Rethinking drug administration in hospital environment through user centered design final1
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This document summarizes a study that used a user-centered design process to develop a graphical user interface (GUI) to support safer drug administration in hospitals. Interviews and observations of healthcare professionals were conducted to understand needs and identify issues. Personas, scenarios and requirements were developed. Prototypes of the GUI were created, tested with users and refined based on feedback. The final validated GUI prototype integrated safety features identified as priorities by professionals to help prevent medication errors. The study demonstrated that involving users in design can help optimize workflows and improve patient safety.
![Rethinking Drug Administration in a Hospital Environment
Through User-Centered Design
Priscila Siqueira de Alcântara
CESAR.EDU
Rua do Apolo, 81, 4° andar - Recife Antigo,
Recife, Pernambuco, Brazil
priscilasalcantara@gmail.com
Paulo Melo
CESAR − Recife Center for Advanced Studies and
Systems
Rua Bione 220, Bairro do Recife, Recife, Brazil
phfm@cesar.org.br
ABSTRACT
Administration of medicines in hospitals involve the
collaborative work of a multidisciplinary team composed of
physicians, pharmacists, nurses, technicians and other
professionals. Preventing mistakes and errors in medication
administration implies in reducing general costs in hospitals
and, most important, avoiding negative consequences for
staff and patients, and for the latter, often leading them to
death.
Decision support systems (DSS) designed through a usercentered perspective allows an efficient communication
among the different professionals and helps ensure the
correct application of medicines to patients. This paper
describes a user-centered design process aimed to conceive
a validated Graphical User Interface (GUI) to support the
administration of medications more safely by the care team
in the hospital environment.
Author Keywords
Healthcare, user-centered design, drug administration,
nursing care, decision support systems, medication errors.
ACM Classification Keywords
H.5.2. User Interfaces: User-centered design. H.5.3 Group
and
Organization
Interfaces:
Computer-supported
cooperative work, Organizational design.
INTRODUCTION
Advances in science and technology over the years has
allowed considerable improvements to promote health, and
preventing diseases. Drugs have been the main instrument
in medical treatment and health promotion. Thus, they have
become increasingly effective against epidemics that used
to decimate thousands of lives throughout the centuries
[11].
Permission to make digital or hard copies of all or part of this work for
personal or classroom use is granted without fee provided that copies are
not made or distributed for profit or commercial advantage and that copies
bear this notice and the full citation on the first page. To copy otherwise,
or republish, to post on servers or to redistribute to lists, requires prior
specific permission and/or a fee.
CHI 2009, April 4–9, 2009, Boston, Massachusetts, USA.
Copyright 2009 ACM 978-1-60558-246-7/09/04...$5.00.
Figure 1. Errors in drug administration at the
admission units [19].
Despite the numerous advances, it is still a major challenge
to administer medications to patients in hospitals safely
[11]. Social, economic and psychological aspects are key
elements to understand why drugs are not always
administered correctly. GIMENES (2007) points out that
one in ten patients admitted to a hospital suffered from drug
administration errors. These events may cause irreversible
damage in patients and sometimes even death.
As shown in figure 1, the literature indicates that most of
the errors in drug administration at the admission units
occur by the omission of medicaments [19].
A data from the Institute of Medicine of the National
Academies (IOM), an American independent organization,
estimates that thousand people die each year as a result of
medical errors. From those cases, at least 7,000 are related
to errors in medication administration. From these data,
medical errors are among the ten leading causes of death in
the United States [11, 12, 13].
In an effort to increase safety on the task of administering
medications, Sistematização da Assistência à Enfermagem,
(SAE)1, which had already been used by healthcare
professionals, became mandatory in Brazil in 2002 [9]. The
nursing model established by SAE aimed to ensure human
care, and continuous quality [5]. Additionally it made the
1
System for Nursing Support, in english.](https://image.slidesharecdn.com/rethinkingdrugadministrationinhospitalenvironmentthroughuser-centereddesignfinal1-131114055102-phpapp02/85/Rethinking-drug-administration-in-hospital-environment-through-user-centered-design-final1-1-320.jpg)
![goal of administering medications safely, one of the top
priorities of healthcare professionals, as this factor
influences the quality of the overall care provided to
patients.
The adoption of information systems has shown to be
extremely helpful while supporting professionals to make
decisions [18]. DSS, such as electronic patient record, have
allowed professionals from diverse areas being more
assertive in their work. One of the areas which benefits
from these systems, for example, is the diagnostic
medicine, which delivers more precise results with the
support of those systems.
Despite the help that these systems can bring [17], there is
still a major concern among professionals who use such
systems due to incomprehensible terms and taxonomies and
badly designed GUIs. Thus, when bad designed such
interfaces likely will have their benefits hidden by the
difficulties of use they impose. Such difficulties may cause
user frustration, mistakes and even failures during
important procedures. To avoid those problems, it is
fundamental to take into account the way professionals
actually perform their routine activities. Therefore medicine
administration, prescription, dispensing pharmacy, and all
needs that a professional may have while performing those
activities have to be observed and understood carefully to
help the design process of any system.
Although nursing informatics started more than 30 years
ago, for many healthcare professionals the ability to interact
with information systems is still scarce. Only in 2001 a
study [16] demonstrated that the different profiles of health
professionals use computing resources in different behavior
patterns, for different purposes and have different needs.
Although there is an increase in the number of institutions
engaged in providing safe electronic means for medication
prescription as a way to increase safety in the
administration of medication, there are few solutions in
healthcare information systems focused on the
professionals' needs, behaviors and healthcare workflows.
The presence of paper records, transcripts and notes and
erasures in printed pages are constant and reduce the
effectiveness of these applications. Much is due to the use
of a few fixed computers in nursing stations and often are
not designed to needs, environments, providers and specific
workflows of the hospital environment [3].
This paper describes a study whose aim was to understand
professionals' needs related to medication administration in
order to design a GUI of a DSS to support that task. The
GUI was first prototyped and then validated with potential
users following a user-centered design process.
METHODOLOGY
The awareness of the problem of patient safety by health
institutions was the main factor in the decision to rethink
the process of medication administration in hospitals using
the user-centered design.
The project described in this article has adopted Processo
de Inovação C.E.S.A.R. (PIC)2 [6] as the methodology
framework for its execution, due to its adaptability to
projects with different themes, timelines and diverse teams.
PIC is a process based on the principles of user-centered
design used by C.E.S.A.R., and has four phases: research
and studies, ideation, prototyping and user evaluation.
The research phase used several techniques: interviews,
surveys, focus groups, naturalistic observation, literature
review and benchmarking [15]. Initially, sources were
collected in the available literature regarding safety issues
in the drugs administration. During the research phase of
this project, 17 people were interviewed: one hospital
administrator, 4 nurses, 3 nursing technicians, 7
pharmacists and 2 doctors.
Field research aimed to understand what healthcare
professionals think about the safety of administering
medications in their daily lives. Furthermore, the field
research helped to observe behaviors, artifacts and
situations that could generate mistakes in medication
administration by professionals involved in this process.
Through unstructured interviews, focus groups and semistructured questionnaires was possible to identify different
causes for the problem, including: medicines not dispensed
at the correct time, lack of medication, the patient rejecting
drugs, a great amount of drugs to be managed at the same
time.
During the ideation process, the data gathered in the
research phase were converted into requirements that were
later used to create prototypes of low and high fidelity. The
prototypes generated were validated with users through
usability testing and, finally, with the applying of the
System Usability Scale (SUS) [1] with the users, it was
possible to evaluate the level of satisfaction with the
interface designed.
RESULTS
The data collected in the survey allowed a qualitative
analysis for categorization [15], and later refined with the
use of task analysis whose goal was to examine carefully
steps needed to safely administer medication to a patient in
a hospital environment [10].
Of the seven pharmacists who took part in the research,
four indicated prescription errors are the most common
causes of problems in the safe administration of
medications to patients. Half of the study participants also
reported the omission of medication as a common problem
for safe medication administration.
2
The C.E.S.A.R. Innovation Process, in english.](https://image.slidesharecdn.com/rethinkingdrugadministrationinhospitalenvironmentthroughuser-centereddesignfinal1-131114055102-phpapp02/85/Rethinking-drug-administration-in-hospital-environment-through-user-centered-design-final1-2-320.jpg)
![Figure 2. One of personas created during this study.
During the interviews, it was possible to notice that the
omission of the medication to the patient can be taken for
various reasons mentioned earlier, even some escape from
the power of healthcare professionals.
After tracing the main flow, the data collected from
respondents helped to created four personas, as illustrated
in figure 2. One for each profile: nurse, nursing technician,
pharmacist and physician. These personas were used to help
in the construction of scenarios of use of the application of
medicines in hospitals [4,14].
The benchmarking was used to analyze the checking
methods, or the way the nursing staff gives visibility to the
doctors and pharmacy staff to the successful
implementation of the prescribed procedure, used by the
professionals who participated in the study. All of them use
the check through the prescription paper. Although at least
two, a technician and a nurse have available electronic
check available. The main problems cited as justification
for the checking of items prescribed to be performed on
paper instead of electronically were small font sizes, a few
computers fixed in nursing stations and difficulty in the
process of checking the drug, due to the large number of
clicks to perform the process.
Alongside the insights gleaned from the respondents, it was
performed a web research to find software aimed to run the
checking of medication by nursing staff. Only a few options
were found. When solutions are available for nursing, they
do not meet some important requirements that were noted
for nursing during interviews, such as: see the full
prescription, appropriate font size, the patient referral or
other documents are designed for the desktop placed in the
nursing stations.
In the stage of ideation was performed a session to generate
ideas through brainstorming technique [10, 8]. The photos
that were captured during the research phase were used as
visual references of the problems encountered, as well as
highlights of the transcribed interviews during the research
were described on cards. From these references, was
created a mind map [2].
Completed the mental map of the ideation session, was
presented a list of tasks that managing the flow of drugs
was involved. This list of tasks was organized in the form
of epic scenarios, in this case, turned out to be a set of 92
user stories, simple descriptions of features, written from
the point of view of users related to the issues of
prescription and checking [7] Together with a nursing
technician and a nurse were established priority values
between 1 and 4 for each of the stories, priority 1 being the
most critical and for the less critical tasks were given a 4.
Those tasks refer to the safe administration of medication
by the care team in hospital environment. The values given
show priorities would guide the prototyped features which
would be the next phase of the study.
The resources cited as important by respondents in the
research phase, were listed, with the help of a nurse and a
nurse technician, and separated into two categories:
resources directly related to the administration of
medications and important resources for the care team, but
which, however, are not directly part of the process of drug
administration. Thus, the features listed in the first group
would be part of a positive scope of this study and would be
prototyped, while other resources would enter into the list
of negative scope. They were:
Scope positive, which will be developed through prototype
for the study:
• List of patients
• Allergies
• Prescription
• Checking
• Drug screening
Scope negative, which is necessary for the care team, but
was not addressed by this study:
• Multidisciplinary progress notes
• Viewing laboratory and image results
• Nursing diagnosis
At the end of these activities, there was a series of
prioritized requirements that would help in prototyping
module of a mobile DSS for safe administration of
medicines in hospital ready to be validated with users.
Based on the defined features, the first step of the
prototyping phase was to elaborate how to navigate among
menu options and evaluate the font size and GUI
components in a mobile application. Components were first
sketched on paper and then digitally designed with Adobe
Photoshop. A tablet was chosen as support for the
application due to the screen size, since small screen
devices have been mentioned in several interviews with](https://image.slidesharecdn.com/rethinkingdrugadministrationinhospitalenvironmentthroughuser-centereddesignfinal1-131114055102-phpapp02/85/Rethinking-drug-administration-in-hospital-environment-through-user-centered-design-final1-3-320.jpg)
![due to the fact that during the interviews the users with
older age were more reticent with regard to the use of
electronic solutions.
User evaluation of the prototypes was conducted at separate
times, requesting that each user rate from 1 to 5, each
evaluated element. For the rating 5 meant excellent and 1
meant very bad. The following items were evaluated: size
of elements, spacing between the elements and displayed
elements. The test was carried out in similar lighting
conditions to which they work in hospitals. The results of
the user evaluations were given as satisfactory, since none
of the questions was scored with a value less than 4 for any
of them.
Figure 3. One of the drafts generated from suggestions
from users in a focus group.
some resistance. Besides that a tablet is more similar to
patient's record in its traditional form, usually A4 pages.
For user evaluation, screen shots of the GUI were presented
on a tablet, 10.1”, running Android 4.0. Users were
purposely selected from different age groups for evaluation,
Having approved the basic GUI elements, along with three
users, a nurse, a pharmacist and a nursing technician, there
was a moment of co-creation, which through users
suggestions were built low-fidelity prototypes [15] on paper
as they thought the functionality of checking the
prescription and, in accordance with the requirements
established in the phases of research and ideation. The
result in one of the screens can be seen in figure 3.
Based on artifacts generated in the focus group were
created prototypes with a higher level of fidelity to the flow
Figure 4. A screen shot of the high fidelity prototype evaluated with users.](https://image.slidesharecdn.com/rethinkingdrugadministrationinhospitalenvironmentthroughuser-centereddesignfinal1-131114055102-phpapp02/85/Rethinking-drug-administration-in-hospital-environment-through-user-centered-design-final1-4-320.jpg)
Rethinking drug administration in hospital environment through user centered design final1
- 1. Rethinking Drug Administration in a Hospital Environment Through User-Centered Design Priscila Siqueira de Alcântara CESAR.EDU Rua do Apolo, 81, 4° andar - Recife Antigo, Recife, Pernambuco, Brazil priscilasalcantara@gmail.com Paulo Melo CESAR − Recife Center for Advanced Studies and Systems Rua Bione 220, Bairro do Recife, Recife, Brazil phfm@cesar.org.br ABSTRACT Administration of medicines in hospitals involve the collaborative work of a multidisciplinary team composed of physicians, pharmacists, nurses, technicians and other professionals. Preventing mistakes and errors in medication administration implies in reducing general costs in hospitals and, most important, avoiding negative consequences for staff and patients, and for the latter, often leading them to death. Decision support systems (DSS) designed through a usercentered perspective allows an efficient communication among the different professionals and helps ensure the correct application of medicines to patients. This paper describes a user-centered design process aimed to conceive a validated Graphical User Interface (GUI) to support the administration of medications more safely by the care team in the hospital environment. Author Keywords Healthcare, user-centered design, drug administration, nursing care, decision support systems, medication errors. ACM Classification Keywords H.5.2. User Interfaces: User-centered design. H.5.3 Group and Organization Interfaces: Computer-supported cooperative work, Organizational design. INTRODUCTION Advances in science and technology over the years has allowed considerable improvements to promote health, and preventing diseases. Drugs have been the main instrument in medical treatment and health promotion. Thus, they have become increasingly effective against epidemics that used to decimate thousands of lives throughout the centuries [11]. Permission to make digital or hard copies of all or part of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. To copy otherwise, or republish, to post on servers or to redistribute to lists, requires prior specific permission and/or a fee. CHI 2009, April 4–9, 2009, Boston, Massachusetts, USA. Copyright 2009 ACM 978-1-60558-246-7/09/04...$5.00. Figure 1. Errors in drug administration at the admission units [19]. Despite the numerous advances, it is still a major challenge to administer medications to patients in hospitals safely [11]. Social, economic and psychological aspects are key elements to understand why drugs are not always administered correctly. GIMENES (2007) points out that one in ten patients admitted to a hospital suffered from drug administration errors. These events may cause irreversible damage in patients and sometimes even death. As shown in figure 1, the literature indicates that most of the errors in drug administration at the admission units occur by the omission of medicaments [19]. A data from the Institute of Medicine of the National Academies (IOM), an American independent organization, estimates that thousand people die each year as a result of medical errors. From those cases, at least 7,000 are related to errors in medication administration. From these data, medical errors are among the ten leading causes of death in the United States [11, 12, 13]. In an effort to increase safety on the task of administering medications, Sistematização da Assistência à Enfermagem, (SAE)1, which had already been used by healthcare professionals, became mandatory in Brazil in 2002 [9]. The nursing model established by SAE aimed to ensure human care, and continuous quality [5]. Additionally it made the 1 System for Nursing Support, in english.
- 2. goal of administering medications safely, one of the top priorities of healthcare professionals, as this factor influences the quality of the overall care provided to patients. The adoption of information systems has shown to be extremely helpful while supporting professionals to make decisions [18]. DSS, such as electronic patient record, have allowed professionals from diverse areas being more assertive in their work. One of the areas which benefits from these systems, for example, is the diagnostic medicine, which delivers more precise results with the support of those systems. Despite the help that these systems can bring [17], there is still a major concern among professionals who use such systems due to incomprehensible terms and taxonomies and badly designed GUIs. Thus, when bad designed such interfaces likely will have their benefits hidden by the difficulties of use they impose. Such difficulties may cause user frustration, mistakes and even failures during important procedures. To avoid those problems, it is fundamental to take into account the way professionals actually perform their routine activities. Therefore medicine administration, prescription, dispensing pharmacy, and all needs that a professional may have while performing those activities have to be observed and understood carefully to help the design process of any system. Although nursing informatics started more than 30 years ago, for many healthcare professionals the ability to interact with information systems is still scarce. Only in 2001 a study [16] demonstrated that the different profiles of health professionals use computing resources in different behavior patterns, for different purposes and have different needs. Although there is an increase in the number of institutions engaged in providing safe electronic means for medication prescription as a way to increase safety in the administration of medication, there are few solutions in healthcare information systems focused on the professionals' needs, behaviors and healthcare workflows. The presence of paper records, transcripts and notes and erasures in printed pages are constant and reduce the effectiveness of these applications. Much is due to the use of a few fixed computers in nursing stations and often are not designed to needs, environments, providers and specific workflows of the hospital environment [3]. This paper describes a study whose aim was to understand professionals' needs related to medication administration in order to design a GUI of a DSS to support that task. The GUI was first prototyped and then validated with potential users following a user-centered design process. METHODOLOGY The awareness of the problem of patient safety by health institutions was the main factor in the decision to rethink the process of medication administration in hospitals using the user-centered design. The project described in this article has adopted Processo de Inovação C.E.S.A.R. (PIC)2 [6] as the methodology framework for its execution, due to its adaptability to projects with different themes, timelines and diverse teams. PIC is a process based on the principles of user-centered design used by C.E.S.A.R., and has four phases: research and studies, ideation, prototyping and user evaluation. The research phase used several techniques: interviews, surveys, focus groups, naturalistic observation, literature review and benchmarking [15]. Initially, sources were collected in the available literature regarding safety issues in the drugs administration. During the research phase of this project, 17 people were interviewed: one hospital administrator, 4 nurses, 3 nursing technicians, 7 pharmacists and 2 doctors. Field research aimed to understand what healthcare professionals think about the safety of administering medications in their daily lives. Furthermore, the field research helped to observe behaviors, artifacts and situations that could generate mistakes in medication administration by professionals involved in this process. Through unstructured interviews, focus groups and semistructured questionnaires was possible to identify different causes for the problem, including: medicines not dispensed at the correct time, lack of medication, the patient rejecting drugs, a great amount of drugs to be managed at the same time. During the ideation process, the data gathered in the research phase were converted into requirements that were later used to create prototypes of low and high fidelity. The prototypes generated were validated with users through usability testing and, finally, with the applying of the System Usability Scale (SUS) [1] with the users, it was possible to evaluate the level of satisfaction with the interface designed. RESULTS The data collected in the survey allowed a qualitative analysis for categorization [15], and later refined with the use of task analysis whose goal was to examine carefully steps needed to safely administer medication to a patient in a hospital environment [10]. Of the seven pharmacists who took part in the research, four indicated prescription errors are the most common causes of problems in the safe administration of medications to patients. Half of the study participants also reported the omission of medication as a common problem for safe medication administration. 2 The C.E.S.A.R. Innovation Process, in english.
- 3. Figure 2. One of personas created during this study. During the interviews, it was possible to notice that the omission of the medication to the patient can be taken for various reasons mentioned earlier, even some escape from the power of healthcare professionals. After tracing the main flow, the data collected from respondents helped to created four personas, as illustrated in figure 2. One for each profile: nurse, nursing technician, pharmacist and physician. These personas were used to help in the construction of scenarios of use of the application of medicines in hospitals [4,14]. The benchmarking was used to analyze the checking methods, or the way the nursing staff gives visibility to the doctors and pharmacy staff to the successful implementation of the prescribed procedure, used by the professionals who participated in the study. All of them use the check through the prescription paper. Although at least two, a technician and a nurse have available electronic check available. The main problems cited as justification for the checking of items prescribed to be performed on paper instead of electronically were small font sizes, a few computers fixed in nursing stations and difficulty in the process of checking the drug, due to the large number of clicks to perform the process. Alongside the insights gleaned from the respondents, it was performed a web research to find software aimed to run the checking of medication by nursing staff. Only a few options were found. When solutions are available for nursing, they do not meet some important requirements that were noted for nursing during interviews, such as: see the full prescription, appropriate font size, the patient referral or other documents are designed for the desktop placed in the nursing stations. In the stage of ideation was performed a session to generate ideas through brainstorming technique [10, 8]. The photos that were captured during the research phase were used as visual references of the problems encountered, as well as highlights of the transcribed interviews during the research were described on cards. From these references, was created a mind map [2]. Completed the mental map of the ideation session, was presented a list of tasks that managing the flow of drugs was involved. This list of tasks was organized in the form of epic scenarios, in this case, turned out to be a set of 92 user stories, simple descriptions of features, written from the point of view of users related to the issues of prescription and checking [7] Together with a nursing technician and a nurse were established priority values between 1 and 4 for each of the stories, priority 1 being the most critical and for the less critical tasks were given a 4. Those tasks refer to the safe administration of medication by the care team in hospital environment. The values given show priorities would guide the prototyped features which would be the next phase of the study. The resources cited as important by respondents in the research phase, were listed, with the help of a nurse and a nurse technician, and separated into two categories: resources directly related to the administration of medications and important resources for the care team, but which, however, are not directly part of the process of drug administration. Thus, the features listed in the first group would be part of a positive scope of this study and would be prototyped, while other resources would enter into the list of negative scope. They were: Scope positive, which will be developed through prototype for the study: • List of patients • Allergies • Prescription • Checking • Drug screening Scope negative, which is necessary for the care team, but was not addressed by this study: • Multidisciplinary progress notes • Viewing laboratory and image results • Nursing diagnosis At the end of these activities, there was a series of prioritized requirements that would help in prototyping module of a mobile DSS for safe administration of medicines in hospital ready to be validated with users. Based on the defined features, the first step of the prototyping phase was to elaborate how to navigate among menu options and evaluate the font size and GUI components in a mobile application. Components were first sketched on paper and then digitally designed with Adobe Photoshop. A tablet was chosen as support for the application due to the screen size, since small screen devices have been mentioned in several interviews with
- 4. due to the fact that during the interviews the users with older age were more reticent with regard to the use of electronic solutions. User evaluation of the prototypes was conducted at separate times, requesting that each user rate from 1 to 5, each evaluated element. For the rating 5 meant excellent and 1 meant very bad. The following items were evaluated: size of elements, spacing between the elements and displayed elements. The test was carried out in similar lighting conditions to which they work in hospitals. The results of the user evaluations were given as satisfactory, since none of the questions was scored with a value less than 4 for any of them. Figure 3. One of the drafts generated from suggestions from users in a focus group. some resistance. Besides that a tablet is more similar to patient's record in its traditional form, usually A4 pages. For user evaluation, screen shots of the GUI were presented on a tablet, 10.1”, running Android 4.0. Users were purposely selected from different age groups for evaluation, Having approved the basic GUI elements, along with three users, a nurse, a pharmacist and a nursing technician, there was a moment of co-creation, which through users suggestions were built low-fidelity prototypes [15] on paper as they thought the functionality of checking the prescription and, in accordance with the requirements established in the phases of research and ideation. The result in one of the screens can be seen in figure 3. Based on artifacts generated in the focus group were created prototypes with a higher level of fidelity to the flow Figure 4. A screen shot of the high fidelity prototype evaluated with users.
- 5. of the main functions of medication administration in a hospital: patient list, and checking the prescription (figure 4). With a set of prototypes representing the flow of step-bystep prescription and administration of drugs in patients, it was evaluated once again with the same pair of users. The flow test followed in the evaluation with users was: assigns the task to the user, before the prototype screen where it runs, then the user performs the task as understand and displays the result of a user action with the following screen prototyped. After the flow test the prototypes, the participants were asked to answer a questionnaire of satisfaction in the same way the SUS to assess the scale of satisfaction with the prototype. The average SUS scores among the results from the users was 80% satisfaction with the use of the interface. Through evaluation it was found the need to improve the highlight of alert items such as drug interaction, duplicate item on prescription and prescription item to which the patient is allergic. The prototype was updated according to users´ feedback. With all the steps applied (figure 5), it was possible to obtain a GUI prototype validated to support the administration of medications more safely constructed through the process of user-centered design. them. The use of a technological solution that meets the needs of users in healthcare has the power to optimize their processes and improve productivity, causing the patient to be treated more safely and less costly for institutions and healthcare professionals. Involve users in the design process of product implies in understanding their routine, their desires and needs. It requires time and a collaborative work, but it will bring as a consequence the users´ satisfaction while interaction with those products. The field for the user-centered design in health care is large and still unexplored. FUTURE WORKS This study opens up a range of new possibilities for creating other modules of an electronic patient record through an user-centered approach. The negative scope raised during the ideation phase is related to some of the functionality needed to care team, such as: a multidisciplinary progress notes, viewing laboratory and image results, nursing diagnosis, for example. It is also possible to extend this study by investigating the logistics network of medicines in hospitals and deepen the processes of drug screening using, for example, technologies as radio frequency. ACKNOWLEDGMENTS We thank those who made this project possible in different ways: the CESAR, its methodology for providing PIC used in this research. Professionals who participated in the research project responding to questionnaires and interviews, as well as testing and validating the artifacts, donating your precious time. Those who included our presence in their lives and abdicated your time with us while we perform this project and to those who supported us, each in his own way. REFERENCES 1. Brooke, J.. “SUS: a “quick and dirty” usability scale” in P. W. Jordan, B. Thomas, B. A. Weerdmeester, & A. L. McClelland. Usability Evaluation in Industry. London: Taylor and Francis. (1996). 2. Buzan, T.. Mapas mentais e sua elaboração: um sistema definitivo de pensamento que transformará a sua vida / Tony Buzan; translate Euclides Luiz Calloni, Celusa Margô Wosgrau, São Paulo, Cultrix, (2005). Figure 5. Process flow followed during the study. CONCLUSION This project showed the importance of designing DSS in healthcare from a user-centric perspective and benefits that such methodology can offer. The healthcare industry still lacks solutions designed for its professionals and through 3. Callen, J., Paoloni, R., Georgiou, A., Prgomet, M., Westbrook, J.. “The rate of missed test results in an emergency department an evaluation using an electronic test order and results viewing system”. Methods of Information in Medicine, (2010), 37-43. 4. Carroll, J.M., “Five Reasons for Scenario-Based Design”. In: Proceedings of the 32nd Hawaii International Conference on System Sciences, (1999)
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