Reading School of Pharmacy, Whiteknights, Reading, University of Reading, Reading, Berkshire, UK.
Pharmacy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.
BMJ Open. 2019 Jul 10;9(7):e029997. doi: 10.1136/bmjopen-2019-029997.
Intravenous insulin infusions are considered the treatment of choice for critically ill patients and non-critically ill patients with persistent raised blood glucose who are unable to eat, to achieve optimal blood glucose levels. The benefits of using intravenous insulin infusions as well as the problems experienced are well described in the scientific literature. Traditional approaches for improving patient safety have focused on identifying errors, understanding their causes and designing solutions to prevent them. Such approaches do not take into account the complex nature of healthcare systems, which cannot be controlled solely by following standards. An emerging approach called Resilient Healthcare proposes that, to improve safety, it is necessary to focus on how work can be performed successfully as well as how work has failed.
The study will be conducted at Oxford University Hospitals NHS Foundation Trust and will involve three phases. Phase I: explore how work is imagined by analysing intravenous insulin infusion guidelines and conducting focus group discussions with guidelines developers, managers and healthcare practitioners. Phase II: explore the interplay between how work is imagined and how work is performed using mixed methods. Quantitative data will include blood glucose levels, insulin infusion rates, number of hypoglycaemic and hyperglycaemic events from patients' electronic records. Qualitative data will include video reflexive ethnography: video recording healthcare practitioners using intravenous insulin infusions and then conducting reflexive meetings with them to discuss selected video footage. Phase III: compare findings from phase I and phase II to develop a model for using intravenous insulin infusions.
Ethical approvals have been granted by the South Central-Oxford C Research Ethics Committee, Oxford University Hospitals NHS Foundation Trust and University of Reading. The results will be disseminated through presentations at appropriate conferences and meetings, and publications in peer-reviewed journals.
静脉内胰岛素输注被认为是治疗危重症患者和不能进食的非危重症持续高血糖患者的首选方法，以达到最佳血糖水平。静脉内胰岛素输注的益处以及所经历的问题在科学文献中已有详细描述。传统的提高患者安全性的方法侧重于识别错误、了解其原因并设计解决方案以防止错误。这些方法没有考虑到医疗保健系统的复杂性，而仅仅遵循标准是无法控制的。一种新兴的方法称为“弹性医疗保健”，它提出为了提高安全性，有必要关注工作如何成功进行以及工作如何失败。
该研究将在牛津大学医院 NHS 基金会信托基金进行，将涉及三个阶段。第一阶段：通过分析静脉内胰岛素输注指南和与指南制定者、经理和医疗保健从业者进行焦点小组讨论，探索工作是如何想象的。第二阶段：使用混合方法探索工作想象和工作执行之间的相互作用。定量数据将包括患者电子记录中的血糖水平、胰岛素输注率、低血糖和高血糖事件的数量。定性数据将包括视频反思民族志：视频记录医疗保健从业者使用静脉内胰岛素输注，然后与他们进行反思会议，讨论选定的视频片段。第三阶段：将第一阶段和第二阶段的发现进行比较，为使用静脉内胰岛素输注开发一个模型。
已获得南中-牛津 C 研究伦理委员会、牛津大学医院 NHS 基金会信托基金和雷丁大学的伦理批准。结果将通过在适当的会议和会议上的演示以及在同行评议期刊上的发表来传播。
