Bad design: Fresenius Applix Smart food pump
The Fresenius Kabi Applix Smart food pump is a masterclass in bad design. There is nothing smart about this food pump and its accessories. It has been designed without taking into consideration the context in which it is to be used. Consequently, some of its accessories are not just safe enough to used around patients and the home and could lead to the compromise of patient safety.
When designing any form of interface, a usability consultant will push for the interface to be: effective and efficient; easy to learn and remember; useful and safe.
After usability comes user experience (in this medical context perceived user satisfaction is enough, as it is never going to be fun to use a food pump on a chronically ill person) which encourages users to feel supported and motivated by a helpful interface.
Fresenius Kabi has failed the user of the Applix Smart food pump on usability and user experience.
Typically, a food pump is used on patients who have medical conditions which prevent them from eating and drinking the amount of calories necessary to sustain them. So, the patient is equipped with a feeding tube and is fed using a feed pump throughout the day and overnight - in hospital or at home, sometimes looked after either by a health professional or a carer (usually a person who is only medically trained to do what the patient needs). Thus, the food pump must address the needs of a range of patients who need diverse but often very precise amounts of feed and the range of users who have little to a lot of technological experience, particularly in medicine.
How not to design a food pump
The Fresenius Applix Smart food pump at first glance looks easy-to-use. It has 10 buttons:
- Two buttons at the top of the pump - one which increases or decreases the alarm volume as you toggle through the options, and one to set a key code.
- Four buttons - two up and two down arrows - to the right of the information display, to set the mls rate per hour and the current volume of mls to give.
Underneath the display from left to right there is:
- The on/off button.
- The information button, which when pressed tells you how many mls you have given and how many you have to give.
- The priming button which when pressed feeds the liquid down from the bag down the line to the end of the tube from the giving set, which is then attached to the patient’s feeding tube.
- The start/stop button.
The not-very-giving giving set on which you can choke
The pump comes with one type of giving set, which is where the feed is stored. The giving set line is fed through the side of the pump and hangs above it. This giving set has a medicine port, which comes off really easily and which a small child could choke on. Children who are chronically ill still experience teething and like to chew and put things in their mouth - particularly the line on the giving set. The medical port is just dangerous, detachable and could easily kill a child.
The giving set line also has a clamp on it. During training we were told never to use the medicine port and the clamp on the giving set and the key code button the pump. No reasons were giving, but it does beg the question why are these features on the giving set if they are never to be used?
There is no way that you can use any other type of set with this food pump, so if you have delivery problems (see customer care), which are quite common with Fresenius Kabi, then you cannot use this food pump at all.
Each feed in the giving set needs an extra 30 mls to prime the lines as they are really long, so you either waste a lot of feed or don’t give your patient enough. This should be mentioned in the literature.
Context is key in good design
Noise control: You may be able to choose the loudness level of alarm from the three preset levels, but you can’t switch it off altogether, so if you set the food pump to run all night and are lying next to the patient to sleep, if that food pump finishes at four in the morning, so does your sleep.
When the stop button is pressed, the alarm will sound every minute. Shouldn’t the user be able to decide how often they need to be told that the pump is on hold?
Backlit screen: A backlit screen is great for when you need to get information in a dim room when your patient is asleep. And an energy saving screen which only lights up when you press the buttons is not the worst idea in the world. But, when coupled with buttons which are small and difficult to see and close together is a terrible idea, especially when the pump has to be running for the screen to light up at all as backlighting doesn’t work in ’stop’ mode. Fluorescent buttons would have helped visibility and reduced errors (particularly switching the machine on and off which wipes out current totals), especially during the night.
Information: The information button is a great idea. But like the backlighting, the food pump has to be running otherwise you cannot get the amount of mls consumed and mls to give. What is the point of the information if you can’t access it at all times?
Increasing and decreasing volumes: The pump will only let you go up in groups of five mls once you are over 200mls. This is fine if you need to give vast amounts of feed, but what if you don’t? What if the patient is fluid-restricted and every ml counts? You can’t, for example, set the food pump to 499mls - it won’t allow you.
The lack of control to set alarms, food limits, and the inability to access important information as and when required leads to a frustrated user.
Grouping similar tasks together
The order of the buttons doesn’t make any sense at all, and seems to suggest that this pump wasn’t sufficiently tested before it was released.
Cognitively, buttons should be grouped together into similar tasks. So, the on/off button should stand alone - not next to the information button. It is easy, especially in a darkened room when interacting with these non-fluorescent buttons, to switch the pump off when you are looking for information. Ideally, the on/off button should be on the top of the machine where it cannot be touched by accident.
Once the on/off button is off the bottom of the machine the order of the buttons should following the order of how the user interacts with the machine: information, priming, and then stop/start.
The stop/start button is used more often than any other button - as patients vomit and need attending to often - so this button should be situated away from the information and priming buttons so that you don’t start priming more fluid into the patient when he/she is vomiting.
The information button should allow the user to access all information including the total mls consumed at all times whether the pump is running or not. So that the user can make an informed decision at each feedtime as to how many mls to give.
Buttons together which encourage the user to make mistakes, reset totals, and inadvertently feed a patient when the patient is vomiting create angry users and little faith in the food pump.
Accessories to complicate your life
We all love accessories and the backpack which comes with the machine at a first glances looks great. It is compact and has a velcro sealed panel which you open to interact with the pump. However, looks aren’t everything. You have to be really careful how to put the giving set into the backpack otherwise creasing leads to air holes and bubbles in the lines and the pump alarms constantly. You cannot prime the pump and giving set in the backpack at anytime, the alarms go off.
The backpack hole which the feeding line comes out of is not big enough for the giving set line to go through without the medical port falling off and without a big struggle with the clamp.
The pump also comes with a table stand which is awkward. It is slightly too big for a table, so has to be set carefully so that it will remain stable. It is not tall enough to stand on the floor, particularly if your patient sleeps in a cot or a raised bed. It is really heavy too so you have to be very careful where you place it, because if it was to fall on a child’s head, it would kill the child, an adult’s head would probably just need some stitches and the removal of the naso-gastric tube in the case of the resulting hairline fracture.
The clamp holding the pump has to sit at bottom of the table stand which would be fine if the a/c socket where you plug in the main adaptor wasn’t tucked so far under the pump holder that you cannot plug it in without tipping the whole stand and pump onto its side. But a pump clamped at the bottom of a stand which is on the floor is just dreadful.
Safety is key in all design. Medicine ports which can be eaten and stands which need a specific height table so that they are stable and can’t topple over and damage the patient’s skull are dreadful design problems which should be addressed immediately.
Customer Care Fresenius Style
The helpline number issued with the foodpump is 24/7, but interaction with the helpline number is dreadful:
Ringing the number outside office hours to talk about missing deliveries, or deliveries that aren’t yours and which have turned up at 6am can lead to you hearing comments such as: “I don’t care about your deliveries. Get off the line I am a nurse and I am here to deal with dying people.”
Ringing up to complain about how the above nurse thinks she can speak to customers anyway she chooses, leads to comments such as: “We have no formal process for complaint. All that happens is that I print out this apology letter whilst I am on the phone to you and I put it in the post. Do you want one?”
You are never given a time for deliveries so they can arrive from 9am until 6pm on your delivery day and if you ring to ask whether they have any idea what time the delivery will arrive, the answer is always resoundingly no.
Users need to feel that they have some control over their deliveries, their day and that they and their time are respected.
Sometimes, the delivery person has absolutely no idea about where you live and will ring you and ask you for directions. And if a delivery is incorrect, you will have to go through the same dreadful delivery process the following week as Fresenius cannot seem to correct their mistakes the same day.
Accidents waiting to happen
The combination of:
- the ill-designed food pump which supports user errors
- its badly-thought out accessories which encourage accidents and could lead to seriously damaging your patient
- the giving sets which have features which fall off and could potentially choke a patient, and ones which you are advised not to use
- the terrible customer care, along with the lack of respect for users on the telephone and the lack of respect for the user’s time when waiting for deliveries
all add up to terrible usability and worse user experience. It is bad enough that a user needs a food pump, as that means they are looking after someone who is chronically ill. This is a very stressful situation to be in already without being provided with a terrible piece of equipment and being treated dreadfully by the company who provides it.
Fresenius Kabi and their Applix Smart food pump are extremely lucky that they haven’t done more damage; their insensitivity and terrible designs add to users’ stress levels everyday of the week.
Tags: control, Design, fresenius kabi, function, human-computer interaction, life cycle, usability, user experience