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.
OBJECTIVES
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
['Helmle|Karmon E|KE|', 'Edwards|Alun L|AL|', 'Kushniruk|Andre W|AW|', 'Borycki|Elizabeth M|EM|']
D000328:Adult D001291:Attitude of Health Personnel D003144:Communication Barriers D003422:Critical Care D003920:Diabetes Mellitus D005260:Female D017144:Focus Groups D007722:Health Knowledge, Attitudes, Practice D006282:Health Personnel D006801:Humans D007297:Inpatients D007328:Insulin D007332:Insulin Infusion Systems D000075762:Interdisciplinary Research D008297:Male D036301:Qualitative Research D058996:Quality Improvement D000076251:Wearable Electronic Devices
basal bolus insulin insulin therapy amélioration de la qualité analyse qualitative glycemic control inpatient diabetes management insulinothérapie prise en charge du diabète en milieu hospitalier qualitative analysis quality improvement régulation de la glycémie schéma insulinique de type basal-bolus