Reading School of Pharmacy, University of Reading School of Chemistry Food and Pharmacy, Reading, UK.
Reading School of Pharmacy, University of Reading School of Chemistry Food and Pharmacy, Reading, UK
BMJ Open. 2021 Mar 23;11(3):e041848. doi: 10.1136/bmjopen-2020-041848.
Variable rate intravenous insulin infusions (VRIII) is a high-risk medication that has a potential to cause significant patient harm if used in error. Complex preparation of VRIII in clinical areas and the need for frequent monitoring and adjustment increase the complexity of using VRIII. An emerging approach, called Resilient Healthcare, proposes understanding complexity of work by exploring how work is assumed to be done and compare it with everyday work. This study aimed to explore how VRIII is perceived to be used by healthcare practitioners, focusing on one aspect of Resilient Healthcare: understanding how work is assumed to be done, using a method called hierarchical task analysis (HTA).
A qualitative study using document analysis and focus groups.
A vascular surgery unit in an acute National Health Service teaching hospital in the UK.
Stakeholders/users in different professional roles involved in the process of using VRIII.
The HTA showed the complexity of using VRIII and highlighted more than 115 steps required to treat elevated blood glucose. The process of producing hospital-specific guidelines was iterative. Careful consideration was taken to coordinate the development and implementation of guidelines. Documents provided detailed clinical instructions related to the use of VRIII but practitioners selectively used them, often in deference to senior colleagues. Intentional adaptations, for example, proactively asking for a VRIII prescription occurred and were acknowledged as part of providing individualised patient care.
Using VRIII to treat elevated blood glucose is a complex but necessary process mediated by a range of factors such as organisational influences. Adaptive strategies to mitigate errors were common and future research can build on insights from this study to develop a broader understanding of how VRIII is used and to understand how adaptations are made in relation to the use of VRIII.
变率静脉内胰岛素输注（VRIII）是一种高风险药物，如果使用不当，可能会对患者造成严重伤害。在临床区域中复杂的 VRIII 准备以及频繁的监测和调整需求增加了使用 VRIII 的复杂性。一种新兴的方法，称为有弹性的医疗保健，建议通过探索工作是如何被假设完成的，并将其与日常工作进行比较，来理解工作的复杂性。本研究旨在探讨医疗保健从业者如何感知 VRIII 的使用，重点关注有弹性医疗保健的一个方面：了解工作是如何被假设完成的，使用一种称为层次任务分析（HTA）的方法。
使用文件分析和焦点小组的定性研究。
英国一家急性国民保健服务教学医院的血管外科病房。
参与使用 VRIII 过程的不同专业角色的利益相关者/用户。
HTA 显示了使用 VRIII 的复杂性，并突出了治疗高血糖所需的 115 多个步骤。制定医院特定指南的过程是迭代的。仔细考虑协调指南的制定和实施。文件提供了与 VRIII 使用相关的详细临床说明，但从业者有选择地使用它们，通常是为了尊重资深同事。例如，主动要求 VRIII 处方的故意调整被认为是提供个性化患者护理的一部分。
使用 VRIII 治疗高血糖是一个复杂但必要的过程，由一系列因素介导，如组织影响。常见的自适应策略来减轻错误，未来的研究可以基于本研究的见解来更广泛地了解 VRIII 的使用方式，并了解如何针对 VRIII 的使用进行调整。
