Table 2 Issues uncovered during Round 2 testing, illustrative quotes and recommended changes to the CDS tool

Users reported that the total DBI score on the MPage could be made more obvious, as this was lost among other information

The score here didn't really jump out in my eyes because of the graph is so more visually stimulating that I didn't actually realise that was there. (P10)

Increase font size of DBI total score

Users were confused about what medications were listed—were these only for the current admission?

Just to clarify, I know the status is on there, or are these drugs ordered on the drug chart currently? (P12)

Include a title above the medication list to indicate that these are current active orders from the current admission

When previous dots on the graph were clicked, it was not clear to users that the med list changed to reflect medication orders current on that day

I can see that if you click on the dots, you can actually see the DBI as the medications change. However, my first instinct was just to hover because in the “between the flags” section of the EMR you can just hover around the blood pressures and it will tell you what it is. (P6)

When previous dates are being viewed (i.e. previous dots are clicked), 1) Change the title on the medication list to indicate that this is a previous list (consider inserting date) and 2) Lighten medications (grey out) to make clear that these are not current medications

It was not clear to users that PRNs were not included in the DBI calculation and almost all users asked about this

It implies that these ones aren’t risky drugs at all … is there some place you could put a little note saying that it’s PRN and that’s why it’s not in the calculation? (P13)

Include a statement near the DBI total score to explain that PRNs are excluded

Users were confused about which dates were being displayed

We’re used to, with the results page or the obs(ervation) page, seeing the date across the top (P11)

Include dates on the DBI graph consistent with format of other graphs in EMR (e.g. “Between the flags” graph)

Users did not access the ‘?’ but asked about DBI, what it means and how it is calculated (for what patient ages, are stat medications included, based on orders or administrations?)

I think this little question mark, I think if you had like ‘What is the DBI?’ or something because I don't know if people would know to go and look up there for. (P12)

Include a ‘what is DBI’ hyperlink on the MPage which describes what DBI is and how it is calculated