication and packaging designers have not acquainted themselves overmuch with the environment in which the product is used. Some medication presentation and packaging and dosages are not very well suited to the real-world in which a sick person is trying to get the medication into their body – tablets that are too large, hard to swallow, difficult to grip, or just too tiny, fragile, or nondescript to handle.

A core concept in quality management is that value and quality are measurement according to how well a product meets the requirements of the “process customer” – the patient. If a medication doesn’t get into the bloodstream of the patient in the right dose, at the right time, then one can scarcely see it as a quality product – regardless of how clever the formulation.

Giving the patient a stroke (figuratively) due to #WrapRage is not a strong value proposition.


Using a Ishikawa fishbone structure, we will chat about several dimensions of #WrapRage.



  1. Policies: How do national, state, or organizational  policies, laws, and processes cause or reduce medication usability and #WrapRage?
  2. Environment: What environmental factors influence medication #WrapRage?
  3. People: What people factors cause or reduce medication usability and #WrapRage?
  4. Modality: What aspects of the treatment modality e.g. liquid, tablet, IM, IV, etc. cause or reduce medication usability and #WrapRage
  5. Materials: What medical materials cause or reduce medication usability and #WrapRage?
  6. Ergonomics: What aspects of the usability, handling characteristics, weight, spillage, etc. cause or reduce medication usability and #WrapRage


MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered. We expand this to include Accessibility, STEEEPA.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.


The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser and board member at the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and blogs regularly for Physician’s Weekly.




Published by

Matthew Loxton

Healthcare Analyst using Lean Six Sigma, Knowledge Management, & Organizational Learning to improve healthcare http://linkedin.com/in/mloxton

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