Abstract
Background Nurses adjust intravenous nitroglycerin infusions to provide acute relief for angina
by manually increasing or decreasing the dosage. However, titration can pose challenges,
as excessively high doses can lead to hypotension, and low doses may result in inadequate
pain relief. Clinical decision support systems (CDSSs) that predict changes in blood
pressure for nitroglycerin dose adjustments may assist nurses with titration.
Objective This study aimed to design a user interface for a CDSS for nitroglycerin dose titration
(Nitroglycerin Dose Titration Decision Support System [nitro DSS]).
Methods A user-centered design (UCD) approach, consisting of an initial qualitative study
with semistructured interviews to identify design specifications for prototype development,
was used. This was followed by three iterative rounds of usability testing. Nurses
with experience titrating nitroglycerin infusions in coronary care units participated.
Results A total of 20 nurses participated, including 7 during the qualitative study and 15
during usability testing (2 nurses participated in both phases). Analysis of the qualitative
data revealed four themes for the interface design to be (1) clear and consistent,
(2) vigilant, (3) interoperable, and (4) reliable. The major elements of the final
prototype included a feature for viewing the predicted and actual blood pressure over
time to determine the reliability of the predictions, a drop-down option to report
patient side effects, a feature to report reasons for not accepting the prediction,
and a visual alert indicating any systolic blood pressure predictions below 90 mm
Hg. Nurses' ratings on the questionnaires indicated excellent usability and acceptability
of the final nitro DSS prototype.
Conclusion This study successfully applied a UCD approach to collaborate with nurses in developing
a user interface for the nitro DSS that supports the clinical decision-making of nurses titrating nitroglycerin.
Keywords
medication management - clinical decision support systems - graphical user interface
- interfaces and usability - requirements analysis and design
