Imagining work: how healthcare workers use insulin infusions

Oral presentation by final year PhD researcher, Mais Iflaifel, at the PhD Pharmacy Conference, April 2019, Henley Business School, University of Reading.

Mais Iflaifel1
Dr Rosemary Lim1, Professor Kath Ryan1 and Dr Clare Crowley2
1 Reading School of Pharmacy, University of Reading, Reading, RG6 6UB. UK
2 Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK

Introduction: To achieve optimal blood glucose levels, intravenous (IV) insulin infusion is considered the treatment of choice for critically ill patients and non-critically ill patients who are unable to eat. An emerging approach to safety, called Resilient Health Care (RHC), proposes that it is necessary to understand in depth the variability in healthcare practitioners’ performance to help transition to a more adaptive organisation which is able to withstand every day clinical work changes and keep focus on how work can be performed successfully as well as how work has failed. This study will focus on one aspect of RHC, understanding how healthcare practitioners imagine work is performed.

Aim: To explore and understand how healthcare practitioners use IV insulin infusions based on their knowledge of related guidelines.

Methods: An analysis of eleven IV insulin infusion guidelines used at the Oxford University Hospitals NHS Foundation Trust was conducted. An inductive thematic analysis was used to analyse the content of the documents and a Hierarchical Task Analysis (HTA) was used to represent the use of IV insulin infusion in a hierarchy of goals, sub-goals, operations and plans. HTA was a way for describing the function of the goals
and activities described in the guidelines.

Results: Eight themes were identified: perform hand hygiene, identify patient, identify problem, prescribe, prepare, administer, monitor, and stop. Although the documents provided details of specific processes there were some contradictions, anomalies and lack of information. In the HTA, the top level goal is to control blood glucose in hospitalised patients using IV insulin infusion. The themes identified in the thematic analysis became the sub-goals in the HTA. For each of these sub-goals, plan(s) for operationalising them was identified. Subsequent levels in the HTA were further broken down into operations/sub goals at the lower levels and were described in terms of measurable performance

Conclusion: A HTA was developed that showed a framework for analysing the use of IV insulin infusion. The output of the HTA was extremely useful and forms the input for the process of understanding RHC. Further research will explore how variables other than the guidelines might affect the control of blood glucose using IV insulin infusion.