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

ObjectiveTo explore the use of user-centered design techniques for developing the requirements for an antibiotic decision support system (DSS) in an intensive care unit (ICU).Design and methodologyThe setting was a 21-bed mixed medical/surgical adult ICU. This was an observational study with unstructured interviews and participatory design process. Models were constructed to demonstrate cultural, workflow, sequence/trigger events and other artefacts used to support antibiotic prescribing in the ICU. Using participatory design, a paper prototype was developed and case studies were used to simulate antibiotic prescribing for bacterial isolates. This information was used to design and pilot the decision support tool.ResultsThe key users were identified as residents, registrars and the unit pharmacist. They identified the major requirements: ability to collate and print microbiology results, and to provide education and antibiotic advice for isolates. The final product was a real time microbiology browser and decision support tool for antibiotic prescribing (ADVISE). Uptake of the system was rapid with over 6000 encounters in the first 6 months. An audit of antibiotic use performed on all consecutive patients 6 months before and after introducing the DSS demonstrated a reduction in total and broad-spectrum antibiotics.ConclusionContextual design methodology in conjunction with participatory design was an effective method to design this antibiotic decision support tool. The process facilitated physician and pharmacist ownership of the system that resulted in immediate uptake and ongoing use.