CAPA for the FDA Regulated Industry

CAPA for the FDA-Regulated Industry

Also available from ASQ Quality Press: The FDA and Worldwide Quality System Requirements Guidebook for Medical Devices, Second Edition Amiram Daniel and Ed Kimmelman Development of FDA-Regulated Medical Products: Prescription Drugs, Biologics and Medical Devices Elaine Whitmore Safe and Sound Software: Creating an Efficient and Effective Quality System for Software Medical Device Organizations Thomas H. Faris Root Cause Analysis: Simplified Tools and Techniques, Second Edition Bjørn Andersen and Tom Fagerhaug Mastering and Managing the FDA Maze: Medical Device Overview Gordon Harnack Root Cause Analysis: The Core of Problem Solving and Corrective Action Duke Okes Get It Right: A Guide to Strategic Quality Systems Ken Imler The Internal Auditing Pocket Guide: Preparing, Performing, Reporting and Follow-up, Second Edition J.P. Russell Measurement Matters: How Effective Assessment Drives Business and Safety Performance Brooks Carder and Patrick Ragan Lean Kaizen: A Simplified Approach to Process Improvements George Alukal and Anthony Manos The Certified Manager of Quality/Organizational Excellence Handbook: Third Edition Russell T. Westcott, editor Enabling Excellence: The Seven Elements Essential to Achieving Competitive Advantage Timothy A. Pine To request a complimentary catalog of ASQ Quality Press publications, call 800-248-1946, or visit our Web site at http://www.asq.org/quality-press.

CAPA for the FDA-Regulated Industry

José Rodríguez-Pérez

ASQ Quality Press Milwaukee, Wisconsin

American Society for Quality, Quality Press, Milwaukee, WI 53203 © 2011 by ASQ All rights reserved. Published 2010. Printed in the United States of America. 16   15   14   13   12   11   10        5   4   3   2   1 Library of Congress Cataloging-in-Publication Data Rodríguez Pérez, José, 1961CAPA for the FDA-regulated industry / José Rodríguez Pérez. p. cm. Includes bibliographical references and index. ISBN 978-0-87389-797-6 (hardcover : alk. paper) 1. Pharmaceutical industry – Government policy – United States. 2. Food industry and trade – Government policy – United States. 3. Total quality management – United States. I. Title. HD9666.6.R63 2010 615.1068’1–dc22 2010031139 No part of this book may be reproduced in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. Publisher: William A. Tony Acquisitions Editor: Matt T. Meinholz Project Editor: Paul O’Mara Production Administrator: Randall Benson ASQ Mission: The American Society for Quality advances individual, organizational, and community excellence worldwide through learning, quality improvement, and knowledge exchange. Attention Bookstores, Wholesalers, Schools, and Corporations: ASQ Quality Press books, video, audio, and software are available at quantity discounts with bulk purchases for business, educational, or instructional use. For information, please contact ASQ Quality Press at 800-248-1946, or write to ASQ Quality Press, P.O. Box 3005, Milwaukee, WI 53201-3005. To place orders or to request ASQ membership information, call 800-248-1946. Visit our Web site at www.asq.org/quality-press. Printed on acid-free paper

Dedication This book is dedicated to my wife Norma and my son José Andrés. Their continuous support and love made this book possible.

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Contents List of Figures and Tables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ix

Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Chapter 1  The Quality System and CAPA . . . . . . . . . . . . . . . . . . . 1.1 The Quality System and CAPA. . . . . . . . . . . . . . . . . . . . . . . 1.2 CAPA Relationship With Other Quality Subsystems . . . . 1.3 Corrective or Preventive?. . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 1 4 6

Chapter 2  CAPA and the Life Sciences Regulated Industry. . . . 2.1 FDA Pharmaceutical CGMP . . . . . . . . . . . . . . . . . . . . . . . . . 2.2 FDA Medical Devices QSR. . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3 FDA Quality System Inspection Technique (QSIT), 1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.4 FDA Guidance: Investigating Out-of-Specification (OOS) Test Results for Pharmaceutical Production, 2006 . . . . . . . 2.5 FDA Guidance: Quality Systems Approach to Pharmaceutical Current Good Manufacturing Practice Regulations, 2006. . . . . . . . . . . . . . . . . . . . . . . . . . . 2.6 European Pharmaceutical GMP (EudraLex Volume 4), 2003. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.7 Harmonization Processes: ICH and GHTF. . . . . . . . . . . . . 2.8 ICH Q10: Pharmaceutical Quality System, 2008. . . . . . . . . 2.9 ISO 13485:2003 and Non-U.S. Medical Devices Regulations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.10 GHTF Quality Management System—Medical Devices—Guidance on Corrective Action and Preventive Action and Related QMS Processes, 2009 . . . . 2.11 Current FDA Regulatory Trends for the CAPA System. . .

9 10 11

vii

13 19 21 23 24 25 25 27 28

viii  Contents

Chapter 3 Effective CAPA Process: From Problem Detection to Effectiveness Check. . . . . . . . . . . . . . . . . . 3.1 Problem Detection: Discovering Problems . . . . . . . . . . . . . 3.1.1 Source of Data About Product and Quality Issues. 3.1.2 Risk Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1.3 Initial Impact Assessment. . . . . . . . . . . . . . . . . . . . . . 3.1.4 Process Trending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.2 Problem Investigation: Discovering Root Causes . . . . . . . 3.2.1 Symptoms, Causal Factors, and Root Causes. . . . . 3.2.2 Problem Description. . . . . . . . . . . . . . . . . . . . . . . . . . 3.2.3 Barrier Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.2.4 Root Cause Identification Processes and Tools. . . . 3.2.5 Root Cause Categories . . . . . . . . . . . . . . . . . . . . . . . . 3.2.6 Investigating Human Errors . . . . . . . . . . . . . . . . . . . 3.3 CAPA Plan: Corrective and Preventive Actions to Fix Root Causes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3.1 Establish Effective Corrective and Preventive Actions. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3.2 Validation and Verification Prior to Implementation. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3.3 Implementation of Corrective and Preventive Actions. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4 Effectiveness Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4.1 Verifying That Solutions Worked . . . . . . . . . . . . . . . 3.4.2 Training Effectiveness. . . . . . . . . . . . . . . . . . . . . . . . . 3.5 Management of the CAPA System. . . . . . . . . . . . . . . . . . . . 3.5.1 CAPA System Structure . . . . . . . . . . . . . . . . . . . . . . . 3.5.2 CAPA Process Metrics. . . . . . . . . . . . . . . . . . . . . . . . . 3.5.3 Risk Management and the CAPA System . . . . . . . . 3.5.4 Management of External CAPA. . . . . . . . . . . . . . . . . Chapter 4  Documenting CAPA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1 Content of the Investigation Report/CAPA Plan Report. . . 4.2 Compliance Writing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

31 33 33 35 42 43 46 47 50 55 56 60 62 76 76 77 78 79 79 80 84 85 85 86 87 89 89 91





Contents  ix

Chapter 5 The Ten Biggest Opportunities of the CAPA System and How to Fix Them. . . . . . . . . . . . . . . 5.1 Timeliness (Lack of) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.2 Everything is an Isolated Event (Lack of Adequate Trending) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.3 Root Cause Not Identified. . . . . . . . . . . . . . . . . . . . . . . . . . . 5.4 Correcting the Symptoms Instead of the Cause. . . . . . . . . 5.5 Lack of Interim Corrective Actions. . . . . . . . . . . . . . . . . . . . 5.6 Root Causes Identified but Not Corrected . . . . . . . . . . . . . 5.7 Lack of True Preventive Actions. . . . . . . . . . . . . . . . . . . . . . 5.8 Lack of Effectiveness Verification of the Action Taken . . . 5.9 Multiple CAPA Systems Without Correlation . . . . . . . . . . 5.10 Abuse of Human Error and Retraining. . . . . . . . . . . . . . . .

93 93 96 98 99 100 100 101 102 103 103

Chapter 6  Developing an Internal CAPA Expert Certification. . 6.1 Content of the Certification. . . . . . . . . . . . . . . . . . . . . . . . . . 6.2 Evaluating the Effectiveness of Internal CAPA Training Efforts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.3 CAPA Certification Exam Example . . . . . . . . . . . . . . . . . . .

105 105

Chapter 7  CAPA Forms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1 Event Description and Investigation. . . . . . . . . . . . . . . . . . 7.2 CAPA Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3 Investigation Report and CAPA Assessment Form. . . . . . 7.4 Human Error Investigation Form. . . . . . . . . . . . . . . . . . . . .

113 114 116 118 122

109 110

Chapter 8  CAPA Final Recommendations . . . . . . . . . . . . . . . . . . . 125 Appendix A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Additional Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Useful Web Sites. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Acronyms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Bibliography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141

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List of Figures and Tables Figure 1.1

The CAPA system and the manufacturing quality system. . . . . . . . . .

5

Table 1.1

Corrective or preventive?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7

Figure 1.2

Figure 2.1 Table 2.1

Figure 2.2 Table 2.2

Feeders of the CAPA system. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Top ten FDA observations during drug manufacturer inspections for fiscal year 2009. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Comparison of top ten observations during drug manufacturer inspections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Top ten FDA observations during medical devices manufacturer inspections for fiscal year 2009. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Comparison of top ten observations during medical devices manufacturer inspections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5

28 29 29 30

Figure 3.1

The CAPA process flow. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

31

Figure 3.3

The ineffective CAPA circle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

33

Figure 3.2 Table 3.1 Table 3.2 Table 3.3

The CAPA system. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Risk assessment criteria. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Risk assessment score matrix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Type of nonconformance investigations. . . . . . . . . . . . . . . . . . . . . . . . .

41

Figure 3.5

Scrap monthly rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Figure 3.7 Table 3.5 Table 3.6

Figure 3.8 Figure 3.9 Table 3.7 Table 3.8

39

40

Risk prioritization of investigations. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Figure 3.6

36

Example of risk assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Figure 3.4 Table 3.4

32

Root cause elements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CAPA example. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Symptoms, causal factors, and root causes. . . . . . . . . . . . . . . . . . . . . . . Examples of causal factors and root causes . . . . . . . . . . . . . . . . . . . . . . Timeline of event. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Change analysis graph. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Barrier controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Barrier control analysis example. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

41 46 47 49 50 51 53 53 55 55

xii  List of Figures and Tables

Figure 3.10

Fault tree analysis example. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

58

Table 3.9

Slips and lapses of memory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65

Figure 3.11 Table 3.10 Table 3.11

Types of human errors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Human error investigation and prevention Do’s and Don’ts . . . . . . . The four levels of the Kirkpatrick model. . . . . . . . . . . . . . . . . . . . . . . . .

64 75 82

Table 4.1

Compliance writing Do’s and Don’ts. . . . . . . . . . . . . . . . . . . . . . . . . . . .

92

Table 6.1

Content of the CAPA expert certification . . . . . . . . . . . . . . . . . . . . . . . .

106

Table 7.1

Human error investigation form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

123

Table 6.2



CAPA expert certification evaluation levels. . . . . . . . . . . . . . . . . . . . . .

110

Preface

M

edical devices, biopharmaceutical, and traditional drug manu­ facturing companies devote an important part of their resources to dealing with incidents, investigations, and corrective and preventive actions. The corrective and preventive action system is known as the CAPA system. The CAPA system is second to none in terms of frequency and criticality of its deviations, and most of the regulatory actions taken by the FDA and foreign regulators are linked to inadequate CAPA systems. This guidance book provides useful and up-to-date information about this critical topic to thousands of engineers, scientists, and manufacturing and quality personnel across the life sciences industries. Understanding the CAPA system is a fundamental prerequisite to improving it. Investigating and discovering the root cause of any event is just the starting point of the CAPA journey. After that, we must develop and implement adequate and effective corrective and/or preventive actions. A formal process must be established to evaluate how well implemented actions prevent the recurrence of those causes. Although preventive actions are half of the CAPA system, many companies do not have any true preventive actions. Understanding and improving the corrective and preventive actions system as a whole is the focal point of this book, the first of its kind dealing exclusively with this critical system within this highly regulated industry. These pages evolved from hundreds of training sessions I have conducted as a consultant to dozens of regulated companies. By reviewing CAPA systems of nearly one hundred manufacturing plants (pharma­ ceuticals, medical devices, biological products, and food manufacturing), I developed firsthand awareness of the real issues of the CAPA system. These are addressed in this book in the form of a decalogue, a set of ten basic rules. Thus, the objective of this book is to help these industries improve their CAPA systems and succeed in their mission of producing safe and effective products. xiii

xiv  Preface

Chapter 1 establishes the relationship between the CAPA system (identification, investigation, and fixing of problems) and the quality system environment. It also includes the most important definitions and concept of the CAPA world. I strongly recommend you begin by reading and understanding those critical concepts. Many people involved in developing and implementing corrective and preventive actions have trouble providing correct definitions of those concepts. Chapter 2 describes the current requirements and regulations by type of products and by country (U.S., European Community) and by international harmonized documents. It also includes a review of ISO 13485:2003 requirements as they apply to medical device manu­ facturers as well as a review of the recent international guidance on CAPA for medical devices published September 2009. This chapter finishes with an overview of the current FDA regulatory trends related to the CAPA system. Chapter 3 describes sequentially the entire CAPA process. It starts with problem detection, continues with root cause investigation, genera­ tion, and implementation of corrective and preventive actions, and ends with the evaluation of their effectiveness and the management of the CAPA system. Topics such as trending, evaluation of training effective­ ness, and risk management concepts and their relation to CAPA are discussed in this chapter. Special emphasis is dedicated to the inves­ tigation of so-called “human error.” Chapter 4 contains useful hints to properly document the elements of the CAPA process. Chapter 5 describes a decalogue containing the ten most common opportunities found in the CAPA system and how to fix them. Real examples are analyzed and best practices are discussed for each. Chapter 6 presents the basic elements to be included as part of an internal CAPA expert certification, which is one of the recommended ways to reinforce your CAPA system. Chapter 7 includes several forms that can be used as templates during failure investigations, development of corrective and preventive actions, and evaluations of effectiveness. These forms include dozens of questions that provide guidance and are a great help during the process of investigation and generation of effective actions to avoid the recurrence of unwanted situations. Also included is a form to be used when investigating human errors. Finally, Chapter 8 presents a list of key recommendations to improve your CAPA system.

1 The Quality System and CAPA 1.1 THE QUALITY SYSTEM AND CAPA A quality system is a set of formalized business practices that define manage­ment responsibilities for organizational structure, processes, proce­dures, and resources needed to fulfill product or service require­ ments, customer satisfaction, and continuous improvement. A quality manage­ment system (QMS) is a set of interrelated elements (processes) used to direct and control an organization with regard to quality. In other words, a quality system dictates how quality policies are implemented and quality objectives are achieved. Continuous improvement is the result of ongoing activities to evaluate and enhance products, processes, and the entire quality system to increase effectiveness. The organization must continuously improve the effectiveness and efficacy of its QMS through the use of its quality policy, quality objectives, audit results, analysis of data, corrective and preventive actions, and the management review processes. Analyzing data is an essential activity for any possible improvement at any level (system, process, and product/service). The organization must collect and analyze appropriate data to demonstrate the suitability and effectiveness of the QMS. This must include data generated as a result of monitoring and measurement and from other relevant sources. The analysis of data will provide information on customer satisfaction, conformity to product or service requirements, trends of processes and products including opportunities for preventive action, and suppliers. Corrective action is one of the most important improvement activities. It identifies actions needed to correct the causes of identified problems. It seeks to eliminate permanently the causes of problems that have a negative impact on systems, processes, and products. Corrective action involves finding the causes of some specific problem and then putting in place the necessary actions to avoid a reoccurrence. Preventive actions are aimed at preventing the occurrence of potential problems. Correction of the problem is the third basic element of the corrective and preventive 1

2  Chapter One

action system. These efforts attack symptoms rather than causes and sometimes are mentioned as immediate, remedial or containment actions. The concept of CAPA is not restricted to any particular industry or sector. It is a widely accepted concept, basic to any quality management system. Since quality systems strive to continuously improve systems, processes, and products/services, there must be mechanisms in place to recognize existing or potential quality issues, take the appropriate steps necessary to investigate and resolve those issues, and, finally, make sure the same issues do not recur. Processes of the life sciences regulated industries (the manufacturing of medical devices, biopharmaceuticals, and traditional drugs) are plagued with deviations and nonconformities. Worldwide regulatory agencies perform thousands of inspections every year; often CAPA system violations are at the top of the list. Within the United States, lack of adequate investigations, no true root cause analysis, lack of effective corrective actions, and lack of true preventive actions are common findings pointed out by Food and Drug Administration (FDA) inspectors. As evidenced by the significant number of problems related to this issue, companies are facing many challenges in making the CAPA system work as intended. Life sciences regulated companies must ensure that their CAPA system looks beyond product issues and considers other quality issues including problems associated with processes and systems. Unfortunately, a significant number of regulated companies are approaching the CAPA system very lightly, implementing corrections but no true corrective and preventive actions. CAPA systems are inherently data driven. Without adequate, relevant data, it can be difficult to draw definitive conclusions about systems, processes, or product quality issues. One of the challenges many companies face is the proliferation of uncorrelated data repository systems within the organization. A typical example for U.S. companies is the existence of two separate systems (domestic and foreign) for investigating customer claims. Another example is the lack of relationship between supplier and internal CAPA systems. By having a correlated CAPA system, a company will be better able to diagnose the health of its quality system and will have a better chance of recognizing and resolving important quality issues. As the quality system within an organization matures, there should be a natural shift in emphasis from corrective action to preventive action. Issues that must be corrected usually become obvious. However, issues that have the potential for becoming a problem are less readily recognized. How can a firm pore over its internal data to find those few situations that might be the precursors of problems down the road? The answer is part of the regulations. Companies must establish methods to evaluate both the nonconformance data (which will feed the corrective action portion of the system) and the in-conformance data (which will be the basis of preventive actions).





The Quality System and CAPA  3

An effective CAPA system must be a closed loop system. This term refers to at least two elements of the CAPA system. First, it means there are sufficient controls in place to ensure that the CAPA process runs through all the required steps to completion, and that management and those responsible for quality have visibility and input to the process. In addition, top management must review the outputs of the CAPA system. Very often companies focus on completing the individual tasks of a particular corrective action, yet lose track of the original purpose of the CAPA system. For example, a particular product problem may be resolved, but no evaluation is ever performed to ensure that the solution was effective. In this example, the loop was never closed. Second, a good CAPA system closes the loop on many of the docu­ mented issues by directly providing input into basic elements of the QMS such as design control. For example, nonconforming product procedures are directed at assuring that the nonconforming product is identified and corrected prior to distribution or prevented from being distributed. Frequently, a correction or temporary change will be implemented to assure that the affected material is fixed. An effective CAPA system will require that the problem be investigated and its root causes effectively attacked with the appropriate corrective actions. A documented procedure for CAPA must define requirements for the following elements: 1. Collect and analyze quality data to identify existing and potential causes of nonconforming products or other quality problems. 2. Investigate the causes of existing and potential nonconformities. 3. Identify corrective and preventive actions.

4. Verify or validate corrective and preventive action prior to implementation. 5. Implement corrective and preventive actions.

6. Evaluate the effectiveness of corrective and preventive actions. 7. Ensure that the information related to quality problems or nonconforming products is disseminated to those directly responsible for assuring the quality of such product or the prevention of such problems.

8. Submit relevant information on identified quality problems, as well as corrective and preventive actions, for management review. Finally, all CAPA system activities, and all quality system activities in general, must follow a risk-based approach. Because all existing and potential problems do not have the same importance and criticality, the prioritization of actions must correlate with the risk and the magnitude of each situation.

4  Chapter One

The four key CAPA definitions are:

• CAPA (corrective and preventive action): A systematic approach that includes actions needed to correct (correction), avoid recurrence (corrective action), and eliminate the cause of potential nonconforming product and other quality problems (“preventive action”). • Correction: Action to eliminate a detected nonconformity. Corrections typically are one-time fixes. A correction is an immediate solution such as repair or rework. Corrections are also known as remedial or containment action.

• Corrective action: Action to eliminate the causes of a detected nonconformity or other undesirable situation. The corrective action should eliminate the recurrence of the issue.

• Preventive action: Action to eliminate the cause of a potential nonconformity or other undesirable potential situation. Preventive action should prevent the occurrence of the potential issue.

1.2 CAPA relationship with other quality subsystems The CAPA system is a critical component of an effective QMS and it must maintain a close relationship with other quality subsystems (as depicted in Figure 1.1). The ultimate goal of any regulated company must be to have a CAPA system that is compliant, effective, and efficient. All relevant subsystems that may produce nonconformances must be part of the process. There are multiple feeders to the CAPA system, both internal and external to the company (as represented in Figure 1.2). Internal processes encompass both nonconformance and in-conformance results, internal audits and assessments, management reviews, and so on. External sources of CAPA process inputs are supplier audits and assessments, customer feedback, and results from external audits and assessment such as regulatory agencies, ISO, and so on. A detailed discussion of those feeders can be found in Chapter 3.1.1





The Quality System and CAPA  5

Management controls Records, document, and change controls

Material controls Corrective and preventive actions Production, laboratory, and process controls

Design controls Equipment and facility controls

Figure 1.1  The CAPA system and the manufacturing quality system.

Internal processes

External [customer feedback]

CAPA

External [3rd-party audit and inspection]

Figure 1.2  Feeders of the CAPA system.

External [supplier]

6  Chapter One

1.3 Corrective or Preventive? One of the most sterile debates one can witness is the discussion between two CAPA professionals about whether a specific action they are work­ ing on should be considered corrective or preventive. The debate is point­less because what really matters is whether the action would attack a root cause. To add even more confusion, one need only read the formal definition of corrective action. ANSI/ISO/ASQ Q9001-2008 section 8.5.2 defines corrective action as “action to eliminate the causes of nonconformities in order to prevent recurrence.” ANSI/AAMI/ISO 13485-2003 contains the same definition, and the FDA regulation for medical devices (Title 21 CFR §820.100) establishes that each manufacturer shall identify “the action(s) needed to correct and prevent recurrence of nonconforming product and other quality problems.” They use the word prevent as part of the corrective action definition. To avoid any confusion, the word prevent is replaced by the word eliminate throughout this book; the definition of corrective action will read “action to eliminate the causes of a detected nonconformity or other undesirable situation. The corrective action should eliminate the recurrence of the issue.” A second common source of confusion and misunderstanding is deeper and more philosophical. Let’s say that company A has a situation where root cause Z is creating a potentially dangerous upward trend, but the result is still within specification. Someone can argue that because the result is still within conformance, the action to be taken can be categorized as preventive. Others may perfectly well argue that it is a corrective action because the cause was already acting, even though the final result is still in conformance. My opinion is that it is a preventive action, but whatever you choose is fine; the important issue is to implement the action as soon as possible. For the sake of clarification, Table 1.1 contains the rules followed in this book. A typical situation that occurs during nonconformance investigations is the discovery of both existing and potential root causes simultaneously. In those cases, actions taken to eliminate the causes of nonconformance will be corrective actions, while actions taken against identified potential causes will be considered preventive actions. It is perfectly possible to have both categories of actions within the same CAPA plan.





The Quality System and CAPA  7

Table 1.1  Corrective or preventive?

Situation Name it corrective action only if you already have a product nonconformance or process noncompliance

Examples • Product failing specifications • Confirmed customer complaint • Use of obsolete documents • Audit finding of product nonconformance or process noncompliance

Name it preventive action whenever the product, process, or system is still in conformance but you discover root causes with the potential to create nonconformities

• Developing adverse trends from a monitoring system (run chart or control chart) – Shifts – Trends – High variability, and so on

Name it preventive action if it is purely a recommendation to enhance or improve any product, process, or system

• Changing to new material or new design • Implement new (enhanced) processes

A third controversy occurs when the same action can be considered both corrective and preventive when applied to different situations. Some CAPA professionals believe that once you have a corrective action (because you already had a nonconformance) to whatever product, process, or system you extend it, it will always be a corrective action. Other professionals, including myself, believe that if the same action can be extended to other products/processes/systems not yet affected by this root cause, then it should be considered a preventive action.

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Index Page numbers in italics refer to tables or illustrations. documenting, 3, 89–91 external process inputs, 4 final recommendations, 125–126 procedures, 34 process metrics, 85 quality subsystems, 4–5 quality systems, 1–4 regulatory importance of, 106 and retraining, 74 and risk management, 35–41 system structure, 85 three separate concepts of, 22–23 widely accepted concept, 2 CAPA circle, 33 CAPA expert certification content, 105–108 effectiveness evaluation, 109 exam example, 110 CAPA forms CAPA Plan, 116 Event Description and Investigation, 114 Human Error Investigation, 122 Investigation Report and CAPA Assessment, 118 CAPA opportunities effectiveness evaluation, 95 effectiveness verification, 102 human error and retraining, 103 interim corrective actions, 100 isolated events, 96–98 root cause identification, 98

A

actions not as planned, 65 actions taken, 89 active failures, 66 Active Implantable Medical Devices Directive 90/385 EEC (AIMD), 9 adequate trending, 96–98 administrative barriers, 55, 55–56 adverse trends, 86 Analyze Data for Trends, 43 ANOVA, 54

B

barrier control analysis, 55, 55–56 batch records, 62–63, 72, 75 behavior (transfer of training), 83 benchmarking, 74 best practices, 94–95, 96, 97, 98–99, 100, 101 blaming, 75 Boolean logic, 57–58

C

calibration and maintenance records, 34 Canadian national standards, 26 CAPA data sources, 34 debate 6, 7 deficiencies and warning letters, 30 definitions, 4 141

142  Index

symptoms v. causes, 99 timelines, 93–95 trending, 96–97 true preventive actions, 101 uncorrelated systems, 103 CAPA Plan (form), 116 CAPA plans best practices, 95 compliance writing, 89 correction/containment action, 90 effective corrective and preventive actions, 76–77 effectiveness evaluation, 79–84 executive summary/abstract, 91 final disposition, 91 implementation of, 78–79 preventive action, 91 reports, 89 sequential elements, 76 team effort, 77 time requirement, 76 training effectiveness, 80–84 validation and verification prior to implementation, 77–78 CAPA processes effectiveness evaluation, 79–80 fixing root causes, 76–78 problem detection, 33–45 problem investigation, 46–75 process flow, 31 system management, 84–88 CAPA systems, 32 closed loop, 3 data driven, 2 defined, 1 external CAPA, 87 fault tree analysis, 58–59 FDA regulatory trends, 28 feeders to, 4, 5 management of, 84–87 management review, 3 and manufacturing quality system, 5 opportunities, 93–103 process metrics, 85–86 processes and systems, 2 product issues, 2 QSIT description of, 14 risk-based approach, 3

risk management and, 86 structure, 85 causal factors, 47–48, 49, 50, 51 cause-and-effect diagrams, 56–57, 99 Center for Drug Evaluation and Research (CDER), 20 certification, internal CAPA expert, 105–109, 106, 110 change analysis, 51, 52 change analysis graph, 53 chronology, 51, 52, 56, 99 clinical adverse events, 34 closed loop systems, 3 Commission Directive 91/356/EEC, 9 commission errors, 65, 66 comparison matrix, 51, 54, 56, 99 complaints, 13, 22, 34 compliance writing, 91, 92, 108 comprehensive quality systems (QS) model, 21 conclusions, about root causes, 90 containment action, 4, 90 continuous improvement defined, 1 control barrier analysis, 55–56 corrective action, 1, 4, 6, 22–23, 49 corrective and preventive action. See CAPA corrective v. preventive action debate, 6–7, 7 current good manufacturing practice (CGMP) Analyze Data for Trends, 43 CAPA regulations and, 9 defined, 132 FDA guidance, 21–23, 43 Medical Devices: CGMP Final Rule, 11 current thinking (in FDA guidance), n.9 customer feedback, 4, 34

D

Daniel, A., 84 data analysis, 1, 2, 15, 43–46, 54 data segregation, 54 defects (nonconformance), 63 defects v. error, 63 deficiencies and warning letters, 30

Index  143

deviations in life sciences regulated industries, 2 and nonconformities, 38 written procedures and, 10 device master and history files, 63, 75 Do It By Design—An Introduction to Human Factors in Medical Devices, 63 document writers, 72 “double digit” rule, 80, 97, 102 drug and biotech products observations, 28, 29

E

effectiveness evaluation, 79–80, 96, 109–111 effectiveness verification, 102 elements of certification, 110 eliminate (part of corrective action definition), 6 environment, 62 equipment, 60 error v. defects, 63 errors. See human error errors of commission, 65, 66 errors of omission, 65, 66 EudraLex, Volume 4, 9, 23 European pharmaceutical GMP, 9, 23 Event Description and Investigation (form), 114 event information, 89 execution errors, 65 executive summary/abstract, 91 external audits and assessments, 4, 22, 34 external CAPA, management of, 87–88 external processes inputs, 4

F

failure investigation procedures, 17, 20 requirements for, 11 timelines of, 38 fallibility, 75, 104 fault tree analysis, 56, 57–58, 58, 99

FDA (Food and Drug Administration) “beyond compliance” approach, 11 common findings in the United States, 2 comprehensiveness of regulations, 9 consideration of human factors, 63 current thinking, n.9 drug and biotech products observations, 28, 29 guidance, n.9 medical devices observations, 29, 30 medical devices QSR, 11–12 out-of-specification (OOS) guidance, 19–20 pharmaceutical CGMP, 10–11 quality system inspection technique (QSIT), 13–19 quality systems approach to pharmaceutical CGMP guidance, 21–22 regulatory trends, 28 Sterile Product Guidance, 43 ten inspectional objectives, 14–16 time requirements, 93 training effectiveness, 80–84 warning letters, 30 field service reports, 34 final disposition, 91 final recommendations, 125–126 finished drugs, CGMP for, 9 fishbone diagrams, 56–57 5 Ms and 1E (investigative technique), 57 5 Whys (investigative technique), 48, 57, 59 fixable root causes, 48 flowcharts, 51, 52 Food and Drug Administration. See FDA frequency of event, 37

G

GHTF quality management system, 27 Global Harmonization Task Force (GHTF), 25 Guttman, H. E., 66

144  Index

H

HACCP (hazard analysis and critical control point) methodology, 35 harmonization processes, GHTF and ICH, 24 hazard analysis, 35 historical records, 34 human condition, 75, 104 “Human Drug CGMP Notes,” 93 human error, 62–75 abuse of, 103–104 better documents, 74–75 defined, 64 and human factors, 63–64 investigation and prevention, 68–69, 75 psychology and classification of, 64–68 in regulated companies, 71–72 and retraining, 103 simplistic approach, 62 supervision, 75 task analysis and, 52 training, 75 training module, 107 types of, 64 Human Error Investigation (form), 122 human factors, 63–64 human factors training module, 107 human reliability engineering, 63 human reliability factors, 61

I-J

ICH Q9, 35 ICH Q10, 25 immediate actions taken, 89 impact assessment, 42–43, 89 in-conformance data, 2, 43–46 In Vitro Diagnostic Directive 79/98 EC (IVDD), 9 ineffective CAPA circle, 33 initial impact assessment, 42–43, 89 inspection findings, examples, 103 inspectional objectives, 14–16 instructions, 61 interim corrective actions, 100 internal audits, 22 internal complaints, 34

internal processes, 4 interview process, 68–71 interview techniques, 68–69 investigation details, 90 Investigation Report and CAPA Assessment (form), 118 investigation reports, 89 investigation stage, 94 investigations, risk management and, 35–36 Is–Is Not matrix, 54 ISO 13485:2003, 25–27 isolated events, 96–98 issue descriptions, 89

K

K-T diagram, 54 Kepner, Charles T., 54 Kimmelman, E., 84 Kirkpatrick, Donald L., 81, 83, 84 Kirkpatrick Model for Training Effectiveness Evaluation, 81, 82, 109 knowledge-based mistakes, 64, 64, 65

L

lack of attention, 62 lapses of memory, 64, 65, 65 latent failures, 66, 67 lawsuits, 34 learning (from training), 82 legal actions, 34 life sciences regulated industries deviations and nonconformities, 2 European pharmaceutical GMP, 19, 21 FDA guidance, 19, 21 FDA medical devices QSR, 11 FDA pharmaceutical CGMP, 10 FDA quality system inspection technique (QSIT), 13 FDA regulatory trends for CAPA, 28 GHTF quality management system, 27 harmonization processes, 24 ICH Q10, 25 ISO 13485:2003, 25 plagued with deviations and nonconformities, 2 process stability, 45 long-term trending, 44–45

Index  145

M

management factors, 62 management review, 3, 19, 22 manufacturing quality systems, CAPA and, 5 materials, 61 Medical Device Directive 93/42 EEC (MDD), 9 medical devices CGMP for, 9 control of nonconforming product, 12–13 FDA observations, 29, 30 regulations, non-U.S., 25 Medical Devices: Current Good Manufacturing Practice Final Rule: Quality System Regulations, 11 medicinal products, GMP for, 23 metrics, process, 86 mistakes (error), 63, 64 monitoring activities, 16

N

non-U.S. medical devices regulations, 25 nonconformance data, 2, 38 nonconformance investigations, 45 risk prioritization of, 41 root causes and, 6 types of, 41 nonconforming product control of, 12 procedures, 3 nonverbal communication, 70

O

omission errors, 65, 66 out-of-specification (OOS) guidance, 19–21

P

performance shaping factors (PSF), 63 personal performance, 60 pharmaceutical CGMP, 10 ICH Q10, 25 quality systems approach to, 21–22

physical barriers, 55, 55–56 poka-yoke (mistake-proofing), 73 potential root causes, 51, 57 prevent (part of corrective action definition), 6 preventive action, 4, 22 previous corrections, 34 problem description, 50–54 problem investigation, 46–48 problem-solving tools, 56–60 procedures and instructions, 61 process metrics, 85–86 process metrics training module, 109 process monitoring data, 34 process trending, 43–46, 109 product and quality issues, source data, 33–34 product quality review, 24 production record review, 11

Q

QMS (quality management systems) CAPA systems and, 4–5 importance of data analysis, 1 QSIT (quality system inspection technique), 13–19 quality control, 24 quality control unit, responsibilities of, 10 quality data, sources of, 34 quality management system (QMS) defined, 1 quality system inspection technique (QSIT), 13–19 quality systems approach to pharmaceutical CGMP, 21–22 defined, 1 maturation of, 2 The Quality Toolbox (Tague), 51 query elements, 98 questions (to determine root causes), 47–48

146  Index

R

reaction (to training, 81 Reason, James, 64, 66, 67, 75 reasonable time lines, 93 record keeping, 13 remedial action, 4 results (impact of training), 84 retraining, abuse of, 74, 103–104 returned product, 22, 34 risk assessment, 35–41 criteria for, 36–37 score matrix, 39, 40 risk-based approach to CAPA, 3 risk management CAPA and, 35–41, 86 training module, 108 root cause analysis, 106 root cause elements, 47 root causes, 49, 50, 51 CAPA to fix, 76–78 categories, 60–62 conclusions about, 90 existing and potential, 6 and human performance, 71 identification processes, 56–60 inability to determine, 59 initial impact assessment, 42–43 nonconformance investigations and, 6 not identified, 98–99 “other” category, 59–60 questions to determine, 47–48 symptoms, 98–99 tools, 56–60 rule-based mistakes, 64, 64, 65

S

sabotage, 62 sampling tables, 17, 18 scrap, rework, and other concessions, 34, 46 sequence errors, 66 severity of event, 37 shaming, 75 short-term trending, 44 should (in FDA guidance), n.9 significant corrective action, 18 silence as communication motivator, 70

situational factors, 62–63, 65 skill-based slips and lapses, 64, 64 slips, lapses, and mistakes, 62, 65 slips of action, 64, 65 source data, product and quality issue, 33–34 spare parts usage, 34 stability issues, 34 standard operating procedures, 97 statistical process control (SPC), 16 statistical tools, 44 Sterile Product Guidance, 43 stratification analysis, 54 Study Group 3, 27 Subpart J §820.100, 12, 20 supervision, 73, 75 supervision and management, 62 supplier audits and assessments, 4 suppliers, nonconformance and, 87 Swain, A.D., 66 “Swiss cheese model” of system failure, 67 symptoms, 49, 50

T

Tague, Nancy R. The Quality Toolbox, 51 task analysis chart, 52 time requirements, 79, 80, 85, 86, 93 timelines, event, 51, 52, 53 timing errors, 66 Title 21 Code of Federal Regulations, §210 and 211, 9, 10 Title 21 Code of Federal Regulations, §820, 9, 13–14 tools problem-description, 51 problem-solving, 56–60, 99 “top-down” subsystem approach, 14 training, 34, 60, 72–73, 75 as a corrective action, 81 effectiveness of, 80–84 training modules certification, 106, 106–109 human error, 107 process metrics, 109 process trending, 109 risk management, 108 root cause analysis, 106

Index  147

Tregoe, Benjamin, 54 trending adequate, 96–98 process, 43–46 of root cause categories, 59 unfavorable, 15–16 true preventive actions, 100

U

unattended root causes, 100 uncorrelated data repository systems, 2 uncorrelated systems, 103 unfavorable trends, 15–16 United States v Barr Laboratories, Inc. (1993), 11, 19, 42–43

V

validation protocols, 18, 76–78 verification protocols, 18, 76–78 violations, 64, 65, 66

W-X-Y-Z

warning letters, FDA, 30 working instructions, 72, 104 written procedures, deviations and, 10

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