TY - JOUR
T1 - Modelling the use of variable rate intravenous insulin infusions in hospitals by comparing Work as Done with Work as Imagined
T2 - Modelling the use of variable rate intravenous insulin infusions
AU - Iflaifel, Mais
AU - Lim, Rosemary H.
AU - Crowley, Clare
AU - Greco, Francesca
AU - Ryan, Kath
AU - Iedema, Rick
N1 - Funding Information:
MI was supported by the University of Reading International Research Studentship [reference number GS16-123 ]. The University of Reading as the study sponsor has no role in study design, conduct, data analysis and interpretation, manuscript writing, and dissemination of results, or the final decision regarding any of these aspects of the study.
Publisher Copyright:
© 2021 Elsevier Inc.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021
Y1 - 2021
N2 - Background: Variable rate intravenous insulin infusions (VRIIIs) are widely used to treat elevated blood glucose (BG) in adult inpatients who are severely ill and/or will miss more than one meal. VRIIIs can cause serious harm to the patient if used incorrectly. Recent safety initiatives have embraced the Resilient Health Care (RHC) approach to safety by understanding how VRIIIs are expected to be used (Work as Imagined, ‘WAI’) and how it is actually used in everyday clinical care (Work as Done, ‘WAD’). Objectives: To systematically compare WAI and WAD and analyse adaptations used in situ to develop a model explaining VRIII use. Methods: A qualitative observational study video-recording healthcare practitioners using VRIII. The video data were transcribed and inductively coded to develop a hierarchical task analysis (HTA) to represent WAD. This HTA was compared with a HTA previously developed to represent WAI. The comparison output was used to develop a model of VRIII use. Results: While many of the tasks in the WAD HTA were aligned with the tasks presented in the WAI HTA, some important ones did not. When misalignment was observed, permanent adaptations (e.g. signing as a witness for a changed VRIII's rate without independently verifying whether the new rate was appropriate) and temporary workarounds (e.g. not administering intermediate-acting insulin analogues although the intermediate-acting insulin prescription was not suspended) were the most frequently observed adaptations. The comparison between WAI and WAD assisted in developing a model of VRIII use. The model shed light on strategies used to imagine everyday work (e.g. incident reports, VRIII guidelines), how everyday work was accomplished (e.g. context-dependent adaptations) and how these contributed to both successful and unsuccessful outcomes. Conclusions: This study provided in-depth understanding of the tasks required while using VRIIIs, and responses and adaptations needed to achieve safer care in a complex environment.
AB - Background: Variable rate intravenous insulin infusions (VRIIIs) are widely used to treat elevated blood glucose (BG) in adult inpatients who are severely ill and/or will miss more than one meal. VRIIIs can cause serious harm to the patient if used incorrectly. Recent safety initiatives have embraced the Resilient Health Care (RHC) approach to safety by understanding how VRIIIs are expected to be used (Work as Imagined, ‘WAI’) and how it is actually used in everyday clinical care (Work as Done, ‘WAD’). Objectives: To systematically compare WAI and WAD and analyse adaptations used in situ to develop a model explaining VRIII use. Methods: A qualitative observational study video-recording healthcare practitioners using VRIII. The video data were transcribed and inductively coded to develop a hierarchical task analysis (HTA) to represent WAD. This HTA was compared with a HTA previously developed to represent WAI. The comparison output was used to develop a model of VRIII use. Results: While many of the tasks in the WAD HTA were aligned with the tasks presented in the WAI HTA, some important ones did not. When misalignment was observed, permanent adaptations (e.g. signing as a witness for a changed VRIII's rate without independently verifying whether the new rate was appropriate) and temporary workarounds (e.g. not administering intermediate-acting insulin analogues although the intermediate-acting insulin prescription was not suspended) were the most frequently observed adaptations. The comparison between WAI and WAD assisted in developing a model of VRIII use. The model shed light on strategies used to imagine everyday work (e.g. incident reports, VRIII guidelines), how everyday work was accomplished (e.g. context-dependent adaptations) and how these contributed to both successful and unsuccessful outcomes. Conclusions: This study provided in-depth understanding of the tasks required while using VRIIIs, and responses and adaptations needed to achieve safer care in a complex environment.
KW - Hierarchical task analysis
KW - Resilient health care
KW - Variable rate intravenous insulin infusion
KW - Work as done
KW - Work as imagined
UR - http://www.scopus.com/inward/record.url?scp=85108511421&partnerID=8YFLogxK
U2 - 10.1016/j.sapharm.2021.06.008
DO - 10.1016/j.sapharm.2021.06.008
M3 - Article
AN - SCOPUS:85108511421
SN - 1551-7411
JO - Research in Social and Administrative Pharmacy
JF - Research in Social and Administrative Pharmacy
ER -