Qualitative Evaluation of the Barriers and Facilitators Influencing the Use of an Electronic Basal Bolus Insulin Therapy Protocol to Improve the Care of Adult Inpatients With Diabetes

• Published in: Canadian journal of diabetes 2018-10, Vol.42 (5), p.459-464.e1
• Main Authors: Helmle, Karmon E., Edwards, Alun L., Kushniruk, Andre W., Borycki, Elizabeth M.
• Format: Article
• Language: English
• Subjects: Adult; amélioration de la qualité; analyse qualitative; Attitude of Health Personnel; basal bolus insulin; Communication Barriers; Critical Care - psychology; Critical Care - standards; Diabetes Mellitus - blood; Diabetes Mellitus - drug therapy; Diabetes Mellitus - nursing; Female; Focus Groups; glycemic control; Health Knowledge, Attitudes, Practice; Health Personnel - psychology; Humans; inpatient diabetes management; Inpatients; Insulin - administration & dosage; Insulin Infusion Systems - psychology; insulin therapy; insulinothérapie; Interdisciplinary Research; Male; prise en charge du diabète en milieu hospitalier; qualitative analysis; Qualitative Research; Quality Improvement; régulation de la glycémie; schéma insulinique de type basal-bolus; Wearable Electronic Devices - psychology
• ISSN: 1499-2671; 2352-3840
• DOI: 10.1016/j.jcjd.2017.10.059

A qualitative evaluation of the perceived impact of a new evidence-informed electronic basal bolus insulin therapy order set on clinical workflow and practice, and exploration of potential barriers and facilitators to electronic basal bolus insulin order set uptake and use in acute care facilities for various acute care team members. We conducted 9 semistructured focus groups with multidisciplinary nursing staff (n=22), resident trainees (n=24) and attending physicians (n=23) involved in the delivery of inpatient diabetes care at 3 adult acute care facilities. The domains of inquiry included impact on workload, perceived impact on patient care and discipline-specific barriers and facilitators to use, including care-providers' needs, comfort and competencies, contributions from the clinical environment and efficacy of communication. The interviews were transcribed and analyzed using a content analysis approach. Several major themes emerged from the focus group discussions, including impact of education, information technology/user interface, workflow, organizational issues and practices, and perceived outcomes. Barriers and facilitators were identified relating to each theme. The outcomes highlight the complex interplay between educational, organizational and technical themes and the significance of employing a systemic approach to support the implementation of electronic inpatient glycemic-management protocols within complex social organizations. Une évaluation qualitative des répercussions perçues d'un nouveau modèle d'ordonnances électroniques relatif aux schémas insuliniques de type basal-bolus qui est fondé sur des données probantes sur le flux de travail et la pratique cliniques, et une exploration des obstacles et des facilitateurs potentiels à la mise en application et à l'utilisation du modèle d'ordonnances électroniques relatif aux schémas insuliniques de type basal-bolus dans les établissements de soins de courte durée pour les divers membres de l'équipe de soins aux malades en phase aiguë. Nous avons mené 9 groupes de discussion semi-structurés auprès d'une équipe multidisciplinaire formée d'un personnel infirmier (n=22), de stagiaires résidents (n=24) et de médecins traitants (n=23) qui participent à la prestation des soins du diabète en milieu hospitalier de 3 établissements de soins de courte durée pour une clientèle adulte. Parmi les domaines d'étude, on notait les répercussions sur la charge de travail, les répercussions perçues sur les soi