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Human factors and a systems approach can offer unique insight into the redesign process of medical charts to enhance usability. This paper describes a mixed method approach utilising numerous HF tools and theories to support the redesign process for an inpatient anticoagulant medication chart. The system factors and error-producing conditions associated with the use of this chart were identified through a qualitative analysis, using the SEIPS 2.0 model, of 65 reported incidents associated with the use of this chart. To better understand the role of this document at a task level, the task ‘first time prescription of anticoagulant medication’ was analysed in more detail using Hierarchical Task Analysis and the Systematic Human Error Reduction Approach. The incident report data was then also mapped onto the HTA and SHERPA of the task. Based on studies that applied heuristic analyses and a human factors perspective to chart design and evaluation, key design characteristics were compiled that were used to evaluate the chart. The results from these three different analyses were used to compile recommendations for the next design iteration of this chart.

The cornerstone of life-saving therapy in immune-mediated thrombotic thrombocytopenic purpura (iTTP) has been plasma exchange (PEX) combined with immunomodulatory strategies. Caplacizumab, a novel anti–von Willebrand factor nanobody trialed in 2 multicenter randomized controlled trials (RCTs) leading to European Union and US Food and Drug Administration approval, has been available in the United Kingdom (UK) through a patient access scheme. Data were collected retrospectively from 2018 to 2020 for 85 patients (4 children) receiving caplacizumab from 22 UK hospitals. Patient characteristics and outcomes in the real-world clinical setting were compared with caplacizumab trial end points and historical outcomes in the precaplacizumab era. Eighty-four of 85 patients received steroid and rituximab alongside PEX; 26% required intubation. Median time to platelet count normalization (3 days), duration of PEX (7 days), and hospital stay (12 days) were comparable with RCT data. Median duration of PEX and time from PEX initiation to platelet count normalization were favorable compared with historical outcomes (P < .05). Thrombotic thrombocytopenic purpura (TTP) recurred in 5 of 85 patients; all had persistent ADAMTS13 activity < 5 IU/dL. Of 31 adverse events in 26 patients, 17 of 31 (55%) were bleeding episodes, and 5 of 31 (16%) were thrombotic events (2 unrelated to caplacizumab); mortality was 6% (5/85), with no deaths attributed to caplacizumab. In 4 of 5 deaths, caplacizumab was introduced >48 hours after PEX initiation (3-21 days). This real-world evidence represents the first and largest series of TTP patients, including pediatric patients, receiving caplacizumab outside of clinical trials. Representative of true clinical practice, the findings provide valuable information for clinicians treating TTP globally.