Usability Testing of a Sick-Day Protocol in CKD

Abstract

Assessing the performance at self-management of patients with CKD is essential for effective strategies to safeguard care. We evaluated the use of a sick-day protocol with structured usability testing by patients with CKD. The Sick-Day Protocol is a selfmanagement protocol developed by National Health Service Highland in Scotland to prevent AKI, and it is made available through the Scottish Patient Safety Program on a "Medicine Sick Day Rules" card (1). The Sick-Day Protocol card describes a gastrointestinal or fever-related and volume-depleting illness; then, it directs patients to withhold specified medications and resume them when well (after 24-48 hours of eating and drinking normally). Five medication classes and examples are listed, including angiotensinconverting enzyme inhibitors, angiotensin receptor blockers, diuretics, nonsteroidal anti-inflammatory drugs, and metformin. We recruited volunteers with stages 3-5 CKD from the Safe Kidney Care program (2). All participants independently scheduled and completed testing. The protocol was deemed exempt by the University of Maryland Baltimore Institutional Review Board. Usability testing sessions were conducted in a private room by a moderator and recorder. Participants were educated about the purpose of the Sick-Day Protocol and qualifying illnesses. The moderator presented the card to all participants and requested each to summarize it in their own words. The study team developed four scenarios representing commonly encountered medical problems. All were reviewed and adjudicated by two physicians (C.J.D. and J.C.F.) for clinical validity and population suitability. Participants were presented the scenarios, including one for which the Sick-Day Protocol would be appropriately activated (index) and one with nonqualifying illnesses, including nephrolithiasis, congestive heart failure, and a "minor" gastrointestinal illness. One half of the sample had scenarios presented in a fixed sequence, starting with the index. The remainder had the scenarios presented randomly. The moderator reviewed the mock patient's medications and comorbidities in each scenario and then, provided mock medication bottles. Participants were asked about the appropriateness of the Sick-Day Protocol, if any of the mock medications should be withheld in each scenario, and if so, which ones. Completion of each task was classified as a success or error. After completing

Demonstrating the value of community pharmacists in New Zealand educating a targeted group of people to temporarily discontinue medicines when they are unwell to reduce the risk of acute kidney injury

“…Not all signalled they would do this after 24 h; some preferred contacting a health professional immediately or within the first 24 h of acute illness. A study by Doerfler et al [ 18 ] showed participants accurately identified the scenario that qualified for Sick‐Day Protocol implementation, but most (95%) made a medicine selection error, compared with 10% in our study. Inappropriate timing of restarting medicines or permanent discontinuation is also potential risks.…”

Medication Holds in CKD During Acute Volume-Depleting Illnesses: A Randomized Controlled Trial of a “Sick-Day” Protocol

“…In preparation for this trial, we conducted usability testing of the sick-day protocol card as designed by the Scottish Patient Safety Programme and reported a range of failures in understanding and errors with its simulated use. 22 We made modifications to the sick-day protocol and associated card and distributed it for use in conjunction with an IVRS platform for reminders of protocol engagement among sick-day protocol participants. The discrepancy between participant enthusiasm to use the sick-day protocol, evidenced by high rates of IVRS interaction, and the ability to successfully identify sick days and implement sick-day protocol instructions illustrates the challenges common with patient education materials.…”

“…In preparation for this trial, we conducted usability testing of the sick-day protocol card as designed by the Scottish Patient Safety Programme and reported a range of failures in understanding and errors with its simulated use 22 . We made modifications to the sick-day protocol and associated card and distributed it for use in conjunction with an interactive voice response system platform for reminders of protocol engagement among sick-day protocol participants.…”

Optimization of Extreme Programming Methods in Plastics Waste Management Company Websites

“…At this stage usability testing is also carried out on the developed system. Usability testing itself is carried out to find out how easy it is for users to use the developed system so that system developers know the end users' difficulties in using the system and find out the shortcomings of the developed system [27]. To determine user satisfaction with the developed system, the measurement uses the following equation: In addition to end-user satisfaction, the level of effectiveness and efficiency of the developed system also needs to be measured to determine the success rate of the system using the user's success rate, which is the percentage of tasks completed correctly by the end-user [28].…”

“…For the measurement of self-satisfaction using equation ( 1) [34]. While the measurement of the level of effectiveness and efficiency of the system uses equation ( 2) [27]. Previously, the questionnaires distributed to 27 respondents were analyzed, as shown in the following table: The results of measuring the level of satisfaction, the level of effectiveness and efficiency of the plastic waste management website at PT.…”