Web App to Improve Tracking of Pressure Ulcers in Long-term Care Homes


The project addresses the challenge of a growing elderly population in Ontario increasing demand for long-term care, leading to a shortage of healthcare staff and resources. This shortage has caused higher burnout rates, incomplete documentation, and a rise in pressure ulcers.

Our goal was to create a system for PSWs and nurses to make pressure ulcer prevention decisions without excessive cognitive load. The system, consisting of two interfaces, was tested through two design iterations, successfully demonstrating usability and effective tracking of prevention efforts despite the pandemic challenges.

Primary Role

UX Researcher

UI/UX Designer

My Team

1 Designers

1 PM

2 Developers

Timeline & Status

September 2020 - May 2021

Awarded Best Overall Project in Systems Design Engineering Department

You're a PSW in a long-term care home just starting your shift.

Check the nursing station for the status of your patients. Note the amount of time since they've been seen last and their Braden Score is.

Yikes, Benjamin hasn't been seen in a while.

You briefly check their information to see what interventions should be performed and what precautions should be taken.

You log the latest intervention performed on Benjamin

During patient treatment, you use the mobile tablet to log the intervention which gets saved to their patient history.

Your patient interventions are now accurately tracked to provide transparency to your team for better decision-making!

Research Shows Urgent Need for Streamlined Documentation to Prioritize Patient Care

From user interviews with 2 personal support workers, 1 registered nurse, and 1 registered nurse practitioner and secondary research, we gathered the following insights:

Long-term care facilities, particularly since COVID-19, face quality challenges, including increased use of restraints, decline in patient physical functioning, and higher rates of pressure ulcers.

Overworked staff experience moral distress, feeling rushed in patient care due to time constraints and observing care suffer due to staffing shortages.

Pressure ulcers, preventable injuries, indicate care quality; their prevalence in Ontario's facilities exceeds benchmarks, highlighting gaps in prevention and planning.

PSWs, RNs, and RPNs primarily dedicate their daily routines to wound treatment, medication administration, and patient data recording.

Healthcare workers have identified inefficiency, redundancy, and time diversion from patient care while entering patient data into the EMR.

Deep-dive into the life of a healthcare worker

We conducted further interviews with the healthcare workers to understand how they are currently interacting with their each other and their technology (Electronic Health Records) the product the following artifacts.


Personas were valuable because even though PSWs and RNs jobs are similar, they both had different needs and pain points.


A systems diagram was helpful defining the interactions between the user groups and their technology.


An HTA helped us break down the workflow of the healthcare workers and identify areas of redundancy.

Design Statement - Let's Get Specific

Based on our research, we knew that pressure ulcer prevalence was linked to the care provided by healthcare professionals, and since the care from the healthcare professionals depended on their strained work conditions, we focused our efforts on improving the workflow for the nurses and PSWs in long-term care homes.

Design Statment

The objective is to design a system to be used by PSWs and registered nursing staff (RN/RPNs) that will support both PSWs and nurses in making preventative pressure ulcer decisions that meet the standard of care without negatively impacting cognitive load.


  • Nurses and PSWs must be able to input charting information, including pressure ulcer information easily. SUS Usability > 80

  • The system must present data to nurses and PSWs so it is simple and intuitive to comprehend. SUS Learnability > 80


  • Adhere to PHIPA / PIPEDA data privacy standards

  • Must not cost more than $200

  • Must not increase cognitive load

A Two-Device System Integrated to the EMR

Bedside/Tablet Interface: This interface enables nurses and PSWs to input pressure ulcer interventions, such as shifting, applying barrier cream, or changing clothes. It ensures efficient logging of interventions, which are compared and updated with the patient's care plan.

Nursing Station: An interface connected to EMR database like PointClickCare. Provides patient info (age, medication), intervention history, and data on pain level and position tracking for informed decision-making.

Bedside/Tablet Interface V3

Nursing Station V1

User Testing with a focus on usability and cognitive load

Prototypes were evaluated using tests for performance, user satisfaction, and cognitive load. To compare with the existing system under COVID-19 constraints, a mock Electronic Medical Record (mock-EMR) was created in Microsoft Excel to compete against the Bedside/Tablet interface. These tests were performed on a virtual call or in-person.

Testing Methods

  • System Usability Scale (SUS): Testers simulated nurse/PSW tasks on prototypes, including mock PCC. Post-task, a 10-question SUS questionnaire assessed usability and learnability for comparison with current and future systems.

  • NASA TLX: Testers replicated tasks on prototypes, including mock PCC. Post-task, a 6-question NASA questionnaire gauged perceived workload that we could compare with the current system.

  • Tapping Test: Testers tapped rhythmically with their non-dominant hand or foot while using the prototype. Areas of slow or irregular tapping indicated increased cognitive load, particularly on the bedside interface, where the test was focused.

  • Sternberg Test: Testers remembered instructions, completed tasks with prototype/mock PCC, then recalled instructions. Success rate indicated impact on short-term memory, exclusive to bedside interface.

  • Qualitative Feedback: After the testing session, the user would provide feedback on the interface and their experience identifying moments of vagueness, confusion, or frustration.

Round 1 Results - Bedside/Tablet Interface


Our interface performed much better than the Mock-EMR. Users also found it more “intuitive”, “easy”, “user-friendly”, and “streamlined”.


Some accessibility violations were present (button size and colour contrast). Users did not know that they could select multiple items on some pages.

Round 1 Results - Nursing Station


Our interface met the learnability and usability SUS requirements while also imposing minimal cognitive load.


The extended duration of Task #2 stemmed from user confusion surrounding an icon representing a late intervention. Accessing Braden scores, vital for decision-making, proved cumbersome as users had to navigate into each patient's section. Furthermore, identified accessibility issues included violations like inadequate button size and insufficient color contrast.

Addressing accessibility issues and selection confusion

Bedside/Tablet Interface

Refinement 1: Some users were confused how many options there were allowed to select on a given page. To address this, checkboxes were used on pages where you could select multiple items and radio buttons were used when only one item can be selected.

Refinement 2: Button size and colour contrast was improved to comply with WCAG 2.0 Accessibility guidelines.

Refinement 3: To reduce confusion, the alert icon was updated to a red clock to show that the patient hasn't been seen in >2 hours

Refinement 4: Button size and colour contrast were changed to comply with WCAG 2.0 and Google Material Design Accessibility guidelines.

Refinement 5: Braden scores were added to the main page because they can help make quicker, better decisions.

Validation that our refinements had a positive impact

Using the improved designs after the redesign, we tested again using the same methods to validate the improvements!

Round 2 Results - Bedside/Tablet Interface


Both iterations were successful in meeting the design requirements but V3 had slightly better results. Although, 83% of testers preferred the V4 interface saying that it was, “more mapped to my inner model”, “cleaner”, and “easier to navigate”.

Round 2 Results - Nursing Station


Nursing station V3 performed significantly better on usability and learnability scales, required the least cognitive load, and possessed the shortest task times.

The MVPs are live!

Things I'll carry onto my next project

Talking to the end-user is SO important!

Every conversation I had with the nurses and PSWs provided more and more clarity about the problems they were facing and also provided reassurance that the ideas that we have had promise before developing the solution.

Validating solutions through data

In Systems Design Engineering, consistent testing methods and data were critical to proving to our professors that our solution was successful. Our largest constraint on the project was ensuring that our solution did not increase cognitive load, so our team conducted multiple types of tests to validate our results.

Navigating ambiguity

The healthcare industry is a complicated industry to tackle and none of us on our team were familiar. Although, using an engineering design approach (almost identical to UXD), we were able to break down the complex problem and define an area where we could make the most impact.

Check out these other case studies!


Long-Term Care Home Bedsore Tracking