Medication Intake tracking
UXD | UX RESEARCH
Type: Individual Project Duration: 4 Days
TracktO is a medication tracking platform provided by Optum Healthcare. It helps inpatient nursing staff keep a record of medicines administered to the patient and its details, at all times. TracktO was designed as part of a design challenge by Optum.
Together with a few nursing acquaintances and their feedback, I've put together a platform that can be further tested and refined to provide a better experience for nurses.
Process:
RESEARCH
01
DEFINE
02
IDEATE
03
DEVELOP
04
USER TESTING
05
Concept Ideation
Proposed concept flow
Features
Analysis of Brief
Ecosystem Mapping
Secondary Research
Primary Research
DILO + AEIOU
Findings
Need Analysis
User Personas
User Journey Mapping
Empathy Mapping
Need Prioritisation
Lo fi sketches
Visual Language
Hi fi Wireframes
Concept MVP Video
UserTesting
Scope
01
RESEARCH
ANALYSIS OF
BRIEF
SCENARIO
A hospital nurse has just visited a patient and needs to give him a medication. The patient has not taken the medication before, but needs to take the medication 4 more times in the next 48 hours.
The patient is currently taking 3 other medications. One medication is for a chronic condition, and the other two medications were first given when the patient arrived to the facility.
INITIAL PROBLEM
A hospital Nurse at a time could be attending to more than one patient. Keeping track of past, new and medications to be taken on a daily basis for every patient can be tedious. Since this activity is memory, focus and observation based, there can be medication dispensing errors by the nurses.
GOAL
To design a digital application for inpatient nursing staff to track the medications given to a patient. The application should be able to provide patient identifiers, Doctor identifiers and medication details.
It should allow entry and recording of new medication given to the patient, should allow access to basic patient information and history of medications administered to the patient.
Breaking down details
4n x 48hrs = 2n x 1D
1n x 1D
Unknown
Unknown
Unknown
MEDICATION
Currently Taking: 3
Newly Added: 1
On an Average, expected to take: 3-8
4.On Orders
1. Chronic
2. Through Stay, On Orders
3. Through Stay, On Orders
TYPE
DOSAGE
n- number
D-Day
1n x 12hrs
INTENT
FOR
HAVING GOAL
DESIGN A DIGITAL APPLICATION FOR INPATIENT NURSING STAFF WHO WANT TO TRACK AND RECORD THE MEDICATION DETAILS AND INTAKE OF PATIENTS
ECOSYSTEM
MAPPING
Nursing Officer
Head Nurse
Ward Nurse
Housekeeping service
DOCTORS
NURSES
PATIENT CARE
Specialists
Ward MD
Resident
Consultants
Internists
Medical Students
Casualty
Routine Admission
Short term admission
Chronic Illness
Recovering Post-Op
Pre-Op Admission
Under Observation
Life support
VARIABLES
Hospital Admin
Hospital Staff
Medical Device Mfcg
Family Support
Economic Status
SECONDARY RESEARCH
A hospital Nurse at a time could be attending to more than one patient. Keeping track of past, new and medications to be taken on a daily basis for every patient can be tedious. Since this activity is memory, focus and observation based, there can be medication dispensing errors by the nurses.
Source: Royal Pharmaceutical Society of Nursing
Source: Royal Pharmaceutical Society of Nursing
CONTRIBUTING FACTORS TO MEDICATION ERRORS
Medication errors complicate up to half of inpatient stays and some have very serious consequences
Fu-In Tang
School of Nursing, National Yang-Ming University
In this study a focus group of nine Registered Nurses discussed medication errors with which they were familiar as a result of both their own experiences and of literature review.
Of the 72 female nurses who responded, 55 (76·4%) believed more than one factor contributed to medication errors. ‘Personal neglect’ (86·1%), ‘heavy workload’ (37·5%) and ‘new staff’ (37·5%) were the three main factors in the eight categories. ‘Need to solve other problems while administering drugs,’‘advanced drug preparation without rechecking,’ and ‘new graduate’ were the top three of the 34 conditions. Medical wards (36·1%) and intensive care units (33·3%) were the two most error-prone places. The errors common to the two were ‘wrong dose’ (36·1%) and ‘wrong drug’ (26·4%). Antibiotics (38·9%) were the most commonly misadministered drugs
PERSONAL NEGLECT
HECTIC WORKLOAD
MULTIPLE PATIENTS
ADMINISTRATION OF DRUGS W/O CHECKING
WRONG DOSE
NEW
STAFF
MISINTERPRETATION OF NOTES
Although the majority of respondents considered nurse's personal neglect as the leading factor in medication errors, analysis indicated that additional factors involving the health care system, patients’ conditions and doctors’ prescriptions all contributed to administration errors.
PRIMARY RESEARCH
In order to understand the nuances involved in a nurse's duty towards their patients better, a qualitative interview was conducted. The participants were 4 practicing nurses of various levels of experience, various nature of ward duty and locations. The documentation method has varied in each case as per the participant's comfort and consent.
PARTICIPANT 1
Ms.Shirin Joseph | ICU Nurse | Exp 2 years
Breach Candy Hospital, Juhu, Mumbai
Mode of Interview: Video Conferencing
FINDINGS
-
Is frustrated about Having to write 'Nurse Notes', which is a paper based file to be submitted at the end of each shift.
-
Stated that medication errors happen often, and in her experience, is mostly due to similar names and packages.
-
Spoke about having to wait till senior consultants or Doctors clarify medication related queries, should they arise.
Click for audio
PARTICIPANT 2
Ms.Sabrina Sebastian | Isolation Ward | Exp 3.5 years
Reliance, Ghansoli, Mumbai
Mode of Interview: Text Based
FINDINGS
-
Says that freshers and new staff are more susceptible to medication errors and incidents.
-
When asked about how they keep track of time for giving medication, said that she constantly looks at her wristwatch.
-
SmartPhones are not accessible while working, how would I use a mobile application to keep track?
-
Would love to use a digital solution to tracking administration of medication, if hospital administration provides it.
PARTICIPANT 3
Mrs. Treesa Wilson | Head Nurse | Exp 15 years
Nanavati Super Speciality Hospital, Mumbai
Mode of Interview: Phone Call
PARTICIPANT 4
Mrs.Bindhu Vinod | Head Nurse | Exp 25 years
Aster Med City, Kochi, Kerala
Mode of Interview: Phone Call
FINDINGS
-
Stated- Experience teaches you, you rarely make mistakes.
-
I manage 10-12 junior nurses in one shift. Each of them come to me for cross checking, clarifications, queries and counter signature multiple times in a shift.
-
Even as a senior, I spend at-least 30-40 minutes after my shift to consolidate Notes and reports.
A DAY
IN THE LIFE
A hypothetical Day in the life of a Nurse on duty was mapped out based on some of the qualitative interview findings.
-
A typical shift comprises of 12 hours, day or night depending on the hospital schedule.
-
On an average, a nurse attends to 4 patients during a shift and is responsible for every medical, hygiene and well being aspect of the patient they attend to.
Patient:
P1: Under Observation post procedure
P2: New Admission pre surgery
P3: Recovering on IV
P4: Chronic, On Ventilator
Task Intensity
1
Level 1
2
Level 2
3
Level 3
Duration
30+ minutes
10-30 minutes
5-10 minutes
HRS
1
2
3
HANDOFF
0 30 60
Minutes
The above figure denotes the various categories of patients in the ICU ward being attended by a single Nurse. Throughout the 12 hour shift (9am to 9pm), various duties of different time durations are being performed by the nurse. The shift ends with a handover report given to the next nurse.
The Challenges observed in this scenario are as follows:
CHALLENGES
OVERLAPS
PRE AND POST PROCEDURE ALTERATIONS OF SCHEDULE
ADMINISTERING MEDICINES
PATIENT EMERGENCIES
HANDOFF- NURSE NOTES
According to the Quantitative evidence, Nursing staff use paper based, written mode of recording medicine administration to the patient. Transcription of other details are entered in the 'Nurse Note' format which is a part of their protocol. Both are time consuming procedures.
STUDYING: A TYPICAL NURSE NOTE SHEET
Events during surgery: Duration, medications and blood products given, complications and necessary interventions
Date and type of surgery, Specialist
Allergies and reactions
Past medical history
Test Results
Medications prior to surgery
Invasive devices information
Contact Information, advance directive and code status
Updates of significant evens written by each nurse at the end of shift.
Sample of a nurse's notes used during handoff
Intubation: Primary Nurse
Patients clinical state on admission to CTICU from surgery, may include update within hours
HOW ARE ADMINISTERED MEDICATIONS MARKED ON SHEETS
Date for past, current and new medications
Names oF Medication
Mode of administration
Dosage detail entry
I.V therapy records
Patients medical
details on admission
Past treatments & allergies
Miscellaneous Notes
MEDICATION ENTRY SHEET
Patients Name, age, sex, diagnosis, date of admission
AEIOU FRAMEWORK
In order to structure the observations and findings of primary and secondary research so far, the AEIOU framework has been used.
ACTIVITIES
Wake Up
Commute to Hospital
Punch-in Entry
Go Through previous shift Notes
Assigned patient rounds
Check Vitals
Assist in bedside procedure
Administer Medication
Record details
Wet Wash
Update Nurse Notes
Collect test samples
Conclude shift nurse notes
Punch-out
Commute to home
Sleep
ENVIRONMENT
Sanitised Hospital
Isolated ICU Ward
Nurses changing rooms
Hospital staff cafeteria
Mumbai- Humid Temperature
Patient Private Room
Visitors waiting room
INTERACTION
Nurse- Interacts with other nursing staff, Head Nurse, Doctors, Ward boys, Janitors.
Device Interactions- Personal Phones, Pagers, Landline facility, Desktop system.
Patient- Interacts with Doctors, Nurse and visitors
OBJECTS
Nurse:
Personal Smartphone
Pager
Pen & Paper
Blood pressure cuffs
stethoscope
Thermometer
Patient:
Medical Gadgets
Bedside bell
Bedside Medications
and refreshments
USERS
Primary use: Inpatient Nurses, for recording and updation.
Secondary use: Head Nurse, for counter confirmation
Rarely used: Doctors, for cross checking should there be a need.
JOURNEY MAPPING
CHALLENGES
AREAS OF INTERVENTION VIA THE DIGITAL APPLICATION
Nurse Shift Commences
Check Bedside Report
Has new/ special medication been prescribed?
No
Greet Patient
Sanitise hands | Put on Gloves
Check Patient ID
Yes
Obtain medication from med.room or pyxis
Counter sign medication details from head nurse
Check vitals | Perform other assessment and care
Review Patient medicine prescription form
Dosage | Name | Time | Expiry
Are further assessments needed before administering medication?
Yes
Perform assessment
Contact head nurse/ Doctor
Perform other assessment and care
Yes
Yes
Verified
Any Concerns?
Administer the medication
Does Patient have other needs?
No
No
Note down time | Dosage | Mode in bedside patient report
Transcribe this information in personal Nurse Notes in room or hallway
Remember the next dosage time and be alert
DEFINE
02
USER PERSONA
BIO
ASPIRATIONS
EXPECTATIONS
SABRINA SEBASTIAN
31 yr | FEMALE. SHE/HER | ICU NURSE
Works in the ICU ward of breach candy hospital. Is passionate about the area of work they're in.
FRUSTRATIONS
To treat her patients with utmost care, Help in rehabilitation and facilitate in a happy and comfortable hospital stay.
Patients are co-operative with medication administration on time. Previous shift nurses have clearly recorded medication details. To be able to record and transcribe medical details with ease.
-
Having to rely on one's memory for administering medication on time.
-
Recording and transcribing of medication and other patient details extends beyond shift hours.
EMPATHY MAPPING
SCENARIO BASED FOCUS AREAS
If a digital application were to be used for tracking medication administered to a patient, these would be the focus areas concerning Sabrina.
-
QUICK ACCESS TO PATIENT DETAILS
-
ACCESS TO MEDICATION DETAILS
-
GETTING THE PRESCRIPTION CROSS VERIFIED, IN CASE OF DOUBTS
-
ACCESS TO DOCTOR DETAILS
-
EASE OF ACCESS AND PLACEMENT FOR USE
-
EASE OF USE WHILE JUGGLING TASKS
-
SHOULD BE TIME SAVING AS COMPARED TO HAND WRITTEN NOTES
Empathising with the User Persona in order to understand the nuances and what goes on in the user's mind while experiencing the scenario. The findings here would help in developing concepts for the digital solution.
THINK
SEE
-
How do I reduce the chances of errors while administering medication.
-
How can the handoff be foolproof
-
If it is a digital app on my personal mobile, how do i access it during duty when it is stored away.
-
I hope I do not forget or get confused with new medication, dosage on time and overlaps.
-
If only nurse notes could be done quickly without eating into my post shift hours.
-
I wish the medication prescription reading was always foolproof
-
A busy ward, 4 other patients under my duty to look after.
-
The nurse notes are missing next to the patient's bedside
-
There is a new prescription sheet in this folder but does not correspond to the diagnosis of this patient.
-
Keeping all the medical notes sheets together.
-
Making sure they don't forget the details before they can write down.
-
Keeping an eye on the watch so as to not miss the next dosage time.
FEEL
DO
NEED ANALYSIS
ALERTNESS LEVELS IN NURSES ACROSS THE SHIFT
A study conducted by the Pennsylvania Patient Safety Reporting System (PA-PSRS) showed working a 12-hour shift or working overtime was related to having trouble staying awake during the shift, reduced sleep times and nearly three times the risk of making an error. The study also indicated the “most significant” error risk seen was when the nurses worked 12.5 hours or longer.
Activities like keeping track of medications being given, making sure the dosage is right and attending to the other needs of their patient are all tasks that are memory and focus based.
What might work for them would be a system that has got their back, somethings that requires them to not remember and note down every detail. Perhaps, a system that even informs and reminds.
The requirements comprehended from initial research, qualitative survey, user study and empathy mapping have been evaluated against the prioritisation of that particular challenge being solved and its effectiveness in the given scenario.
MUST HAVE
-
QUICK ACCESS TO PATIENT DETAILS
-
ACCESS TO MEDICATION DETAILS
-
GETTING THE PRESCRIPTION CROSS VERIFIED, IN CASE OF DOUBTS
-
ACCESS TO DOCTOR DETAILS
GOOD TO HAVE
-
EASE OF ACCESS AND PLACEMENT FOR USE
-
EASE OF USE WHILE JUGGLING TASKS
-
SHOULD BE TIME SAVING AS COMPARED TO HAND WRITTEN NOTES
OKAY TO NOT HAVE
-
ASSISTIVE SYSTEM THAT GENERATES NURSE NOTES
-
ENTERTAINING EXPERIENCE THAT CAN BE DISTRACTING
-
SHORTENING THE COUNTER SIGNATURE PROCESS FROM HEAD NURSES.
03
IDEATE
CONCEPT
IDEATION
Not compromising on Familiarity- Taking cue from the Paper Based sheets that are used for recording and tracking of medication administration by Nursing staff.
DOSAGE AND TIME
RECORDING OF INFORMATION?
PATIENT IDENTIFIERS
USE OF INSTRUMENTS/ LAB / SUPPLEMENTS
WHY MUST I ENTER AND MANAGE SO MUCH DATA ON MY PERSONAL SMARTPHONE?
SEAMLESS EXPERIENCE FOR THE NURSE- CUE- FAMILIARITY WITH SHEETS
ALERTS AND REMINDERS
CHECKING BOXES ON TIME,
REWARD SYSTEM BASED ON POINTS - NURSE OF THE MONTH?
CONTACTING DOCTORS
ERROR NOTIFYING?
DOSAGE CODE FOR PRESCRIBED MEDICATION TO AVOID ERRORS
TEST & LAB REPORTS ACCESS
BRAINSTORMING FEATURES
BEDSIDE CASE FILES AND SHEETS = BEDSIDE APPLICATION ?
IF I WERE TO USE THE COMMON DESKTOP IN THE WARD, WON'T IT BE CHAOTIC WITH SO MANY NURSES?
INTENDED
FLOW
SYSTEM DIAGRAM
USER:NURSE
APPLICATION
Patient Bedside
FEEDS DATA
TRACK
REMINDS
ALERT
VERIFY
USER FLOW
* AOM- Administration of Medication
04
DEVELOP
LO FI WIREFRAME SKETCHES
VISUAL LANGUAGE
Dark themes reduce the luminance emitted by device screens, while still meeting minimum colour contrast ratios. This also helps in lowering battery consumption for devices that are expected to run throughout the day and night. I chose a dark theme as the ICU Wards in the scenario, are dim lit, the environment is not supposed to be very bright. to Dark backgrounds help improve visual ergonomics by reducing eye strain, adjusting brightness to current lighting conditions.
HI-FI PROTOTYPE
The Standby Screen: The Countdown to the next dose of Medication to be given to the patient is shown here.
Patient’s Vitals, Medication Details, Doctor Details along with details like patients medical history and medications to be given are shown in the Overview section.
Patients profile consists of the Patient’s Demographic, ID Number, Diagnosis, past and current medical records, information of underlying condition and allergies and medical prescription.
To know about the Doctors involved in this high risk case, the User (Nurse) can browse the Doctor Details Section. Contacting the Doctors for any queries or support is possible.
A new medication can be added to the Medication Tray via prescription, Search or request for prescription.
Credentials like the Patient ID and Dosage Code is entered while adding the new medication.
Once added, the new medication details are added to the Medication Tray, and also reflects in the timer running for the patient's next dose of medication.
Once the timer indicates 'time for medication' to be administered to the patient, it sends out an alert to the standby screen.
The Nurse, after giving the medication to the patient can update it here.
The timer resets to countdown towards the next dosage time for the patient as per the data fed-in by the User.
The Standby Screen displays 'Time Until the next dose'
The Concept Video
USER TESTING
To test out this version from the real User’s point of view, I shared the prototype across to the Nurse Participants from my qualitative study. The results are to be consolidated.
SCOPE
-
tracktO, based on usability feedback can be bettered to suit the fast-paced and hectic workplace of the Nursing staff.
-
Since many protocols followed by the Nursing professionals are universal, the application could be suited for global reach.
-
Many more features that were identified during the research, can be added as per the scenario needs.
-
tracktO model can be applied to other areas of the medical profession such as lab and report services, ambulance and stretcher services, online consultations and so forth.