Impact of systematic user testing of written guidance on the rate of moderate to severe errors made by hospital nurses during in situ simulation of the preparation and administration of an intravenous medicine

Up to half of medicine injections are prepared or given in the wrong way. This can cause serious patient harm. To help prevent these mistakes, the NHS produces the Injectable Medicines Guide (IMG). This tells nurses how to prepare each injection correctly. Some people think that the IMG is confusing for nurses. This is worrying, as research shows that confusing information can cause mistakes. So improving the way the IMG is written might lead to fewer mistakes.

One way to improve the way something is written is user testing. The people who use the information are asked to use it to find specific important facts and then give their comments on how it is written. User testing is used to improve every patient information leaflet about medicines. User testing might be a good way to improve the IMG, but it has only been used once before for information about medicines written for doctors or nurses.

This research will find out whether it is possible to reduce the number of medicine mistakes by giving nurses a more clearly written IMG. To do this, the research aims to do four things:
- Use user testing to improve the IMG information about one medicine.
- Test whether nurses make fewer mistakes when using the new IMG
compared with using the old IMG.
- Calculate whether user testing the IMG will save money.
- Recommend ways to improve future versions of the IMG.

The IMG information on medicines called voriconazole and aminophylline will be used. They have been chosen because they are complicated injections to give. During this research, the real medicine names will be changed to invented names, so that nurses cannot use their memory of giving these medicines before.

The current IMG information on voriconazole and aminophylline will be improved by three rounds of user testing. In each round, ten nurses will be asked to find specific information in the document. This will highlight which pieces of information are not well explained. They will then be interviewed about problems with the document, such as the order of the information or the words used. These interviews will be recorded and typed up. The
text of all the interviews will be examined to find shared opinions and ideas.

Using these findings and what is already known about writing clearly, the IMG information will be rewritten to make it clearer. It will then be user tested and revised twice more to produce a new version of the IMG information.

The new and old versions of the voriconazole information will then be compared, to see which one leads to fewer mistakes when giving an injection. This will involve at least 242 nurses working on their usual hospital ward. Each nurse will be asked to give a dose of medicine to a mock patient. They will be randomly given either the new or old version of the IMG to help them. The researcher will watch each nurse and make a note of any mistakes they make. Any nurse who makes a mistake will be interviewed to find out why.

Next, a group of experienced doctors, nurses and pharmacists will agree whether each mistake would have had a minor, moderate or severe effect on the patient. The main result from this part of the research will be the number of moderate or severe mistakes made using the new and old IMG.

The cost of the user testing will be calculated and compared with the costs saved by reducing mistakes.

This research has been designed with advice from the nurses and pharmacists who produce and use the IMG. These people will join an advisory group to continue to give advice as the research is carried out. Two members of the public will be asked to join a lay advisory group. They will learn more about the project and help share the results with other members of the public.

This research will benefit patients by recommending ways to improve future versions of the IMG, which should reduce the number of mistakes. In the future, the entire IMG might be improved by user testing. The results will be shared with the advisory group so they can quickly use them to improve the guide. The results will also be shared with NHS medicines information pharmacists, who might wish to use user testing when they write other types of safety information.