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. 2019 Dec 25;10(5):981–990. doi: 10.1055/s-0039-3402714

Table 2. Major design changes made to the original design and DEC orders and order sets based on formative usability testing, resulting in the development of UCD orders and order sets.

Design change Rationale
Original design and DEC: when user selects blood product, both “prepare” and “transfuse” orders are default checked.
UCD: When user selects blood product, “prepare” order is default checked but not “transfuse” order. If user signs “prepare” order without pre-op indication and no “transfuse” order present, sees alert to confirm.
In formative testing, 2 of 3 providers signaled nurse to transfuse when scenario did not call for it with original design and DEC.
With UCD, no transfuse orders placed when scenario did not call for it, but 1 of 16 providers did not signal nurse to transfuse when scenario did call for it.
Original design and DEC: when preparing blood products in mL, always ask volume of 1st aliquot and volume of 2nd aliquot a .
UCD: ask for 1st aliquot volume, then ask “2nd aliquot needed?” If yes, cascade to 2nd aliquot volume.
In scenario requiring only 1 aliquot, 2 users entered the volume for both 1st and 2nd aliquot with the original design and DEC, which would lead to over transfusion.
Original design: separate order sets for general, OR, and Hem/Onc populations.
DEC: collapsed into 1 order set with sections for “non-OR, general,” “non-OR, Hem/Onc,” “OR general,” “OR Hem/Onc.”
UCD: single order set with “non-OR,” “OR,” and “emergency O-negative” sections; no special Hem/Onc sections.
In scenarios of Hem/Onc patients, 2 participants made order selections in the wrong subsection for the clinical scenario (“OR” vs. “non-OR”), leading to inaccurate use of “transfuse” order.
Original design and DEC: User can order split aliquots a when ordering by volume, not by units.
UCD: allow option to order 1/2 unit packed red blood cells or platelets; when 1/2 unit selection, cascade option of “2nd aliquot needed?”
Anesthesia and Hem/Onc providers described use cases for ordering 1/2 unit packed red blood cells. In original design and DEC, these providers wrote instructions to split a single unit in the order comments, which were sometimes missed by blood bank technologists and risks over-transfusion.
Original design and DEC: ask providers to choose each special processing request (i.e., irradiated, washed, phenotypically similar, CMV-negative, etc.).
UCD: ask providers if indications present for each special processing request and provide buttons to select indication.
Multiple providers did not know when to select special processing requests because they didn't know the indications requiring special processing and made frequent errors. When participants were presented with a list of indications, accuracy and reported satisfaction increased.
Original design and DEC : when ordering 2 aliquots, order 2 occurrences of “transfuse” order so nurse can document administration of each aliquot.
UCD: each aliquot requires separate “Transfuse” order; require user to specify nursing tasks before 2nd aliquot (e.g., “notify MD,” “Draw Labs”).
Hem/Onc participants noted that nurse would often transfuse both aliquots without seeing instructions to notify provider or draw laboratories. Original design and DEC provided affordance to administer and document 2nd aliquot.
UCD removed this affordance and made instructions for tasks between aliquots more prominent for nurse.

Abbreviations: CMV, cytomegalovirus; DEC, design by expert committee; Hem/Onc, hematology/oncology; OR, operating room; UCD, user-centered design.

a

Smaller pediatric patients cannot receive full units of blood product and are therefore transfused in mL aliquots. The blood product is allocated to the individual patient and reserved for future aliquots as needed for the same patient to minimize antigen exposure and the risk of developing alloantibodies, especially for patients requiring frequent transfusions.