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Labeling as Risk Control Measure

  • 1.  Labeling as Risk Control Measure

    This message was posted by a user wishing to remain anonymous
    Posted 23-Feb-2023 14:45
    This message was posted by a user wishing to remain anonymous

    From EU perspective information (i.e. labeling risk controls) should not be attributed to risk reduction.

    Does it apply to user training as well?  (under the assumption I can measure training effectiveness)

    In the ISO standard 14971 - 7.1 Risk Control Option Analysis (c) - Infomation for safety and, where appropriate, training to users are written together. 



  • 2.  RE: Labeling as Risk Control Measure

    Posted 23-Feb-2023 15:48

    The concept, "From the EU perspective information (i.e., labeling risk controls) should not be attributed to risk reduction" stems from a misunderstanding.

    In 2012, the EU prepared a version of the 14971 for use in the EU only. It used Content Deviations to explain the difference between the EU version and the international version.

    One of the Content Deviations said that the manufacturer had to apply, if possible, all the risk control measures and not stop when the risk became acceptable. One of the risk controls was information for safety, so manufacturers had an obligation to use it.

    One of the Content Deviations said that disclosure of residual risk is not a risk control measure.

    The problem arose because some NBs did not understand the difference between providing information for safety and disclosing residual risk; these NBs thought they are the same thing. As a result, they told their clients they could not use information for safety as a risk control measure notwithstanding the requirement in the Content Deviation. (A great case study for Catch 22!).

    Fortunately, those dark days have been replaced by happy sunny days.

    The EU regulation is now (correctly) more expansive. Not only does labeling provide information for safety but also training does. A manufacturer could reduce or eliminate harm to the patient or user by training.



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    Dan O'Leary CQA, CQE
    Swanzey NH
    United States
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  • 3.  RE: Labeling as Risk Control Measure

    Posted 24-Feb-2023 00:39

    It is important to note that information for safety (and likewise any accompanying training) is the lowest priority risk control option per ISO 14971:2019, clause 7.1 (in which one is pointed to ISO/TR 24971:2020 for additional information).  With respect to the means by which such a control measure may reduce risk, it can at best reduce the probability of harm by giving users "clear instructions on what actions to take or avoid, in order to prevent a hazardous situation or harm from occurring" (as noted in ISO/TR 24971:2020 Annex D).  As such, consideration should be made to the magnitude of risk reduction claimed due to implementation of information for safety, as well as training to such material.  

    Likewise, with respect to the effectiveness of the information for safety and training to its use, IEC 62366-1:2015+AMD1:2020 is a helpful reference.  In particular, the manufacturer must ensure that such information is "perceivable by, [...] understandable to, and supports CORRECT USE of the MEDICAL DEVICE by USERS of the intended USER PROFILES in the context of the intended USE ENVIRONMENT."



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    Christopher Erwin
    Scottsdale AZ
    United States
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  • 4.  RE: Labeling as Risk Control Measure

    Posted 24-Feb-2023 07:32

    We currently use our label and IFU as the mitigation for risk just like Dan explains.  Our technical files have all been approved.

     

    D. Michelle Williams, CESCO

    VP – Operations

     

    Action Products, Inc.

    www.actionproducts.com

    301.797.1414 X1022

     

    https://www.linkedin.com/in/dmwilliamsvpopapiwvu88

     

     

    Action-MMD-Ribbon_Logo_5in_cmyk

     






  • 5.  RE: Labeling as Risk Control Measure

    Posted 25-Feb-2023 10:11

    The reason your files have been approved is that the statement in the original question is incorrect. The MDR and IVDR in GSPR 4 state that IFU is an acceptable method of risk control. This section also applies the option order of preference. So just don't jump to putting in IFU as the risk control before you can rationalize, preferably in written form, that design or precautions (options 1 and 2) are not possible.

    Be aware that all risk controls must be verified for effectiveness, which in the case of IFU, if done with Usability Validation and is not as easy as it may look. 

    Also, for legal reasons, your risk controls may include Warnings and (Pre)Cautions in the IFU, regardless of the use of Design and Preventive Measures also being used in your product. 



    ------------------------------
    Edwin Bills MEd, BSc, ASQ Fellow, CQE, CQA, CQM/OE, RAC
    Principal Consultant
    Overland Park KS
    United States
    elb@edwinbillsconsultant.com
    ------------------------------



  • 6.  RE: Labeling as Risk Control Measure

    Posted 27-Feb-2023 08:46

    Our files were reviewed for accuracy and completeness by PhD scientists/consultants just like yourself.  They were then accepted by our AR.  They are also reviewed during our ISO and quality audits.

     

     

     

    D. Michelle Williams, CESCO

    VP – Operations

     

    Action Products, Inc.

    www.actionproducts.com

    301.797.1414 X1022

     

    https://www.linkedin.com/in/dmwilliamsvpopapiwvu88

     

     

    Action-MMD-Ribbon_Logo_5in_cmyk

     






  • 7.  RE: Labeling as Risk Control Measure

    Posted 28-Feb-2023 00:23

    A review by "experts" does not meet the requirement of ISO 14971 if you are claiming that Instructions for Use (which also includes training) reduces the risk.  You must Verify the Effectiveness (14971:2019 Clause 7.2-See Notes 2 and 3, Also Annex A.2.7.2; See also  ISO TR 24971:2020 7.2) of the Risk Control which is usually done, in the case of Instructions for Use, during Design Validation using the techniques in Usability Engineering.  This provides data supporting the estimated reduction of the risk.  Techniques for Verification of Effectiveness of IFU are similar to other Design Validation activities where actual users are given the product as shipped and they are to use it, and are observed to see how they use the IFU and if they get the proper results.  



    ------------------------------
    Edwin Bills MEd, BSc, ASQ Fellow, CQE, CQA, CMQ/OE, RAC
    Principal Consultant
    Overland Park KS
    United States
    elb@edwinbillsconsultant.com
    ------------------------------



  • 8.  RE: Labeling as Risk Control Measure

    Posted 28-Feb-2023 07:04

    Mr. Bills,

     

    Yes, that was all done.  Contrary to your belief, our GSPR, hazard traceability matrix and risk assessment are correct and our IFU was used to mitigate risks where applicable.

     

    Thank you,

     

    D. Michelle Williams, CESCO

    VP – Operations

     

    Action Products, Inc.

    www.actionproducts.com

    301.797.1414 X1022

     

    https://www.linkedin.com/in/dmwilliamsvpopapiwvu88

     

     

    Action-MMD-Ribbon_Logo_5in_cmyk

     






  • 9.  RE: Labeling as Risk Control Measure

    Posted 28-Feb-2023 11:54

    I don't believe the inference is that your documentation is incorrect, in the context of the initial question it is simply important to note that usage of information for safety (including labeling) requires thoughtful consideration when it comes to demonstrating effectiveness of the risk control measure.  Review of the risk management file by experts is desirable and in fact likely required to meet competency requirements and to ensure that the state of the art is met by the complete final product.  I think it is necessary to point out that expert review on its own is insufficient to demonstrate the effectiveness of the risk control, particularly where information for safety is the method.  It is not unreasonable to consider the practitioners and users involved in Design Validation as experts; however, it is necessary to employ Usability Engineering to objectively demonstrate effectiveness, rather than only relying on review of the information.  

    This is an important distinction, in order to ensure that those with less experience or seeking guidance understand that use of information for safety involves a non-trivial demonstration of effectiveness (one that typically cannot be shown until late in the product development process).  Review of the risk management file is necessary, but alone it is an incomplete verification of effectiveness.



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    Christopher Erwin
    Scottsdale AZ
    United States
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  • 10.  RE: Labeling as Risk Control Measure

    Posted 27-Feb-2023 10:30

    Hi,

    In case if training is used as risk reduction, effectiveness has to be validated by usability study.

    Information for safety to be included in the IFU and IFU should be used in the usability study to show that it was effective.



    ------------------------------
    Raje Devanathan
    Amerisource Bergen
    TPIreg, Innomar Strategies
    Senior Manager - Regulatory Affairs, Medical Devices
    rdevanathan@tpireg.com
    3470 Superior Court
    Oakville ON L6L0C4
    Canada
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  • 11.  RE: Labeling as Risk Control Measure

    Posted 01-Mar-2023 06:09
      |   view attached

    Just as a historical note on IFU, in 1993 CDRH published "Write it Right", Recommendations for Developing User Instruction Manuals for Medical Devices
    Used in Home Health Care. I've attached some pages related to testing. (FDA this document from its website some years ago.)



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    David Manalan
    Principal, INQC Consulting
    Acton MA
    United States
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