This position statement is a cohesive document that is NOT to be quoted in part or excerpted. If you are from a CCG or Hospital Trust and wish to discuss it, please contact INPUT. It is crafted with the intention of ensuring equity of access to therapy for all people using insulin pump therapy, regardless of pump warranty status.
INPUT’s position statement
INPUT does not see any problem in a patient continuing to use an out-of-warranty pump which is still working correctly as long as paperwork is in place to replace the pump immediately at the first sign of a problem. Note:
- If the out-of-warranty pump is in any way damaged or not working right, patients should report it to the company right away (as well as the DSN) because it must be replaced. In particular patients should look out for
- cracks around the battery compartment or the reservoir
- sticky buttons
- displays that may not show all the information
It may be a surprise how many patients are tolerating a faulty product because of misperceptions about the warranty and terms of replacement.
Many patients we have met think a hairline crack (which would compromise watertightness) or a sticky or unresponsive button or even a broken-off bit (due to wear-and-tear) is nothing to mention. They don’t understand that these are faults with the product that mean it needs to be replaced. Instead they fear that if they mention the product fault, they will be held responsible and made to pay the full price of a new pump.
Many patients also think that if they got a replacement pump under warranty, the clock on the warranty restarts and they will be stuck with the same make/model for an additional 4 years, rather than the warranty of the original pump being the one that expires at the 4-year mark.
INPUT proposes that:
- Healthcare providers should provide written information at the outset about what to do if there is a pump fault, and how the warranty works: when 4 years starts, what happens if there is a fault, etc.
- Care providers explain that the pump companies have 24 -hour helplines to provide technical support in case there is a problem with the pump, but clarify that this resource cannot be relied upon to provide advice on diabetes management. These helplines should be the immediate point of contact for a pump fault (rather than the patient thinking they have to wait until their next scheduled pump clinic appointment to mention a problem)
- Care providers ask the patient at each appointment if the pump is working as new or not (sometimes faults with battery power level indicators are intermittent, for example, and the care provider wouldn’t be able to determine by looking at someone’s pump whether the battery indicator works. Also, sometimes the pump can start making a louder or different noise during the rewinding process, which the patient or carer would detect only during a refill).
- If clinical needs have changed, healthcare providers should make a case to the commissioners for early upgrade if medically required. For example,
- if someone’s vision or dexterity has changed and they can’t safely use their current pump because they can’t see it or program it right, but another make/model would be more appropriate, the diabetes clinic team should make that case to the commissioners.
- Or if there is a new feature on a pump that wasn’t available when the patient got their pump and the diabetes team believes the patient will benefit clinically from the new feature, they can make that case to the commissioners.
2. The diabetes care team should check with each pump company they deal with regarding what support is available out of warranty. They should share this information with each patient as the patient’s pump warranty approaches expiry. If a pump breaks out-of-warranty, there should be a procedure in place for the patient to safely revert to MDI with support, and for a new pump to be ordered expediently. This will reassure the patient that they will not be stranded for months using MDI because their pump broke out-of-warranty (a very common fear among patients)
If the patient is going on an extended or far-away holiday for which a loaner pump would be most appropriate, the patient and/or healthcare provider can approach the pump company or directly provide a loaner pump to use for this purpose. (a pump patient ending up in hospital in a foreign country because their Plan B with MDI didn’t meet their needs after a pump failed on holiday and they did not have a loan pump is an undesirable outcome all around).
3. Diabetes care teams should put in place a policy that a replacement for a pump that breaks out-of-warranty will be ordered within 2 working days of the clinic being notified by the patient of the fault, and ensure clinics give each patient a copy of this policy.
‘Going back’ (the language patients use) to MDI can be very disruptive to patients’ diabetes control and quality of life. Even the prospect of reverting to injections for longer than a couple of days can cause emotional distress for patients who have benefited from pump therapy.
INPUT suggests that patients who receive letters saying their pump will not be replaced should request a letter (on clinic stationery) from their diabetes care team assuring them that the clinic will put in the paperwork for a replacement pump within 2 working days of the patient reporting to the clinic the failure an out-of-warranty pump. This would empower the patient with a piece of evidence if there were a delay in the order process and establish the clinical team’s accountability for ensuring continuation of therapy.