Patient Rounding Tool

A web and iOS application that allows nurse leaders to round on patients and employees, and document issues.

Role: Lead Product Designer. I worked with the product analyst and business analyst teams to collaborate on design ideas and execute the final design.

Problem

When a patient is admitted to the ICU, their blood glucose (BG) levels are closely monitored. If the patient’s BG levels jump too high, the nurse must administer insulin. This is typically done through an IV drip which slowly administers the insulin for several hours. Sometimes the nurse must administer a subcutaneous (SubQ) dose of insulin via injection. Determining the correct dosage and drip rate isn’t simple. There’s a complex protocol that contains pages of “if this, then that” statements that the nurse must use to calculate the dosage. In many hospitals, this is done on paper and takes a significant amount of time and leaves a large margin of error—two things that negatively impact patient care. The Clinical Informatics Group asked us to turn the protocol into a phone app that nurses could use bedside. We were asked by the Clinical Informatics Group to “put the protocol in an app.” Having worked with nurses on other applications, we felt that an app could provide more value than just being a calculator. We knew there would likely be value in seeing a list of patients on a selected unit as well as seeing the patient’s glycemic history. We also wanted to understand what the workflow looked like and how this application would fit in the process. What happens when a nurse goes into a patient’s room to get their BG reading? After they get the dosage, how do they administer the insulin? How do they document the reading and dose? Where is it recorded?

An excerpt from the Portland Protocol

Communication

Because I don’t have a clinical background, it was a challenge to understand the nursing workflow and the requirements. Because the Clinical Informatics Group wasn’t familiar with the product development, they were frustrated by the discovery process and our questions. I finally had to sit down with the team and say “I went to design school, and I don’t have a clinical background—I need your help to understand how this works in the hospital.” I also used a storyboard to show the workflow as I understood it to illustrate my point. Things immediately clicked with the team, and from then on they became excellent collaborators.

User Testing

It can be difficult to find time to user test with clinicians. They are often very enthusiastic participants, but trying to carve out 30 minutes in their workday is a struggle. In this project, we had to run our prototype tests over Webex and were only able to test with a few people. I made the mistake of using random numbers in my initial prototype, which derailed the conversation as the clinicians tried to make sense of my fake data. I quickly consulted with the Clinical Informatics Group (who were former clinicians) to get the data to look more realistic.

Data Density

A constant challenge in healthcare UX is data density. You have to display an extraordinary amount of complex data in a way that makes sense. You can’t use too much white space because nurses need to see everything at a glance. But, you can’t condense the information too much because then you run into accessibility issues. There are no hard and fast rules about what works. Because the company uses iPhones as shared devices in the hospital, our iOS design kit is based on Apple’s HIG. I reference the Apple Health App and the Settings App when I’m looking for a concise way to display complex data.

Unique Challenges

Solution

Using HCA’s design system, Neutron, and Apple’s HIG, I created a detailed wireframe of the Glycemic Dosing tool. From there, our design intern Rachel finished out the high fidelity comps.

The application opens to the patient list of the selected unit. The nurse can gets a quick overview of a patient’s stats and when they’re due for a BG check. The nurse taps into the patient profile and can see a detailed history of the patient’s BG checks and doses.

  • Patient List

    Showing a list of ICU patients on an insulin drip. Each row gives the patient’s name, DOB, diabetic type, room number, and last A1c levels. It also shows when a patient is due for their next check and if they’re last reading was hyper- or hypoglycemic.

  • Patient Overview

    The patient’s overview page shows high level details, followed by the last BG reading with a button to start the dosing process. The nurse can also see the patient’s IV Insulin History, which can give them insight into the patient’s overall progress and health.

  • Enter Insulin

    After tapping “Get IV Insulin Dosage,” the nurse double checks the date and time and inputs the patient’s glucose level from the bedside monitor.

  • Drip Adjusted Confirmation

    After tapping get dosage, the app calculates the drip rate and dosage details. Some hospitals require another nurse to sign off that the drip rate was calculated and adjusted. We have a field for the second signer to input their employee ID. From there, the nurse can confirm the drip rate.

This engagement wrapped in March 2020 and was preparing to go into development. Unfortunately, the pandemic forced the company paused all non-COVID related projects indefinitely. Even though this project didn’t go to production, I still think it was a cool problem to solve.

Outcomes