Using a human-centred design approach to develop a comprehensive newborn monitoring chart for inpatient care in Kenya.

Journal: BMC health services research

Volume: 21

Issue: 1

Year of Publication: 2021

Affiliated Institutions:  Athena Institute, VU University Amsterdam, Amsterdam, Netherlands. nmuinga@kemri-wellcome.org. Centre for Tropical medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, GB, England. Rice University, Houston, USA. KEMRI/Wellcome Trust Research Programme, Nairobi, Kenya. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. Sexual and Reproductive Health Group, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. Athena Institute, VU University Amsterdam, Amsterdam, Netherlands.

Abstract summary 

Job aids such as observation charts are commonly used to record inpatient nursing observations. For sick newborns, it is important to provide critical information, intervene, and tailor treatment to improve health outcomes, as countries work towards reducing neonatal mortality. However, inpatient vital sign readings are often poorly documented and little attention has been paid to the process of chart design as a method of improving care quality. Poorly designed charts do not meet user needs leading to increased mental effort, duplication, suboptimal documentation and fragmentation. We provide a detailed account of a process of designing a monitoring chart.We used a Human-Centred Design (HCD) approach to co-design a newborn monitoring chart between March and May 2019 in three workshops attended by 16-21 participants each (nurses and doctors) drawn from 14 hospitals in Kenya. We used personas, user story mapping during the workshops and observed chart completion to identify challenges with current charts and design requirements. Two new charts were piloted in four hospitals between June 2019 and February 2020 and revised in a cyclical manner.Challenges were identified regarding the chart design and supply, and how staff used existing charts. Challenges to use included limited staffing, a knowledge deficit among junior staff, poor interprofessional communication, and lack of appropriate and working equipment. We identified a strong preference from participants for one chart to capture vital signs, assessment of the baby, and feed and fluid prescription and monitoring; data that were previously captured on several charts.Adopting a Human-Centred Design approach, we designed a new comprehensive newborn monitoring chart that is unlike observation charts in the literature that only focus on vital signs. While the new chart does not address all needs, we believe that once implemented, it can help build a clearer picture of the care given to newborns.The chart was co-designed and piloted with the user and context in mind resulting in a unique monitoring chart that can be adopted in similar settings.

Authors & Co-authors:  Muinga Paton Gicheha Omoke Abejirinde Benova English Zweekhorst

Study Outcome 

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Statistics
Citations :  David Sharrow LH, Liu Y, You D, on behalf of the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) Levels and trends in child mortality 2020. UNICEF headquarters: United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) 2020.
Authors :  8
Identifiers
Doi : 1010
SSN : 1472-6963
Study Population
Male,Female
Mesh Terms
Hospitalization
Other Terms
Documentation;Human-centred design;Inpatient;Newborn;Nursing care
Study Design
Study Approach
Country of Study
Kenya
Publication Country
England