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T. R. Girill
Society for Technical Communication/Lawrence Livermore Nat. Lab. (retired)
[email protected]
Technical Writing: Lessons from Narcan Instructions
Narcan (naloxone hydrochloride) counteracts suspected opioid overdoses.
In the spring of 2023, the U.S. Food and Drug Administration reviewed
narcan for NONprescription use by NONprofessionals. FDA decided that
while the nasal spray was fine, the usage instructions needed
improvement. This case illustrates what young technical writers
can learn about text design from instructions rather than descriptions:
unlike descriptions, instructions directly support reader ACTIONS,
so user missteps with those actions can reveal flaws in the text.
The Smithsonian Magazine succinctly summarized the FDA's review of
narcan use as follows:
Most panel members agreed the nasal spray was safe to
administer without medical supervision. But their concerns
centered around whether people would understand the drug's
instruction label. The experts gave suggestions for
making the directions easier to follow, including
fitting them on a single panel and adding pictograms.
[https://www.smithsonianmag.com/smart-news/opioid-
overdose-treatment-might-soon-be-available-over-the-
counter-180981652 ]
First Concern: Add Pictograms
Instructions often need to contain explicit medical, biological,
or chemical terminology to fully specify the actions a user should
take for success (here, administering narcan quickly to an
unconscious victim). But that can make the text challenging or
confusing for low-literacy or second-language readers. Here, for
example, one step reads 'gently insert the tip of the nozzle into
one nostril until your fingertips on either side of the nozzle
are against the bottom of person's nose.'
Simple line drawings (not photographs, which usually have too
much distracting detail) could quickly clarify these spatial
relationships across diverse language communities. Hence, the
Emergent Devices corporate instruction sheet (www.narcan.com)
for narcan contains six line drawings to supplement the technical
text. But they are both very small (about 1 cm on each edge) and
fairly faint, making their visual details hard to examine without
magnification in strong light, not a likely viewing condition
during an overdose crisis.
New York State's alternative instruction set for narcan offers
14 2-by-3-inch bold-stroke drawings spread across two full pages
(www.health.ny.gov/publications/12028.pdf). This alternative text-
graphics combination is easy to see even under poor lighting or
stressful conditions. But the narcan instructions are now so
long that they spread across two full-size pages, which could
become separated or must be turned over during use if printed
back-to-back. This danger is what prompted the FDA's second
concern.
Second Concern: Fit on a Single Panel
New York's easy-to-see version of narcan instructions is so big that
it invites skipping/skimming to see only the key steps. If printed
on individual sheets, they could split apart, effectively hiding
half the instructions. If printed back-to-back, stressed users
might not read both sides (or even realize that there was a second
side), thus missing half of what they need to know.
Writing for Action
To help promote effective action here, the instruction designer
must balance thoroughness (to support correct actions throughout
narcan administration) and conciseness (to help stressed users
quickly see key steps in the right order). Iterative design--
testing draft versions with people actually trying to administer
narcan in various circumstances--is likely crucial to reveal the
most reliable text/graphics mix and the most robust presentation
format for these instructions.
Instruction drafting thus quickly brings the student writer into
the real world of reader actions, mistakes, and consequences.
Authentic text-usage circumstances are not always friendly, so
anticipating reader problems and compensating by revising the draft
instruction text as needed (with repeat testing) is a key writer
responsibility that students can practice.
[For more on helping students prepare effective instructions, see
http://writeprofessionally.org/techlit/instructions
For more on making technical text generally more helpful, see
http://writeprofessionally.org/techlit/usbility]
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