User-centered design of central venous access device documentation

Kandaswamy, Swaminathan; Gill, Anne E.; Wood, Shellie; McKay, Leah; Hike, Jessica; Popkin, Melissa; Ray, Edwin; Maude, Heather; Johnston, Crawford; White, T. Kirk; Orenstein, Evan

doi:10.1093/jamiaopen/ooac011

Cited by 4 publications

(3 citation statements)

References 13 publications

(10 reference statements)

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“…We developed a candidate alert design to reduce weight discrepancies based on heuristic design [3]. We then adopted in situ usability testing to iteratively improve design of the alert [4,5]. We identified participants in real clinical settings who appeared not to be too busy and asked for 10 minutes of their time to improve EHR design.…”

Section: Clinical Decision Support Designmentioning

confidence: 99%

Accurate Dosing Weight: When the 10% Really Matters

Kandaswamy,

Thompson,

Orenstein

2024

Studies in Health Technology and Informatics

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Introduction: Children are at increased risk of medication-associated adverse events, often due to weight-based dosing errors. We aimed to reduce the proportion of medications that were administered where the dosing weight was ≥ 10% different from the recorded weight. Methods: We adopted in-situ usability testing to iteratively improve design of clinical decision support that would enable accurate dosing weight documentation by prompting clinicians to update weight if recorded weight was > 10% different and it had been at least 7 days since the last dosing weight update. Results: The proportion of medication administrations with difference >10% between their recorded weight and dosing weight decreased from 13.1% (56,256/ 429,006) in the baseline period to 9.5% (35,560 / 372,443) in the intervention period (P < 0.001). Discussion and Conclusion: User-centered design of an interruptive alert improved the accuracy of dosing weights during medication administrations without substantial alert burden. In-situ usability testing is an effective approach to rapidly obtain feedback from frontline users and iterate on the design to effect desired behavior changes

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Section: Clinical Decision Support Designmentioning

confidence: 99%

Accurate Dosing Weight: When the 10% Really Matters

Kandaswamy,

Thompson,

Orenstein

2024

Studies in Health Technology and Informatics

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“…We then performed formative usability testing with pediatric residents using scenarios, a think- aloud protocol, 10 and a test EHR interface to iteratively update the language and images in the representation of the alert. [11][12][13] This alert was first implemented on March 10, 2021 in all areas served by the inpatient pharmacy, including inpatient, emergency department, intraoperative, and hospital outpatient departments.…”

Section: Phasementioning

confidence: 99%

Reducing Therapeutic Duplication in Inpatient Medication Orders

et al. 2023

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Background: Therapeutic duplication, the presence of multiple agents prescribed for the same indication without clarification for when each should be used, can contribute to serious medical errors. Joint Commission standards require that orders contain clarifying information about when each order should be given. In our system, as needed (PRN) acetaminophen and ibuprofen orders are major contributors to therapeutic duplication. Objective: Design and evaluate effectiveness of clinical decision support (CDS) to reduce therapeutic duplication with acetaminophen and ibuprofen orders. Methods: This study was done in a pediatric health system with 3 freestanding hospitals. We iteratively designed and implemented two CDS strategies aimed at reducing the therapeutic duplication with these agents: (1) interruptive alert prompting clinicians for clarifying PRN comments at order entry and (2) addition of discrete “first line”, “second line” PRN reasons to orders. Therapeutic duplications were measured by manual review of orders for 30-day periods before and after each intervention and 6 months later. Results: Therapeutic duplications decreased from 1485 in the 30 days prior to the first alert implementation to 818 in the 30 days after but rose back to 1208 in the 30 days prior to the second intervention. After discrete reasons were added to the order, therapeutic duplication decreased to 336 in the immediate 30 days and 6 months later remained at 277. Alerts firing rates decreased from 76.0 per 1,000 PRN acetaminophen or ibuprofen orders to 42.9 after the second intervention. Conclusion: Interruptive alerts may reduce therapeutic duplication but are associated with high rates of user frustration and alert fatigue. Leveraging discrete PRN reasons for “first line” and “second line” produced a greater reduction in therapeutic duplication as well as fewer interruptive alerts and less manual entry for providers.

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“…CDS design often suffers from poor usability and consideration of workflows [34,35], leading to poor adoption and ultimately to inconsistent effectiveness of CDS [36][37][38]. Adopting human factors principles and following a user-centered design process with iterative design based on feedback from users and usability evaluations can improve effectiveness of CDS by improving usability as well as ensuring appropriate workflow integration [39][40][41].…”

Section: Introductionmentioning

confidence: 99%

User-Centered Design and Evaluation of Clinical Decision Support to Improve Early Peanut Introduction: Formative Study

Nguyen¹,

Cunha²,

Rowland³

et al. 2023

JMIR Form Res

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Background Peanut allergy has recently become more prevalent. Peanut introduction recommendations have evolved from suggesting peanut avoidance until the age of 3 years to more recent guidelines encouraging early peanut introduction after the Learning Early about Peanut Allergy (LEAP) study in 2015. Guideline adherence is poor, leading to missed care opportunities. Objective In this study, we aimed to develop a user-centered clinical decision support (CDS) tool to improve implementation of the most recent early peanut introduction guidelines in the primary care clinic setting. Methods We edited the note template of the well-child check (WCC) visits at ages 4 and 6 months with CDS prompts and point-of-care education. Formative and summative usability testing were completed with pediatric residents in a simulated electronic health record (EHR). We estimated task completion rates and perceived usefulness of the CDS in summative testing, comparing a test EHR with and without the CDS. Results Formative usability testing with the residents provided qualitative data that led to improvements in the build for both the 4-month and 6-month WCC note templates. During summative usability testing, the CDS tool significantly improved discussion of early peanut introduction at the 4-month WCC visit compared to scenarios without the CDS tool (9/15, 60% with CDS and 0/15, 0% without CDS). All providers except one at the 4-month WCC scenario gave at least an adequate score for the ease of use of the CDS tool for the history of present illness and assessment and plan sections. During the summative usability testing with the 6-month WCC new build note template, providers more commonly provided comprehensive care once obtaining a patient history concerning for an immunoglobulin E–mediated peanut reaction by placing a referral to allergy/immunology (P=.48), prescribing an epinephrine auto-injector (P=.07), instructing on how to avoid peanut products (P<.001), and providing an emergency treatment plan (P=.003) with CDS guidance. All providers gave at least an adequate score for ease of use of the CDS tool in the after-visit summary. Conclusions User-centered CDS improved application of early peanut introduction recommendations and comprehensive care for patients who have symptoms concerning for peanut allergy in a simulation.

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User-centered design of central venous access device documentation

Cited by 4 publications

References 13 publications

Accurate Dosing Weight: When the 10% Really Matters

Accurate Dosing Weight: When the 10% Really Matters

Reducing Therapeutic Duplication in Inpatient Medication Orders

User-Centered Design and Evaluation of Clinical Decision Support to Improve Early Peanut Introduction: Formative Study

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