Using Co-design To Develop An Anti-microbial Clinical Dosing Decision Support Tool

• By: WONG, Sherilyn (University Of South Australia, Australia)
• Co-author(s): Ms Sherilyn Wong (University Of South Australia, Adelaide, Australia)
  Dr Aaron Davis (University Of South Australia, Adelaide, Australia)
  Mr Philip Selby (SA Pharmacy, Royal Adelaide Hospital, Adelaide, Australia)
  Mr Richie Khoo (University Of South Australia, Adelaide, Australia)
  Prof Ian Gwilt (University Of South Australia, Adelaide, Australia)
  Dr Sophie Stocker (Sydney School of Pharmacy, The University of Sydney, Sydney, Australia / St Vincent's Clinical School, The University of New South Wales, Sydney, Australia / Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, Australia)
  Associate Prof Michael Ward (University Of South Australia, Adelaide, Australia)
  Associate Prof Stephanie Reuter (University Of South Australia, Adelaide, Australia)
  
• Abstract:

  Background information: Numerous pharmacokinetic-based clinical dosing decision support tools have been developed to support healthcare professionals with individualised drug dosing and therapeutic drug monitoring (TDM). However, poor usability and integration into workflow have partly limited their uptake in practice. This likely represents the limited involvement of healthcare professionals in the development of dosing decision support tools. This study applied co-design principles using the experiences and expertise of healthcare professionals to inform the design of an anti-microbial dosing decision support tool to address barriers in drug dosing, using vancomycin as an example.
  
  Purpose: To identify pharmacist and prescriber barriers in vancomycin drug dosing and explore how clinical dosing decision support tools can address these barriers.
  
  Method: A co-design process was conducted as a series of three workshops with pharmacists and prescribers. User journey storyboards, personas and prototyping tools were used to gather participants’ opinions on existing barriers to practice and opportunities to address these through the design of a dosing decision support tool. A prototype of the tool’s user interface was presented to participants for feedback.
  
  Results: 11 hospital pharmacists and 6 prescribers with ≥2 years of clinical experience were recruited. Participants identified a lack of confidence in vancomycin dosing and pharmacokinetic understanding, as well as difficulty in accessing practice guidelines as key barriers which could be addressed through tool implementation and design. Accessibility to information (e.g. guidelines and pharmacokinetic resources), the types of information required, and ways to visualise and communicate data depended on the needs and experience of the user.
  
  Conclusion: Clinical dosing decision support tools need to be designed with and for the end-user to promote successful translation into practice. Their design needs to be adaptable to the needs and workflow of clinical users. The whole clinical context of the patient also needs to be considered, not just the drug itself. The involvement of healthcare professionals in the development of dosing decision support tools, as well as training and education, is needed to promote tool utilisation in practice and improve individualised drug dosing and TDM.