User-centered design techniques for a computerised antibiotic decision support system in an intensive care unit

Area of Science:

• Medical Informatics
• Clinical Pharmacy
• Health Systems Engineering

Background:

• Antibiotic prescribing in intensive care units (ICUs) requires robust decision support.
• Developing effective systems necessitates understanding user needs and workflows.
• Existing tools may not adequately address the complexities of antimicrobial stewardship.

Purpose of the Study:

• To apply user-centered design techniques for requirements gathering for an ICU antibiotic decision support system (DSS).
• To develop and pilot a DSS aimed at optimizing antibiotic prescribing practices.

Main Methods:

• An observational study in a mixed medical/surgical adult ICU.
• Utilized unstructured interviews and a participatory design process.
• Developed a paper prototype and conducted case study simulations for antibiotic prescribing.

Main Results:

• Key user requirements included microbiology result collation/printing and antibiotic advice.
• The developed system, ADVISE, is a real-time microbiology browser and DSS.
• Rapid system uptake (over 6000 encounters in 6 months) and a reduction in total and broad-spectrum antibiotic use were observed.

Conclusions:

• Contextual and participatory design effectively created the antibiotic DSS.
• Physician and pharmacist ownership facilitated immediate adoption and sustained use.
• User-centered approaches are crucial for successful clinical decision support system implementation.