User testing to improve the content, wording, structure and formatting of the NHS Injectable Medicines Guide

M.D. Jones, B.D. Franklin, D.K.T. Raynor, M. Watson

Research output: Contribution to journalConference Contributionpeer-review

1 Citation (Scopus)


Introduction: The NHS Injectable Medicines Guide (IMG) is used by nurses in ˜125 hospitals to guide the preparation and administration of intravenous medicines. Surveys suggest it is overly detailed and confusing[1]. This may make it difficult to find relevant, unambiguous information and could lead to serious medication errors.

Aim: We aimed to identify and resolve problems in two typical IMG monographs via user testing – a diagnostic testing method mainly used for patient‐facing information[2].

Method: We recruited 30 nurses from 3 hospitals who administer intravenous medicines during at least 50% of shifts. These users tested existing IMG monographs for voriconazole and aminophylline via three iterative rounds of ten interviews, each followed by monograph revision.

Each interview included direct questions to determine whether the participant could locate and use key points of information (KPIs). Responses were compared with pre‐specified answers to determine whether participants could find and fully explain each KPI. The interview concluded with open questions to explore views on monograph content and format (analysed thematically).

The study was approved by the University of Bath Research Ethics Approval Committee for Health and the Health Research Authority.

Results: The number of participants unable to find/explain KPIs decreased following monograph revisions made between rounds 1 and 2 (see table). Based on feedback and information design best practice, these changes included combining the ‘reconstitution’ and ‘dilution’ sections, a new ‘before treatment’ section, greater use of tables to reduce the need for calculations, example calculations and increased visual differentiation among sections.

Similarly, the number of participants unable to find/explain KPIs decreased following the revisions made between rounds 2 and 3. Fewer changes were necessary, but these included use of colour to highlight the ‘preparation’ and ‘administration’ sections, moving and revising the description of the concentration of reconstituted voriconazole, highlighting the link to a table of voriconazole infusion rates, and a pictogram to highlight the aminophylline NPSA alert.

Conclusion: The original monographs performed poorly for several important KPIs. The user testing process improved monograph performance in the interview context. However, this is a limitation of the study, as an interview is significantly different from the context where the IMG is used. A subsequent study will use a randomised in situ simulation design to determine whether user testing results in fewer administration errors in a ward environment.
Original languageEnglish
Pages (from-to)45-46
Number of pages2
JournalInternational Journal of Pharmacy Practice
Issue numberS2
Early online date3 Apr 2019
Publication statusPublished - 30 Apr 2019


  • user testing
  • NHS
  • injectible medicines guides

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