Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
Women's College Hospital Research and Innovation Institute, Toronto, Canada.
Appl Clin Inform. 2024 May;15(3):583-599. doi: 10.1055/s-0044-1787755. Epub 2024 Jul 24.
Nurses adjust intravenous nitroglycerin infusions to provide acute relief for angina by manually increasing or decreasing the dosage. However, titration can pose challenges, as excessively high doses can lead to hypotension, and low doses may result in inadequate pain relief. Clinical decision support systems (CDSSs) that predict changes in blood pressure for nitroglycerin dose adjustments may assist nurses with titration.
This study aimed to design a user interface for a CDSS for nitroglycerin dose titration (glycerin Dose Titration ecision upport ystem []).
A user-centered design (UCD) approach, consisting of an initial qualitative study with semistructured interviews to identify design specifications for prototype development, was used. This was followed by three iterative rounds of usability testing. Nurses with experience titrating nitroglycerin infusions in coronary care units participated.
A total of 20 nurses participated, including 7 during the qualitative study and 15 during usability testing (2 nurses participated in both phases). Analysis of the qualitative data revealed four themes for the interface design to be (1) clear and consistent, (2) vigilant, (3) interoperable, and (4) reliable. The major elements of the final prototype included a feature for viewing the predicted and actual blood pressure over time to determine the reliability of the predictions, a drop-down option to report patient side effects, a feature to report reasons for not accepting the prediction, and a visual alert indicating any systolic blood pressure predictions below 90 mm Hg. Nurses' ratings on the questionnaires indicated excellent usability and acceptability of the final prototype.
This study successfully applied a UCD approach to collaborate with nurses in developing a user interface for the that supports the clinical decision-making of nurses titrating nitroglycerin.
护士通过手动增加或减少剂量来调整静脉硝酸甘油输注，以提供心绞痛的急性缓解。然而，滴定可能会带来挑战，因为过高的剂量会导致低血压，而过低的剂量可能导致疼痛缓解不足。预测硝酸甘油剂量调整时血压变化的临床决策支持系统（CDSS）可能有助于护士进行滴定。
本研究旨在设计用于硝酸甘油剂量滴定的 CDSS 的用户界面（甘油剂量滴定决策支持系统[]）。
采用以用户为中心的设计（UCD）方法，包括初步的定性研究和半结构化访谈，以确定原型开发的设计规范，然后进行三轮迭代可用性测试。参与的护士均具有在冠心病监护病房中调整硝酸甘油输注的经验。
共有 20 名护士参与，其中包括 7 名在定性研究中，15 名在可用性测试中（2 名护士同时参加了两个阶段）。对定性数据的分析揭示了界面设计的四个主题，分别是（1）清晰一致，（2）警惕，（3）互操作性和（4）可靠性。最终原型的主要元素包括一个功能，用于查看随时间推移的预测和实际血压，以确定预测的可靠性，一个用于报告患者副作用的下拉选项，一个用于报告不接受预测的原因的功能，以及一个视觉警报，表示任何收缩压预测低于 90mmHg。护士在问卷上的评分表明，最终原型具有出色的可用性和可接受性。
本研究成功应用了 UCD 方法，与护士合作开发了用于支持护士滴定硝酸甘油的临床决策的用户界面。
