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Two New Live 510k Webinars – October 14, 2016

On October 14, 2016 I will be be presenting two new live 510k Webinars for the cost of $29.

Two Live 510k Webinars Two New Live 510k Webinars   October 14, 2016

Where to register for live 510k webinars

I hope you can participate in these live webinars, but all my webinars are recorded and you will receive a link to download the recording if you are registered for the live event. Have a great weekend!

Posted in: 510(k)

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Product Launch in 300 Days: 3x 100 Days – Design, 510k and QMS

This article explains the process and major milestones for completing a new medical device product launch in 300 days–including the product design, 510k clearance and quality system implementation.

Device Product Launch in 300 Days Product Launch in 300 Days: 3x 100 Days   Design, 510k and QMS

One of the most valuable pieces of information you can receive is a plan for your medical device product launch. Some companies contact me asking for help implementing their quality system. You should be implementing this step last if you are a start-up company. Some companies contact me asking for help preparing their 510k submission. But you need to seek help much earlier. The best time to contact an expert for help with your product launch is 300 days before you want to actually launch your product.

Three Major Milestones of a Product Launch

There are three major milestones that must be completed before a medical device product launch can proceed. First, you need to complete the design specifications for your device. Second, you need to complete the design verification and validation activities and summarize this testing in a 510k submission or another type of regulatory submission. Third, you need to implement a quality system that meets the requirements of 21 CFR 820 and/or ISO 13485:2016. Each of these three major tasks can be completed in less than 6 months, but with proper planning and motivation all three can be completed sequentially in less than one year for many products. In fact, completing all three milestones in 300 days is possible.

Break Your Product Launch into Phases

Whenever I plan a design project I break the overall product development into chunks that are easily understood, with measurable milestones and I establish a timeline that is aggressive but possible. The design process typically has six phases, but several of these phases are shorter than you really want and the overall process is too long for a single chunk. Therefore, I decided to break the six phases into 3 chunks: 1) product development, 2) verification and validation, and 3) regulatory clearance. The end of the first chunk is marked by a “design freeze” where your team will conduct a design review and approve the final design outputs before you begin verification and validation of your product design. The second chunk is marked by the submission of a 510k or some other regulatory submission. The third chunk is marked by the completion of your quality system and receipt of your 510k clearance letter from the FDA.

How Long Should Each Phase of the Product Launch Be?

In the past I would choose a timeline of approximately 3-4 months for each major phase of product launch. However, I have been learning a lot about goal setting and I now target 100 days for completion of most milestones. The reason is that 100 days is a time period over which most people can maintain their enthusiasm and motivation for completing a goal. If a goal takes longer than 100 days, then you should probably break down the goal into two or more smaller goals. If each of the three major phases of your product launch require 100 days, then you can complete the overall product development and product launch within 300 days. One of the tools I recommend for planning and tracking your progress toward a 100 day goal is: The Freedom Journal.

Product Launch Phase 1 – Your Design Plan

Your design plan should be the first thing you create. In order to create a design plan you will need to identify the regulatory pathway–including all of the testing that is required for verification and validation of your new medical device. This design plan should identify all the design reviews, all the verification and validation testing that is required and the regulatory approval process required prior to product launch.

Product Launch Phase 2 – Preparing Your 510k Submission

Once you have approved your design outputs during the “design freeze,” now you need to complete the verification and validation testing. During this phase you will need to make sure that you have identified all the testing, how many samples will be required for each test and you need to determine which steps of the testing process can be performed in parallel instead of performing tasks in series. For example, you will need to package and sterilize samples that are needed for biocompatibility testing, but electrical safety testing samples can be non-sterile. Therefore, the packaging validation must be completed prior to biocompatibility testing, but the electrical safety and EMC testing can be performed in parallel with both activities. For most products, the biocompatibility testing is one of the last tests that is typically completed, and the longest of these tests typically takes between 8-12 weeks. Therefore, 100 days is probably the fastest you can complete your verification and validation testing. During the entire verification and validation process you should be preparing your 510k submission. This will ensure that the submission is ready when the last test report is received–instead of frantically rushing to complete the submission in just a few weeks at the end of the process.

Product Launch Phase 3 – Implementing Your Quality System

Many companies start their quality system at the beginning of the design process. However, you should only implement two procedures prior to completing your 510k submission: 1) design controls, and 2) risk management. These two procedures are needed to properly document your design history file (DHF), and it is much harder to document your DHF after the design is completed. The balance of the procedures can be implemented in about 100 days, while your 510k submission should take between 90 and 180 days to receive clearance from the FDA. Therefore, you should be able to complete the quality system implementation prior to receipt of your 510k clearance letter.

“Rinse and Repeat” for Your Next Product Launch

Once your have completed your product launch, you should review the post-market surveillance of from your customers during the first 90 days. I like to call this the 100-day review. One-hundred days after the first product launch is the perfect time to conduct your first management review meeting. You should have your first internal audit completed during the first 100 days and you should have a lot of great feedback from customers during the first 90 days of product use. Therefore, top management can review the customer feedback, internal audit results and progress toward other quality objectives in order to identify improvement action items needed. These improvements may be quality system improvements and/or product improvements. One of the outputs of your first management review meeting should also be identification of your next product development.

Posted in: 510(k)

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Implementing Procedures for CAPA, NCMR & Receiving Inspection

The article shares lessons learned from implementing procedures for a new ISO 13485 quality system. This is the second in a series. The first month of procedure implementation was covered in a previous article titled, “How to implement a new ISO 13485 quality system plan in 2016.”

Implementing Procedures Implementing Procedures for CAPA, NCMR & Receiving Inspection

Typically, I recommend implementing a new ISO 13485 quality system over a 6-month period, but recently I a few clients have requested my assistance with implementing a quality management system within 4 months. In November I wrote an article about implementing a new ISO 13485 quality system. That article described implementing procedures for the first month. Specifically, the implementation of the following procedures was covered:

  1. SYS-027, Purchasing
  2. SYS-001, Document Control
  3. SYS-002, Record & Data Control
  4. SYS-004, Training & Competency
  5. SYS-011, Supplier Quality Management
  6. SYS-008, Product Development
  7. SYS-010, Risk Management
  8. SYS-006, Change Control

These 8 procedures are typically needed first. This article covers implementation of the next set of procedures. During this month, I recommend conducting company-wide quality management system training for the ISO 13485 and 21 CFR 820.

Implementing Receiving Inspection Procedures

During the first month procedures for purchasing components and services are implemented. As these products are shipped and received by your company, you need to create records of incoming inspection. It is not sufficient to merely have a log for receiving inspection. You need records of the results of inspection. You may outsource the inspection activities, but receiving personnel must review the records of inspection for accuracy and completeness prior to moving product to your storage warehouse or production areas. Even if inspection is 100% outsourced, it is still recommended to periodically verify the inspection results independently on a sampling basis. This is should be a risk-based sampling that takes into account the importance of the item being inspected and the existence of in-process and final inspection activities that will identify potential nonconformities.

The most difficult part of this process typically is identifying inspection procedures and calibrated devices for inspection. Your company must find a balance between inspections performed by suppliers, incoming inspection, in-process inspection and final inspection. Each of these process controls requires time and resources, but implementation should be risk based and take into account the effectiveness of each 

inspection process–as determined by process validation. Sample sizes for inspection should also be risk-based.

Implementing Procedures for Identification and Traceability

The lot or serial number of components must be identified throughout product realization–including incoming inspection, storage, production, final inspection and shipping. In addition to identifying what things are, you must also identify the status of each item throughout the product realization process. For example:

  • Is product to be inspected or already inspected?
  • After inspection is product accepted or rejected?
  • Which production processes have been completed?
  • Is product released for final shipment?

The procedure for identification and traceability should be implemented immediately after the purchasing process, implemented during 1st month, because traceability requirements should be communicated to suppliers as part of supplier quality agreements and as part of each purchase order.

Initially when this process is implemented there is a tendency to complete forms for every step of the process and to distribute copies of the forms to communicate status. Completing forms and copying paperwork requires labor and adds no value. Therefore, learn manufacturing methods and visual indicators such as color coding are recommended as best practices for identifying product and its status.

Implementing CAPA Procedures

When product is identified as nonconforming, corrective actions need to be implemented to prevent recurrence. Procedures need to include the requirement for planning corrective actions, containing product that is nonconforming, correcting nonconformities and implementing actions to prevent any future nonconformities. These procedures also need to address negative trends to prevent nonconformities before product is out of specification (i.e., preventive actions). Procedures also need to provide guidelines for how to verify effectiveness of corrective and preventive actions. Initially the actions implemented will be specific to purchased product that is received and rejected. However, over time data analysis of process monitoring and internal auditing will identify additional corrective and preventive actions that are needed.

The effectiveness of CAPA processes in general requires three key elements:

  1. A well-designed CAPA form
  2. Proper training on root cause analysis
  3. Performing effectiveness checks

In the CAPA training provided during the second month, the best practices for CAPA form design are covered. The training includes several methods for root causes analysis too. Finally, the training emphasizes using quantitative measurements to verify effectiveness of corrective actions. In fact, it is recommended to identify the quantitative acceptance criteria for an effective corrective action prior to initiating actions in order to ensure that the actions planned are sufficient to prevent recurrence.

Monitoring Your Procedure Implementation Process

As indicated in November’s article, I recommend using quantitative metrics to track progress of procedure implementation. For example:

  1. % of procedures implemented,
  2. duration of document review and approval process, and
  3. % of required training completed.

Implementing Procedures for ISO 13485:2016

If you already have a quality system in place a you are implementing procedures that are modified for ISO 13485:2016 compliance, some of the same lessons learned apply. If you are interested in learning more about the changes required for compliance with the 2016 version of the standard, we recorded two live webinars on March 24, 2016.

Posted in: ISO 13485:201x

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ecopy: Hidden System Files Created by Windows 10 Update

This article explains how to fix a 510k submission ecopy on a USB flash drive–including how to debug problems created by the most recent Microsoft Windows 10 Update.

ecopy replacement for 510k submission 1024x422 ecopy: Hidden System Files Created by Windows 10 Update

The above picture is a USB flash drive with a replacement ecopy for a recent 510k submission I worked on. A couple of weeks ago, one of these little USB flash drives and the Microsoft Corporation conspired to create one of the most creative riddles I have ever solved in my entire life.

How do you delete a file you can see?

Not just any old hidden file, but a hidden system file called: “IndexerVolumeGuid.”

ecopy with System Volume Information Folder

IndexerVolumeGuid is a special system file that was on my brand new USB flash drive in the System Volume Information Folder. This file keeps an index of the files in the System Volume Information Folder. Your computer can use that index to recover accidentally deleted information. Normally this is a useful and desirable feature, but I purchased my brand new USB flash drive to send an ecopy 510k submission to the FDA Document Center. Unfortunately, the FDA Document Center can not accept system files. The problem was that I couldn’t see the files, because they are hidden.

How can you delete a file you can’t see?

I had a software problem, and the process used to fix software problems is called debugging.

Debugging Windows Software Updates

There is a specific position that you should be in when you are trying to debug a software problem. First, you need to be sitting down and hunched over your computer. Second you need to rest your forehead in your hand, sigh heavily and maybe even moan softly from time to time. Personally I prefer to curse the genius programmers at Microsoft and repeat my mantra of “I can’t believe this. It’s ridiculous.” You really know you are concentrating properly if the vein in your forehead is throbbing so much that other people can see it throbbing through your hand.

The most valuable tool for debugging software problems with Windows is Windows Help. It’s an on-line manual that has the answers to every conceivable question you can ask about Windows. The only time it’s really failed to be helpful is when I’m trying to connect to the internet. The “on-line” nature of Windows Help limits its usefulness in solving problems with internet connections for some reason.

Finding Hidden System Files

I typed into Windows Help, “Show hidden system files.” After a 10 minutes of reading I learned that the default setting for Windows Explorer is to hide system files, and bad things can happen if you unhide those files. I also learned that you can change the default setting by entering the Windows Control Panel, and then clicking on “Appearance and Personalization.” Finally, you click on “File Explorer Options,” click on “View” and then scroll through about 50 possible configuration options until you see the setting for “Hide Protected Operating System Files.” Then you deselect this option–despite the recommendation to keep these files hidden.

Finding the Control Panel

Next I typed into Windows Help, “How to find Windows Control Panel.” After another 10 minutes of reading I learned about a secret key stroke that pulls up a secret, black menu (Windows Key + “X” Key). On that menu is the Windows Control Panel. Of course there are about 20 different ways to reach the Windows Control Panel, but this secret key stroke is by far the coolest method.

I followed the instructions from Windows Help and finally I could see the hidden system folder, but I couldn’t delete it.

Next I tried formatting the USB drive. That worked, until I pulled the USB drive out and inserted it again. Windows has a cool new feature that automatically creates a hidden system folder on your USB drive–even if you don’t want one.

Disable Removable Drive Indexing

Windows Help again to the rescue. I learned that I needed to disable the removable drive indexing feature. In order to do that I needed to use Group Policy Editor, which I didn’t have. Windows Help told me that I could use the Windows Registry Editor or “regedit” program instead if I was unfortunate enough to be using something other than Windows XP. Next Windows Help instructed me to open a folder called Windows Search. Windows Search was a folder found 7-levels deep in the registry of the computer, but it seemed to be missing from my computer. Again, Windows Help instructed me on how to create a Windows Search Folder and add a file called “DisableRemovableDriveIndexing”. Then I only needed to change the settings from a “0” to a “1” and reboot my computer.

Finally, 2 hours later my USB drive no longer had a hidden system file on it and my computer would no longer create one automatically–until the next Windows update, which occurred a week later.

Other Resources

Last week I recorded a live webinar on “510k Lessons Learned.” If you are interested in specific guidance related to ecopy, you can also review the following FDA guidance documents:

  • ecopy Guidance – FDA Guidance document revised 12/3/2015; ecopy Program for Medical Device Submissions
  • ecopies Validation Module (a voluntary tool that verifies the format of an ecopy you have already developed on your local drive)

Posted in: 510(k)

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FDA Guidance Documents Released Recently

Article reviews FDA guidance documents released in the past few months including the new Final FDA guidance on biocompatibility released June 16.

ODE Final Guidance Documents FDA Guidance Documents Released Recently

For anyone that is responsible for monitoring new and revised regulatory requirements, the FDA guidance documents are something you probably check at least once every month. If you are not familiar with these FDA resources, here are the links for two of the medical device FDA guidance documents webpages:

New Final FDA Guidance Documents

The last time I reviewed an FDA guidance document was in February for the new guidance document from the FDA related to usability engineering and human factors engineering. There was a new final FDA guidance document released by the office of device evaluation on June 16: “Use of ISO 10993-1“.This biocompatibility guidance was expected for release in December, but the release was delayed.

Use of ISO 10993-1

The new biocompatibility guidance that was published last month provides specific guidance about the application of certain tests required for demonstrating biocompatibility. For example, test article preparation and risk assessments for the applicability of specific tests is addressed. A revised test matrix is included in the guidance document. Special considerations are provided for each of the following biocompatiblity tests:

  • cytotoxicity,
  • sensitization,
  • hemocompatibility,
  • pyrogenicity,
  • implantation,
  • genotoxicity,
  • carcinogenicity,
  • reproductive and developmental toxicity, and
  • degradation assessments

New Final Rule for Symbology

In addition to FDA guidance documents, the FDA also released a final rule on symbology that will modify 21 CFR Parts 600, 801 and 809. The FDA is finally changing its position on acceptance of harmonized symbols in lieu of English text. The FDA is accepting ISO 15223-1 as a recognized standard and allowing manufacturers to use the symbols instead of English text in order to facilitate global harmonization of labeling. The FDA is only allowing the use of Rx-Only as to indicate that a product is prescription only. The guidance even defines the acceptable process for creating new product-specific pictograms. The effective date of the new final rule will be September 13, 2016. 

New Draft FDA Guidance Documents

In addition to final FDA guidance documents, there have been several new draft guidance documents that were released recently:

  1. List of Highest Priority Devices for Human Factors Review
  2. Public Notification of Emerging Postmarket Medical Device Signals (“Emerging Signals”)
  3. Characterization of UHMWPE for Orthopedic Devices
  4. Technical Considerations for Devices for Additive Manufacturing

The second two FDA guidance documents focus on materials that are important for orthopedic manufacturers, because UHMWPE is used as a wear surface for join implants and many of the implants and instruments are now being manufactured using additive manufacturing instead of forging, casting or milling bar stock.

How to keep up on FDA Regulation Changes

If you are interested in keeping up on new and revised regulations from the FDA, I wrote a blog explaining 4 ways to to identify new and updated FDA regulations. The blog identifies FDA webpages for the following 4 types of updates:

  1. Guidance Documents
  2. Recognized Consensus Standards
  3. Device Classifications
  4. Total Product Lifecycle (TPLC) Database

The ISO 15223-1 standard for medical device symbols has been released for several years, but it was not recognized by the FDA until June 14, 2016. The recognition of the Standard is part of the implementation process for the new final rule regarding the use of symbology for medical device labeling. The timing of this new final rule coincides with implementation of UDI labeling requirements for Class II devices. In addition, the new European Medical Device Regulations now specify labeling requirements for the primary sterile packaging as part of Essential Requirement (ER) 19.2:

  • (a) an indication permitting the sterile packaging to be recognized as such,
  • (b) a declaration that the device is in a sterile condition,
  • (c) the method of sterilization,
  • (d) the name and address  of the manufacturer,
  • (e) a description of the device,
  • (f) if the device is intended for clinical investigations, the words: ‘exclusively for clinical investigations’,
  • (g) if the device is custom-made, the words ‘custom-made device’,
  • (h) the month and year of manufacture,
  • (i) an indication of the time limit for using or implanting the device safely,
  • (j) an instruction to check the Instructions For Use for what to do if the sterile packaging is damaged etc.

These new requirements will require many manufacturers to redesign labeling for sterile packaging and the ability to use symbology will assist in creating globally harmonized labeling.

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FDA 483 Inspection Observations Pareto Chart for FY 2015 Data

This article presents a Pareto Analysis of FDA 483 inspection observations from FY 2015 and compares the trends observed with a similar Pareto analysis that was performed a couple of years ago on FY 2013 data.

FY 2015 Pareto Analysis of FDA 483s FDA 483 Inspection Observations Pareto Chart for FY 2015 Data

Method of Data Analysis for FDA 483 Inspection Observations

The FDA posts Excel spreadsheets on it’s website in order to download data for FDA 483 Inspection Observations. These spreadsheets include inspection results for all the divisions of the FDA. In order to perform a data analysis for FY 2015 results, I deleted the sheets that were not specific to medical device manufacturer inspections (i.e., only used data from CDRH). I sorted the data by the regulation that was referenced. For example, all the sub-clauses for 21 CFR 803 were combined into one category for the Pareto analysis. The combined categories were then sorted from the most frequent 483 inspection observation to the least frequent 483 inspection observation. The data was then added to the graph that I produced in February 2014 using FY 2013 results as a second data set. The resulting graph is shown above.

Comparison of FDA 483 Inspection Observations between FY 2013 and FY 2015

For MDR Compliance (i.e., 21 CFR 803), there was a slight increase in the number of 483 observations issued from FY 2013 to FY 2015. However, the difference was only a 1% increase from 6.2% to 7.2% of the total number of 483s issued. There was an even smaller increase in the number of findings related to purchasing controls (i.e., 5.6% increased to 6.1%). I noticed a slight drop in the number of findings related to design controls, CAPA and complaint handling. However, the overall trend for FY 2013 and FY 2015 is essentially the same.

There are two other categories where an increase was observed: 1) process validation increased by 0.7% from 4.8% to 5.5%; and 2) control of nonconforming product increased 0.8% from 4.3% to 5.1%. These areas are important. Control of nonconforming product is one of the major sources of CAPAs and often results in design changes. Therefore, FDA inspectors are reviewing your data for nonconforming product during inspections  in order to help them identify potential CAPAs and design changes that may have been made. The typical sequence is: 1) nonconformity, 2) investigate nonconformity as part of a CAPA, and 3) initiate a design change as a corrective action.

Process validation is a completely different area that is separate from CAPA, complaint handling and MDRs. However, inadequate process validation is a common root cause for nonconformities. Therefore, inspectors often follow an audit trail from a nonconforming product record back to a process change that was implemented but inadequately validated. Therefore, an increased focus on nonconformities may be the reason for an increase in FDA 483 inspection observations related to process validation.

So what’s the big deal?

This proves that the FDA inspectors continue to be predictable. The “playbook” for FDA inspections is the QSIT Manual. It hasn’t changed since 1996. Yet, companies continue to be shocked and amazed by FDA inspectors.

Additional Resources

If you want to learn how to prepare for FDA inspections, I recorded a webinar you can download (FREE). I recorded the webinar in May of 2014, but it’s been a couple of years and I’ve learned a few new tricks. Therefore, I’m going to re-record the webinar and update it for lessons learned. I’ll even share a few tools and approaches to avoid findings and reduce the risk of warning letters. I’m even evaluating a new application that is designed for teams to have private chats and file sharing during an inspection. Stay tuned to my webinars page and I’ll post that webinar soon. Maybe I’ll record something from Germany next month.

Until then, I am working on an webinar specific to medical device reporting. Many companies have still not updated their MDR procedures to reflect the eMDR process using electronic submissions gateways. Therefore, I’m releasing an updated procedure for MDRs and I am offering a webinar bundle to train people how to comply with 21 CFR 803 and the procedure. You might also be interested in my previous webinar specific to control of nonconforming product.

Posted in: FDA

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Finally, New European Medical Device Regulations are Confirmed!

This article announces confirmation of the New European Medical Device Regulations by negotiators of the Dutch presidency of the Council and EU Parliament.

Confirmed Finally, New European Medical Device Regulations are Confirmed!

Announcement of New European Medical Device Regulations

Yesterday, May 25, the European Parliament and the Dutch presidency of the Council reached an agreement and it was announced in press release.

The agreement is subject to confirmation by permanent members of the Council and Parliament’s Envi Committee. The new regulations include the following substantial changes:

  • A scrutiny process for high risk (i.e., Class IIb implants and Class III) products
  • Eudamed database will be expanded to provide public access to information about Notified Bodies, Economic Operators (i.e. – manufacturers, importers, distributors, authorized representatives, etc.) and comprehensive product information
  • Eudamed database will become publicly accessible for searching market surveillance and vigilance data (similar to the FDA’s MAUDE database)
  • Implementation of a Unique Device Identifier (UDI) requirement in Europe.

The Eudamed database will be an invaluable global resource for manufacturers, physician and patients.

Next Steps for New European Medical Device Regulations

The next step in the process of approving the new regulations is an invitation of the Council’s Permanent Representatives Committee and the Parliament’s ENVI Committee to endorse the agreement. The regulations will finally be adopted by the Council and the Parliament after Committee approvals and we can expect implementation of the regulations this fall. The new regulations will have a three year transition after publication for medical devices and a five year  transition for in vitro diagnostic medical devices.

MedTech Summit June 13-17

On June 13 I will be in Brussels at the MedTech Summit hosted by Informa Life Science. There will be 300+ attendees with a fantastic assembly of industry experts representing the Competent Authorities, Notified Bodies and manufacturers. This meeting provides a unique opportunity to learn and discuss the details of the New European Medical Device Regulations and the challenges we will all face in the preparation for the transition to the New European Medical Device Regulations. I will have the pleasure of speaking about risk management and its integration with device design, post-market surveillance and labeling. I will also be Chairperson for the Labeling Stream in June 16.

Please stay tuned to my blog feed. I will be posting related blogs over the next month.

Register for the MedTech Summit

Click on the blue text above to register or you can also call Informa Life Sciences at: +44 (0) 20 7017 7481 or registrations@informa-ls.com.

New Live Webinar on MDRs June 9, 2016

I’m releasing an updated procedure for MDRs and I am offering webinar bundle to train people how to comply with 21 CFR 803 and the procedure. The webinar is scheduled for June 9. I’m even offering two times to accommodate companies in Europe as well as the USA.

Here’s a link for the webinars page.

Posted in: CE Marking

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Time management to prevent work overload: Top 10 ideas

This article lists my top 10 ideas for time management to help prevent work overload–including suggestions for apps and other resources.

Handling Work Overload 1 Time management to prevent work overload: Top 10 ideas

I am a workaholic and I don’t recommend it–unless overweight, out of shape, friendless and divorce sounds like a great life plan. I work with regulatory affairs and quality assurance managers at every client, and 100% of them have insufficient resources. Expectations internally and externally never decrease. The saying used to be, “Do more with less.” Now it feels like we have one egg, one basket and we are expected to save the world.

Stop feeling sorry for yourself. Every department manager feels this pressure. If you don’t believe me, look around you. Everyone is popping 400mg of ibuprofen and stressed to their limit.

So what can you do to make things better?

That question is critical. It shows that internally you acknowledge that you can do something to make things better. I obviously don’t have all the answers, but I have found some tools in the past year that really made a magnificent difference in helping me with time management. 100% of these ideas were suggested by others that appear to be more at peace and happier than I was last year.

#1 Get some sleep

Two years ago I woke up after 3-4 hours of sleep every night. Last year I was almost up to 6 hours of sleep on a good night. Now I am consistently getting 6-8 hours of sleep, and once I slept for 9 hours. There are lots of suggestions for how to get more sleep, and I’ve tried them all. What works for me is: 1) no alcohol or coffee within 4 hours of bedtime, 2) melatonin just before bed, 3) exercise every day, 4) eating well, and 5) a habit of reading each night to calm myself and relax. I also use a white noise app on my phone.

#2 Budget your time management

You will never get everything done. It’s a fact. Just like money, you can always spend more. Instead, decide how much of your life you want to spend doing things. Don’t micromanage your time. Think of the big picture. There are 168 hours in a week, and >42 hours should be spent sleeping. 40-50 hours a week will be spent working. 5-10 hours per week will be spent getting to work. More than two-thirds of your life is spent sleeping and work-related–if you’re not a workaholic. Be very selfish of how you budget the remaining third of your life. I like to re-read habit #3 from Steven Covey’s book “7-Habits of Highly Effective People.” It will help you remember what’s important. Your priorities should be physical health, mental health and your family. If you devote an hour a day to each of those, you might have time left for eating, grooming and reading a book. Yes, you need vacations too!

#3 Minimize multitasking

Some people believe time management is managing multiple tasks at once, but it is actually less efficient to multitask. Picking something up, putting it down, picking it up again…didn’t you learn from your lean manufacturing training that motion, waiting and queue are all muda (i.e., waste). You need to start a task, finish that task and then start the next task. If you want more advice on this topic, try reading “Getting things done” by David Allen. This one was recommended to me by an uber-productive orthopaedic surgeon.

#4 Don’t forget to “sharpen the saw”

This is the seventh habit from Covey’s book. You should never stop improving. For example, entrepreneurs need to learn marketing. I don’t have time for an executive MBA to learn marketing. Instead, I teach myself every day while I’m working out. I have a bicycle on a trainer set-up in front of my TV. The TV is only connected to the internet. If I need a break, I watch Netflix while cycling. However, usually I’m listening to podcasts, watching YouTube videos about marketing and software tools or I’m reading books on my Kindle. I also purchase a lot of audiobooks that I listen to in the car while driving my children to rock climbing, soccer, plays and during my two-hour ride to and from the nearest airport. This is the only kind of multitasking I’m good at.

#5 Just say no.

You need to put first things first (i.e., habit #3). On a scale of 0-10, how important is it. Is it important to you, your boss, your spouse, your children or your best friend. If not, why are you wasting your precious time on it. Say no. If it’s a 9 or 10 to your spouse, say yes–even if it’s a 2 on your scale. If you have a time conflict with two items that are high on the scale, then you need to find a win-win (i.e., habit #4). This is why communication skills and empathic listening (i.e., habit #5) are the most important skills you will ever learn.

#6 Don’t read your emails “real-time”

You should have a plan for what you are going to do each day. Reading your emails throughout the day will result in reactive behavior that will always result in time management failure. Be proactive (i.e., habit #1). Read your emails just before lunch in a batch and just before you go home in a batch. You should also read “Getting things done” by David Allen. He has fantastic advice for how to process emails. This is an area I’m still working on, but I get 400+ emails a day and that doesn’t include spam, social media or promotions. You should also tell people you work with, “Call me or text me if it’s important.” Good advice for any client of mine. For example, you should probably text me if the FDA is coming on Monday and you need my help.

#7 Use productivity apps for time management

Microsoft seems to have a strangle hold on corporate America, but Outlook is a horrible tool for managing your tasks and time. You need something for personal time and personal tasks, because you have less time available for the things that are more important in your life (i.e., health, family and friends). If I empty the milk carton, I grab my phone and add milk to my “Out of Milk” app. I also use this app for planning what I need for trips, meetings and Christmas present ideas for the kids. Evernote is an uber-app. It organizes everything. Website links, blog ideas, business cards, photos, an address, directions, photos of the person I’m meeting and I use it for lists too (if I already have it open instead of Out of Milk). If you want to know how the most productive people in the world use apps like Evernote, John Lee Dumas includes apps like Evernote in every entrepreneur interview he does–1,303 podcasts and counting.

#8 Block off time to get work done

Some people believe that time management only involves scheduling meetings. You schedule weekly meetings with your boss. You schedule lunch meetings. You should also block off some time for getting work done–without interruptions. You might try blocking off every day from 11:30-Noon for emails, Noon-1pm for a lunch and a walk and 4:30-5pm for emails. If you need to review complaints each day for the need to report as an adverse event, block off some time for that each day. My advice would be to devote time to reviewing CAPAs, complaints and MDRs every day. These are the most critical areas for FDA inspections and you can’t afford to let these tasks fall behind. If you have these tasks assigned to you, then you work on the most urgent task and get it done. Then you schedule the next step for that CAPA, complaint or MDR and go onto the next task you scheduled. If you manage these processes, then you should block off time for reviewing metrics and investigate the exceptions. If it seems like you never have enough time in your schedule for all the tasks, maybe you need to delegate some of those tasks to other departments or people in your department.

#9 Schedule shorter meetings

Not all meetings deserve 1 hour. Some things can be done in 15 minutes, 30 minutes or 45 minutes. Learn about good meeting etiquette, make an agenda and manage the meeting so it’s done on-time or early. Make sure you show up on-time and get it done on-time or early. If people leading meetings are poor at time management, do not let them lead the meeting.

#10 Schedule breaks too

Outlook will allow you to schedule back-to-back meetings from 7am to 7pm (or longer). That doesn’t mean that you should, and that is definitely not good time management. Time management needs to create windows of time where you can rest too. I drive a lot. In order to survive 50,000 miles of driving a year with a congenital spine defect (i.e., L5 fused to pelvis one one side), I need to take breaks and stretch. When I don’t do this I pay dearly. The same thing happens to me when I try to work 12 hours straight without a break. You will be more focused and productive if you take a break once and while.

Posted in: Education

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Special Controls Guidance Document – Content and Format

This article explains the content and format of a special controls guidance document issued for Class 2 medical devices regulated by the CDRH division of the US FDA.

Searching Guidance Documents Special Controls Guidance Document   Content and Format

There are many differences between Class 1 and Class 2 medical devices regulated by the FDA, but one of the primary differences is that many (not all) Class 2 medical devices have a special controls guidance document. Class 1 devices only have “general controls.” These “special” guidance documents can be found on the FDA website by searching the guidance document database. The title of each guidance document typically begins with “Class II Special Controls Guidance Document.” The middle of each title specifies the device type, and the end of the title states, “- Guidance for Industry and FDA Staff.” However, there are many exceptions.

Status of a Special Controls Guidance Document

A guidance document may be a final guidance or a draft guidance. Only the final guidance is considered official, however, draft guidance often indicate what the FDAs current thinking is on a topic. Draft guidance documents sometimes take years before they are approved as a final guidance. Sometimes the draft is so controversial that it will even be withdrawn. The FDA also publishes a list each year of planned guidance documents for the next fiscal year. Some of the final versions of special controls guidance documents were written in the 1990’s, but these documents remain the current final guidance until a new final guidance is approved. Often there is no urgent need to update a guidance document, because there are one or more active ISO Standards specific to the product classification and the standard(s) is recognized by the FDA.

Outline of a Recent Special Controls Guidance Document

Here is the general outline that is currently being used by the FDA for a special control guidance document for Class 2 devices:

  1. Introduction
  2. Topic – Background
  3. Pre-Market Notification – Background
  4. Scope
  5. Risks to Health
  6. Specific Device Description Requirements
  7. Performance Studies
  8. Device Specific Labeling
  9. References

Each product classification has the potential for slightly different requirements due to the differences in types of devices. For example, in vitro diagnostic products do not have animal studies and typically have human clinical study requirements for the performance section of the guidance document. However, an implant is more likely to have details about the materials of construction, biocompatibility and sterilization.

Searching the Guidance Database

There are 8 fields that are searchable for the guidance database.

  1. Product
  2. Date Issued
  3. FDA Organization
  4. Document Type
  5. Subject
  6. Draft or Final
  7. Open for Comment
  8. Comment Closing Date on Draft

For a De Novo application, I sometimes need to create a proposed draft special controls guidance. For this activity, I prefer to find a representative template. In order to do this, I will typically use four of these search fields. First, I narrow the product field to “medical devices” and the FDA organization to “CDRH.” Second, I select “guidance documents” for the document type. Finally, I select “premarket” for the subject and “final.” This narrows the list to 374 documents. Not all of the 374 documents are specific to a product classification, because some of these documents cover more general premarket issues such as risks of wireless telemetry.

You can further narrow your search by adding a word or words to the keyword search field. Therefore, if you are looking for a specific guidance you can find it very quickly.

Format of Special Controls Guidance Documents

If you submit a proposed draft guidance to the FDA (anyone can do this), there is no specific required format. However, I recommend copying the most recent format used by the FDA in order to minimize the amount of work required by the FDA for modifying the guidance prior to publishing your guidance as a draft. You also do not need to include all the sections of a guidance. Some of the guidance documents only update certain sections where technological characteristics have recently changed significantly. Most importantly, if you have a strong reason for deviating from what the FDA has always done–do it. The format of guidance documents has changed since the 90’s and will continue to do so.

Additional Resources

If you are preparing a premarket notification (i.e., 510k submission), you might have more questions than just guidance document availability. You might be interested in purchasing “How to Prepare Your 510k in 100 Days” or the on-line 510k Course or one of our Live 510k Workshops.

Posted in: 510(k)

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Minimum Data Points Constituting a Trend Is 3?

This article explains why three is never the right answer, and this article explains why asking how many minimum data points are needed to identify a trend is the wrong question.

Minimum Data Points for CAPA Minimum Data Points Constituting a Trend Is 3?

Recently a client sent me an email asking the same question about data analysis in two different ways. The first question asked, “How many of the same situation need to occur before it is considered a trend?” The second question asked, “How many nonconformities can occur before a CAPA should be opened?” This question can be asked a hundred different ways, but it’s the wrong question.

Minimum Data Points for Variable Data

In the graph above we have variable data rather than attribute data. When you have variable data, the answer regarding the number of minimum data points is always a quantitative answer that is objective rather than subjective. Typically the new data point lies outside of the upper or lower specification for the element being measured (i.e., >6.6 or <6.1 in the graph above). Even if the new data point remains within specifications, a CAPA may still be issued if the new data indicates that there has been a shift in the normal distribution of data.

In our graph above, on March 13 the newest data point was 6.37. Although this value is within specifications, in fact close to the center of the range, this value represented a shift in the trend that exceeded the normal distribution of data observed for the previous 12 days of the month.  The mean for the first 12 days was 6.54 and the standard deviation was 0.0250. Many people establish alert limits that equal mean +/- 2x standard deviation (i.e., 6.59 and 6.49) and the action limit is often set equal to the mean +/- 3x standard deviation (i.e., 6.62 and 6.47). Therefore, a value of 6.37 is well outside the normal distribution for the first 12 days of the month–but not outside specifications.

The shift in data values for this graph indicates a shift, but the process was capable of remaining within specifications before the shift and process capability actually appears to be slightly better after the shift. In this case, there is no need for a CAPA but if the reason for the shift is unknown an investigation would be recommended. However, if different lower specification were chosen (e.g., 6.4) then the new data point on March 13 would be outside the specification and product would be identified as nonconforming.

Nonconforming results should always trigger in an investigation?

If the process was validated and the mean +/- 2x standard deviations remains within the specifications, then greater than 95% of the product should be conforming. If the the mean +/- 3x standard deviations remains within the specifications, then greater than 99.5% of the product should be conforming. Therefore, based upon the data from the first 12 days of March any data points that are lower than 6.47 should be very rare unless there is a process shift.

An investigation of the data point on March 13 should result in a CAPA unless the outlying data can be explained and a new trend with a lower mean is expected. If the new data point cannot be explained, then only one new data point is needed and the data does not even need to be nonconforming. If no actions are taken the drop in the measured value could continue and nonconforming product could result, while any action taken on March 13 is a preventive action.

Minimum Data Points for Attribute Data

In the case of the first question, the negative customer situation that is reported to a company may be an attribute rather than variable data. For example, “customer unsubscribed” after an email blast went out is a negative customer situation. If you know the % of customers that unsubscribed when email blasts go out, then you have variable data. If you only know that one person unsubscribed, then you only have an attribute (i.e., unsubscribed instead of continued subscription). The first time an unsubscription occurs, you should do an investigation to see if there is an issue other than frequent email blasts that exceed a customer’s expectations in frequency. The action taken could be to establish an alert and action limit for unsubscribed emails based upon industry norms or the % calculated from the first event.

What are the right questions?

Instead of asking how many minimum data points are needed to initiate a CAPA, we should make sure we are measuring the right variables. The % of unsubscribed is a valuable variable data point, but knowing that one person unsubscribed without knowing how many people received that email blast is not nearly as helpful in making future decisions. Another question is to ask, “Why did the person unsubscribe?” If the reason is unknown, you may want to contact the former subscriber and ask them–but probably not by email. If you have a theory why people are unsubscribing you can also perform an experiment to test your hypothesis. If you think the cause is that emails are being sent too frequently, then you can split your list and send the same emails to two halves of a list at different frequencies. If you are correct, then the list that has more frequent emails should also have a higher % of unsubscribers. This type of design of experiment (DOE) is one of the root cause investigation tools I recommend in my Risk-Based CAPA webinar.

Recommendations for Trend Analysis

Whenever you establish a new metric or quality objective, you should also establish a limit for when you intend to investigate and when you intend to take preventive or corrective actions. If you simply start measuring a variable or attribute, you may have difficulty recommending actions to management during your next management review and explaining why actions were not taken during an FDA inspection or an audit.

Additional Related Reading
If you are interested in reading more about how this might be applied to inspection results, please read my blog titled, “21 CFR 820.80: 3 Ways to Record Inspection Results.”

Posted in: CAPA

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