Anna Zandanel - Design & Innovation in Intensive Medicine Administration

Design & Innovation in Intensive
Medicine Administration

Healthcare Experience Design - Boston 2012 | Anna Zandanel | azandanel@iuav.it

User Experience Design

> [...] The first requirement for an exemplary user experience is to meet
the exact needs of the customer, without fuss or bother. Next comes
simplicity and elegance that produce products that are a joy to own, a joy to
use. True user experience goes far beyond giving customers what they say
they want, or providing checklist features. In order to achieve high-quality
user experience [...] must be a seamless merging of the services of
multiple disciplines [...]
(Nielsen- Norman Group Definition)


happy user!


User Experience Design and co-working

In a very complex area as Healthcare one, designers have to work closely
to specialists of the field (such as doctors, nuersers and medical staff in
general), depening on aims and topics of the work.
Collaborate with different experts bring to co-design.
Co-design is a development of systems thinking which, according to C. West
Churchman: «begins when first you view the world through the eyes of
another».


Design and Innovation in Intensive Medicine
Administration

Research project | topics
1. chemotherapic medicine preparation, management
and administration
2. design sciences as process analysis and improvement possibility

Partners
1. IUAV, University, New Design Frontiers Research Unit
2. Monico spa, medicine company
3. Fondazione Oncologica Trevigiana, foundation for
cancer problems studies


Design and Innovation in Intensive Medicine
Administration

Aims
1. find critical points at the status quo
2. improve security and efficency in the path
3. reduce errors in processes
4. improve chemoterapic medicine treacibility

Methodology
first 6 months last 6 months
obervations proposals
> behaviors > concepts
> state of the art > strategies
> technologies > products

ETHNOGRAPHY QUESTIONNAIRES


Chemotherapy path in the Ca’ Foncello
Hospital, Treviso (Italy)


Production
The company that represents production in this
project is Monico spa. They produce vials, bottles
and pockets with different medicines.

Problems:

> communication/ graphics on vials
> medicine management inside
Hospitals
> medicine monitoring

Potassium and Glucose Vials


Production/ Pharmacy
Warehouse
In the warehouse medicine were stocked
with elastics on open shelves in an unsafe
and untidy way.


Distribution- Pharmacy Warehouse

In the Warehouse staff and pharmacists cannot
find easily medicines. Stocking has not an order,
graphics are not clear, space is not enough...

Questionnaires were administrated to staff and
pharmacists: none was satisfied by the situation
and everybody felt frustrated.

Several problems came out: discontent staff,
limited and sad space, chaos, bad lighting
system, difficult personal relations, unsafe, ...


Production/ Pharmacy
Warehouse
To increase its value, Monico spa can
develop and SRP (Shelf Ready Packaging),
useful to hospitals.


“Quick and dirty” solutions
Chaos on shelves > dispenser


before after (prototype)


fs 46450
TERADOSI NA
cp 5m g
before after



Bad graphics, chaos > labels, regular graphics,
signal

fv345gz fv345gz fv345g z
CIPROFLOXACINA C I P RO F LOXAC I NA PA L O N O S E T R O N
250mg 250m g 250m c g

PALONOSETRON
fv345gz fv345gz fv345gz

250mcg
CIPROFLOXACINA CIPROFLOXACINA
250mg 250mg

CALCIO LEVOFOLIANTO
fv345gz fv345gz
PENTAIDRATO 100 mg
CIPROFLOXACINA
250mg

fv345gz
CALCIO LEVOFOLINATO
PENTAIDRATO 100mg

INIETTABILI USI TOPICI

NON INIETTABILI ONCOLOGICI

ANTIBIOTICI FUORI PRONTUARIO


Chemoterapy medicines > before


Chemoterapy medicines > after (they were already working on it)



Bad graphics, chaos > labels, regular graphics,
signal

A
B


Prescription

Several observations were conducted in the
Cancer Ward and in the Day Hospital Section.
Questionnaires were administrated to doctors
and nurses.
Every document is still on paper and that doctors
have the worst handwriting ever.
Misunderstanding and explanation requests are
a lot, every day, and they cause interruptions
and concentration brakes.
More, doctors are just a few and they can
dedicate only 15 min to each patient.

The Main Problem is that they cannot have
money easily by the Public HealthCare Service.


Prescription
Transcribing errors, time for documents >
software development with users’ requests

Treviso, Cancer Ward, Doctors and Pharmacist’s desktop
On the Right, Bozen, Diluition Area, Pharmacist’s desktop


Prescription
Questionnaires to physicians. Some results

Necessity of Difficulty in
doctors handwriting reading colleagues’
legibility handwriting: 45%
improvment: 100%

Frequency of
not compiling all
the requested
documents: 75%

Questionnaire extract: handwriting
example


Prescription
Questionnaires to nurses. Some results- CANCER WARD

Wrong Lackness in
chemoterapy communication
typology about fundamental
trasnscription data from doctor to
22% patient 50%

Wrong
chemoterapy
dosage
trasnscription
22%

Medical errors noticed by nurses in Ca’ Foncello Hospital Cancer Ward


Prescription
Questionnaires to nurses. Some results- DAY HOSPITAL

Wrong Lackness in
chemoterapy communication
typology about fundamental
trasnscription data from doctor to
40% patient 50%

Wrong
chemoterapy
dosage
trasnscription
50%

Medical errors noticed by nurses in Ca’ Foncello Hospital Cancer Day
Hospital. Please note that data are referred to possibility of error:
nurses always stop documents and ask for clarifing to doctors!


Prescription
Questionnaires to nurses. Some results- CANCER WARD

Difficulty
Difficulty in in checking
home therapies patients
identification understand
34% important infos
66%

Difficulty in
medicine
intake checking
40%

Difficulties in realtionships with patients


Prescription
Questionnaires to nurses. Some results- DAY HOSPITAL

Difficulty
Difficulty in in checking
home therapies medicine
identification intakement hour
61% 73%

Difficulty in
medicine
intakement
checking
63%

Difficulties in realtionships with patients


Prescription
Domiciliar therapies notebook

legible and clear font

N.B. Si raccomanda di portare con sè, durante la prima visita,
oltre a questo diario, anche le confezioni dei farmaci che
CHE FARMACI PRENDO A CASA?
normalmente vengono assunti a casa. Le mie terapie domiciliari

Per domande e assistenza, contattare il DH dalla 08:00 alle
12:00, dal lunedì al venerdì. Telefono: 0422******

instructions (just
for testing period
packagings are
required to first
visit- to check)

NOME PAZIENTE ______________________

Diario delle terapie domiciliari, da portare con sè
per le visite in ospedale e le somministrazioni di
chemioterpia.
Università IUAV di venezia con
Fondazione Oncologica Trevigiana Piazzale Ospedale, 1
c/o Oncologia Medica Ospedale “Ca’ Foncello”, 31100
Treviso | info@fondazioneoncologicatrevigiana.it.
description

contacts


Prescription
Domiciliar therapies notebook-inside
notes
contents clarity

COME SI CHIAMA? CHE DOSE? CHE COS’È? QUANDO? NOTE
nome del farmaco dosaggio forma farmaceutica assunzione

crema tisana colluttorio mattino altro
pastiglie puntura supposta pomeriggio
gocce bustina cerotti sera







suggested answers


Diluition

Questionnaires and Observations underlined an
high stress level. Nurses don’t feel safe diluiting
(chemoterapy is carcinogenic).
They don’t report any waste or odds at the end
of the day. The Ward spent 94,3% of its budget
for chemotherapies (5,1 mln €, 16,8% of the
Hospital ULSS 9 total budget).
Italian Department of Health discovered 10%
of wrong/failed medicine administration into
hospitals, that extends initial patient prognosis
of 2/3 days > avioding handwriting is
necessary!

Software personalized requirments are being
collected by questionnaires results and given to
sofware developers.


Conclusion


Conclusion

99 A lot of projects could start from this first research

99 Many problems were discovered, but we decided to focus on a few of
them

99 Co-designing was the best way to solve problems

Constructing the whole User Experience following people’s attitudes help to
generate a useful and winning Innovation and can be particulary satisfying
in Wellness and Healthcare.


Thank you!
Questions?

azandanel@iuav.it
skype: anna_zandanel

Anna Zandanel - Design & Innovation in Intensive Medicine Administration

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