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Understanding safety differently: developing a model of resilience in the use of intravenous insulin infusions in hospital in-patients—a feasibility study protocol
  1. Mais Hasan Iflaifel1,
  2. Rosemary Lim1,
  3. Kath Ryan1,
  4. Clare Crowley2,
  5. Rick Iedema3
  1. 1Reading School of Pharmacy, Whiteknights, Reading, University of Reading, Reading, Berkshire, UK
  2. 2Pharmacy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
  3. 3Centre for Team Based Practice & Learning in Health Care, King’s College London, London, UK
  1. Correspondence to Rosemary Lim; r.h.m.lim{at}


Background Intravenous 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 intravenous 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 Healthcare 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 intravenous 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 intravenous 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 intravenous insulin infusions.

Ethics and dissemination Ethical approvals have been granted by the South Central—Oxford C Research Ethics Committee, Oxford University Hospitals NHS Foundation Trust and University of Reading. The results will be disseminated through presentations at appropriate conferences and meetings, and publications in peer-reviewed journals.

  • Resilience
  • resilient healthcare
  • intravenous insulin infusion
  • hospital
  • safety
  • video reflexive ethnography
  • work as done
  • work as imagined

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  • Contributors RL and CC conceived the idea for the study. MHI, RL, KR and CC collaborated in designing the study. The manuscript was first drafted by MHI. The statistical advice was provided by RL, KR and CC. MHI, RL, KR, CC and RI contributed to the critical revision of the manuscript. RI contributed to the methodology advice on VRE. All authors read and approved the final manuscript.

  • Funding This research is funded by the University of Reading in the form of a PhD Studentship 564 (International Research Studentship/ Fees only) (ref GS16-123).

  • Competing interests None declared.

  • Ethics approval Ethical approval for the study has been granted by the South Central—Oxford C Research Ethics Committee (REC reference 18/SC/0456), Oxford University Hospitals NHS Foundation Trust Research and Development department (REC reference18/SC/0456) and University of Reading’s Research Ethics Committee (UREC 18/03).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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