Abstract/Summary

Background Intravenous (IV) 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 IV 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 Health Care proposes that, to improve safety, it is necessary to focus on how work can be performed successfully as well as how work has failed. Methods and analysis 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 IV 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 IV 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 IV insulin infusions.