Heuristic Evaluation of the Electronic School Medication Administration Record (eSMAR) Application: Improving Medication Management in Schools

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Approximately 27% of the 50.1 million K-12 school-age children in the US experience at least one chronic medical condition requiring them to receive medication during the school day. Findings indicate that 58.4% of school nurses reported missed doses as the most common medication error, followed by the wrong time (19.0%), and the wrong dose (18.3%). To reduce errors in medication administration in schools, we developed a technology-assisted system eSMAR to help school nurses safely and efficiently manage medication administration and documentation. To ensure the safety and usability of the eSMAR system within the school environment and identify design improvement opportunities, four evaluators used Nielsen's Usability Heuristics to assess usability problems in three medication administration tasks involving creating and modifying medication administration records and administering medications. The usability problems when performing the three tasks were organized and categorized by usability design principles and rated for severity (1 to 4). Task 1, “planning and creating student’s administration records” had the most usability problems. Example usability problems included ability to proceed to the next step in the medication administration flow and managing no-shows. This evaluation revealed key design opportunities including the option to modify a medication once entered and feedback regarding past due medications. These insights will be used to refine the design of the eSMAR application. Balancing safety and usability is a main consideration the design team will need to account for while addressing the identified usability issues.