Reading School of Pharmacy, University of Reading, Reading, Berkshire, UK.
Centre for Team Based Practice & Learning in Health Care, King's College London, London, UK.
BMC Health Serv Res. 2022 Apr 23;22(1):545. doi: 10.1186/s12913-022-07883-w.
The use of variable rate intravenous insulin infusion (VRIII) is a complex process that has consistently been implicated in reports of error and consequent harm. Investment in patient safety has focused mainly on learning from errors, though this has yet to be proved to reduce error rates. The Resilient Health Care approach advocates learning from everyday practices. Video reflexive ethnography (VRE) is an innovative methodology used to capture everyday practices, reflect on and thereby improve these. This study set out to explore the use of VRIIIs by utilising the VRE methodology.
This study was conducted in a Vascular Surgery Unit. VRE methodology was used to collect qualitative data that involved videoing healthcare practitioners caring for patients treated with VRIII and discussing the resulting clips with participants in reflexive meetings. Transcripts of these were subjected to thematic analysis. Quantitative data (e.g. blood glucose measurements) were collected from electronic patient records in order to contextualise the outcomes of the video-observed tasks.
The use of VRE in conjunction with quantitative data revealed that context-dependent adaptations (seeking verbal orders to treat hypoglycaemia) and standardised practices (using VRIII guidelines) were strategies used in everyday work. Reflexive meetings highlighted the challenges faced while using VRIII, which were mainly related to lack of clinical knowledge, e.g. prescribing/continuing long-acting insulin analogues alongside the VRIII, and problems with organisational infrastructure, i.e. the wireless blood glucose meter results sometimes not updating on the electronic system. Reflexive meetings also enabled participants to share the meanings of the reality surrounding them and encouraged them to suggest solutions tailored to their work, for example face-to-face, VRIII-focused training.
VRE deepened understanding of VRIII by shedding light on its essential tasks and the challenges and adaptations entailed by its use. Future research might focus on collecting data across various units and hospitals to develop a full picture of the use of VRIIIs.
变率静脉内胰岛素输注（VRIII）的使用是一个复杂的过程，在报告的错误和随之而来的伤害中一直被牵连。对患者安全的投资主要集中在从错误中学习，尽管这尚未被证明能降低错误率。有弹性的医疗保健方法提倡从日常实践中学习。视频反思民族志（VRE）是一种用于捕捉日常实践、反思并因此改进实践的创新方法。本研究旨在利用 VRE 方法探讨 VRIII 的使用。
本研究在血管外科病房进行。VRE 方法用于收集定性数据，包括对接受 VRIII 治疗的患者进行护理的医疗保健从业者进行录像，并在反思会议上与参与者讨论产生的剪辑。对这些转录本进行主题分析。从电子患者记录中收集定量数据（例如血糖测量值），以便为视频观察任务的结果提供背景。
VRE 与定量数据的结合使用表明，依赖于上下文的适应（寻求口头医嘱以治疗低血糖）和标准化实践（使用 VRIII 指南）是日常工作中使用的策略。反思会议突出了在使用 VRIII 时面临的挑战，这些挑战主要与缺乏临床知识有关，例如在 VRIII 旁边开长效胰岛素类似物的医嘱/继续使用，以及与组织基础设施有关的问题，即无线血糖仪的结果有时不会在电子系统上更新。反思会议还使参与者能够分享他们周围现实的意义，并鼓励他们根据自己的工作提出量身定制的解决方案，例如面对面、专注于 VRIII 的培训。
VRE 通过阐明 VRIII 的基本任务以及使用 VRIII 所涉及的挑战和适应，加深了对 VRIII 的理解。未来的研究可能集中在跨多个病房和医院收集数据，以全面了解 VRIII 的使用情况。
