Information Architecture Analysis of ICU Medication Management Plans

A Card Sorting Study Evaluating Template Design Requirements for Intensive Care Unit Pharmacy Practice

Author

Affiliation

Rayan Nabizada

Monash Health Pharmacy

Keywords

ICU, pharmacy, medication management, information architecture, card sorting, healthcare informatics, clinical documentation

1 Executive Summary

This report presents findings from a card sorting study conducted to inform the redesign of Intensive Care Unit (ICU) Medication Management Plans (MMPs). The study, conducted as the second phase of a comprehensive ICU MMP review following an initial audit, evaluated information architecture preferences among ICU pharmacists using unmoderated closed card sorting methodology.

Key Findings:

• Strong evidence supporting the hypothesis that generic pharmacy MMP templates are inadequate for ICU patients
• Clear bifurcation emerged between Background Information and ICU-Specific MMP Structure categories
• 100% consensus on placement of core medication management elements (New, Ceased, Suspended medications, Medication Issues)
• High agreement (75-88%) on ICU-specific elements requiring dedicated template sections
• Preference for simplified formatting with minimal color usage and context-aware documentation

Primary Recommendation: Expand current generic pharmacy MMP templates to include dedicated ICU-specific therapeutic domain sections, moving beyond traditional home medication management to comprehensive ICU medication oversight.

2 Introduction

2.1 Background

Intensive Care Unit pharmacy practice requires specialized documentation approaches that differ significantly from general pharmacy services. The complexity of ICU patients, rapid medication changes, and critical nature of therapeutic decisions demand information architecture that supports efficient clinical decision-making.

2.2 Study Rationale

Following an initial audit of current ICU MMP practices, this card sorting study was designed to test the hypothesis that current generic pharmacy MMP templates are not suitable for ICU patients and that additional ICU-specific elements are required. The study aimed to identify intuitive information groupings and labeling patterns among ICU pharmacists to inform evidence-based template redesign.

2.3 Objectives

1. Evaluate the appropriateness of current generic MMP templates for ICU use
2. Identify distinct information categories required for ICU medication management
3. Determine consensus on placement of ICU-specific documentation elements
4. Gather preferences for formatting and workflow considerations

3 Methodology

3.1 Study Design

Unmoderated closed card sorting was conducted using the UXtweak platform between May 20, 2025, and June 19, 2025. This methodology allowed participants to categorize MMP-related items under headings of their choosing, revealing natural mental models of information organization.

3.2 Participants

• Total recruited: 12 ICU pharmacists
• Completed: 8 participants (67% completion rate)
• Site: Monash Health, Multiple Sites
• Experience levels: 50% (<1 year), 25% (1-3 years), 25% (>7 years)

3.3 Data Collection

Participants completed: 1. Pre-study questionnaire (baseline experience and current MMP perceptions) 2. Card sorting exercise (MMP element categorization) 3. Post-study questionnaire (formatting preferences and workflow considerations)

4 Results

4.1 Participant Characteristics

4.2 Current MMP Usage Patterns

Participants reported their typical first review item when accessing an ICU MMP:

• Medication issues: 43.8% (primary focus on safety concerns)
• Reason for ICU admission: 31.3% (clinical context establishment)
• Clinical issues: 12.5% (ongoing clinical concerns)
• New medications: 12.5% (recent therapeutic changes)

4.3 Identified Frustrations with Current Templates

4.4 Card Sorting Results: Information Architecture Analysis

The card sorting exercise revealed two dominant categories:

1. Background Information - Clinical context and patient history
2. MMP Structure - ICU-specific medication management elements

4.5 Consensus Analysis

5 Analysis and Discussion

5.1 Hypothesis Validation

The card sorting results provide compelling evidence supporting the hypothesis that current generic pharmacy MMP templates are inadequate for ICU patients. Key supporting evidence includes:

1. Generic vs. ICU-Specific Element Distinction: While participants showed 100% consensus on placement of generic pharmacy MMP elements (New, Ceased, Suspended medications, Medication Issues - which primarily relate to home medication decisions), they also demonstrated 75-88% consensus that additional ICU-specific elements are essential.

2. Critical ICU-Specific Additions Required: Elements unique to ICU practice (VTE prophylaxis, sedation/analgesia, antimicrobials, infusions, nutrition) showed high consensus (75-88%) for inclusion in the MMP structure, demonstrating that generic pharmacy templates are missing essential ICU therapeutic domains.

3. Template Expansion Necessity: The identification of multiple ICU-specific elements as essential components indicates that generic templates require substantial expansion beyond traditional home medication management to adequately serve ICU practice needs.

5.2 Information Architecture Implications

Background Information Category

Elements consistently placed in this category (HPI, clinical issues, past medical history) serve as clinical context establishment. These elements require: - Streamlined presentation format - Easy accessibility without overwhelming medication-focused workflow - Integration with existing clinical documentation systems

ICU-Specific MMP Structure Category

The high consensus on ICU-specific elements reveals unique documentation requirements:

Complete Consensus Elements (100%) - Generic Pharmacy MMP:

• New Medication (home medication decisions)
• Ceased Medication (home medication decisions)
• Suspended/Withheld Medication (home medication decisions)
• Medication Issues (pharmacy recommendations)

High Consensus Elements (75–88%) - ICU-Specific Additions:

• VTE prophylaxis (88%)
• Antimicrobials (88%)
• Altered Medication (88%)
• Infusions (88%)
• Sedation/Analgesia (75%)
• Nutrition (TPN) (75%)
• Unaltered Medication (75%)
• Other relevant therapies (75%)

5.3 Workflow Optimization Insights

Current Workflow Pain Points

The frustration analysis reveals critical design failures in current templates: - 30% cite poor structure/lack of ICU relevance - directly supporting the need for specialized templates - 25% report excessive length/detail - indicating need for focused, concise presentation - 20% note inconsistent formatting - highlighting standardization requirements

Preferred Documentation Patterns

Post-study questionnaire results indicate preferences for: - Manual documentation (66.7%) over automated EMR verification - Context-specific formatting for ceased medications - Minimal color usage (37.5% prefer plain text) - Time-based information management (37.5% prefer removing changes >48-72 hours)

5.4 Technical Implementation Considerations

Template Structure Recommendations

Based on consensus analysis, the ICU MMP template should include:

1. Background Information Section (streamlined):
   • Brief HPI/HOPC
   • Current clinical issues
   • Relevant past medical history
2. ICU-Specific MMP Structure (detailed):
   • Core medication changes (new, ceased, suspended, altered)
   • Medication issues (safety concerns)
   • ICU-specific therapeutic domains:
     • VTE prophylaxis
     • Antimicrobials
     • Sedation/analgesia
     • Infusions
     • Nutrition support

Formatting Specifications

• Implement consistent date formatting (50% accept either dd/mm or dd/mm/yyyy)
• Develop context-aware ceased medication display
• Use hyphen prefix for medication indications (75% preference)
• Maintain plain text emphasis with minimal color coding

6 Limitations

1. Sample Size: While 8 completed responses provide valuable insights, larger samples would strengthen statistical confidence in consensus measurements.

2. Experience Distribution: 50% of participants had <1 year ICU experience, potentially limiting representation of expert workflow patterns.

3. Single Heath-care system: The findings reflect practices from a single health network. Results may not generalise to other Australian or international systems with different documentation models.

4. Methodology Constraints: Closed card sorting may have constrained discovery of additional relevant categories.

7 Recommendations

7.1 Immediate Actions

1. Develop ICU-Specific Template: Create specialized template with distinct Background Information and ICU-Specific MMP Structure sections.

2. Standardize ICU Therapeutic Domains: Implement dedicated sections for VTE prophylaxis, antimicrobials, sedation/analgesia, infusions, and nutrition.

3. Establish Formatting Standards: Develop consistent formatting guidelines based on participant preferences.

7.2 Implementation Strategy

1. Pilot Testing: Deploy prototype template with subset of ICU pharmacists for usability testing.

2. Training Development: Create training materials highlighting differences from generic templates.

3. System Integration: Collaborate with EMR or Pharmacy Informatics to implement ICU-specific template options.

7.3 Future Research

1. Usability Testing: Conduct task-based usability studies with prototype templates.

2. Outcome Measurement: Evaluate impact on documentation time, error rates, and clinical decision-making.

3. Longitudinal Validation: Assess template effectiveness over extended implementation periods.

8 Conclusion

This card sorting study provides compelling evidence that current generic pharmacy MMP templates are inadequate for ICU patients. The clear emergence of Background Information and ICU-Specific MMP Structure categories, combined with high consensus on ICU-specific therapeutic domains, validates the need for specialized template development.

The study’s findings support immediate implementation of ICU-specific MMP templates with dedicated sections for VTE prophylaxis, antimicrobials, sedation/analgesia, infusions, and nutrition support. These elements, showing 75-100% consensus for specialized categorization, represent fundamental requirements for effective ICU medication management documentation.

Moving forward, the development of evidence-based, ICU-specific templates should significantly improve pharmacist workflow efficiency, reduce documentation frustrations, and ultimately enhance patient safety through more intuitive and comprehensive medication management plans.

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This report represents the second phase of a comprehensive ICU MMP review process, building upon initial audit findings to provide evidence-based recommendations for template redesign.