Abstract
IntroductionJob 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.MethodsWe 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.ResultsChallenges 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.DiscussionAdopting 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.ConclusionThe 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.
Highlights
Job aids such as observation charts are commonly used to record inpatient nursing observations
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
Summary
Job aids such as observation charts are commonly used to record inpatient nursing observations. It is important to provide critical information, intervene, and tailor treatment to improve health outcomes, as countries work towards reducing neonatal mortality. 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. In sub-Saharan Africa, the newborn mortality rate remains high at 27 deaths per 1000 live births in 2019 [1]. Most of these deaths are caused by preventable and treatable illnesses, such as preterm birth complications, birth asphyxia, pneumonia, congenital anomalies, diarrhoea, and malaria, emphasizing the need to strengthen health systems [3]. Hospitals provide intensive neonatal care and need to be well equipped to provide care for small and sick newborns, whether born on-site or referred [5]
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