Some other auto-injectors are designed like upside-down ball-point pens. The end where the needle emerges can be confused with the activation button, as on a pen.1 In the back there is also a second hole which can be confused as being the needle exit. Patients turn their auto-injector the wrong way leading to needle stick injury.2-3
Education and training on the use of the auto-injector is important. Training can however not compensate for a poor product design.4
Human-factor engineer L.L. Gosbee explains: “Each time their tendency is to push the top end of the auto-injector as if they were activating a ball-point pen. They instinctively do it even with previous training. I try to remind them: It does not work like a pen!” 4