The SHINE (Safe Hospital Insulin Use for Older or Frail Adults) study is underway to develop an intervention aimed at improving insulin safety for older or frail adults with diabetes during surgical hospital admissions. This qualitative study employs a co-design approach, integrating perspectives from patients, caregivers, and healthcare professionals to create a system-based learning model. The study seeks to address the high risk of insulin errors in hospitals, which can lead to dangerously low or high glucose levels and other severe consequences.
Background: Insulin Errors in Hospitals
Insulin is a high-risk medication, and errors in its use are frequent in hospitals. In the UK, one in six hospital beds is occupied by a person with diabetes, who often experiences longer stays and higher readmission rates. The SHINE study aims to tackle the multiple interacting components that contribute to insulin errors, including patient-level factors (stress, appetite changes), healthcare professional factors (knowledge deficits, poor communication), and systemic factors (changes in meal times, treatments).
Study Design and Methods
The SHINE study, guided by the UK’s Medical Research Council and National Institute for Health and Care Research frameworks, uses a co-design approach involving non-participatory observations, interviews, and co-design workshops at a National Health Service (NHS) hospital in England. Participants include older or frail individuals with diabetes, their caregivers, and healthcare staff responsible for their care during surgical admissions. The study focuses on understanding their experiences and perspectives to establish priorities and generate ideas for a conceptual model supporting the insulin safety review process.
Key Objectives
The study has several key objectives:
- Elicit experiences and perspectives of older adults with diabetes and healthcare professionals regarding insulin use in surgical care settings.
- Identify key factors involved in insulin safety and errors from patient and healthcare professional viewpoints.
- Model factors contributing to insulin errors in the context of perioperative care for older people using insulin.
- Elicit potential solutions and intervention components from patients, healthcare professionals, and other stakeholders.
- Develop an intervention framework modeling potential intervention components to address factors associated with insulin errors.
Expected Outcomes and Impact
The SHINE study is expected to provide a better understanding of the multiple interacting components implicated in hospital insulin use, including patient, staff, and contextual factors. The findings will support further work around system-based strategies to enhance insulin safety resilience in hospitals. By co-designing a model for a multimodal intervention, the study addresses the complexity of hospital surgical settings and considers patient, healthcare professional, and systemic factors that contribute to insulin errors in older people in perioperative care settings.
Ethical Considerations and Dissemination
Ethical approval was obtained from the East Midlands-Derby Research Ethics Committee. The study adheres to GDPR and Data Protection Act 2018 guidelines, ensuring data is de-identified and securely stored. Results will be disseminated through academic outputs, including conferences and peer-reviewed publications. De-identified research data will be made available upon request after study completion and publication.
