title: An interprofessional qualitative study of barriers and potential solutions for the safe use of insulin in the hospital setting.
abstract: OBJECTIVE
  Insulin is regularly used in hospitalized patients for glycemic control but is associated with significant risks. The goals of this study were to describe the strengths and weaknesses of a university health centre in the safe use of insulin, to collect improvement proposals from health professionals involved in the management of insulin therapy and to assess inpatient glycemic control.
  
  
  METHODS
  This is a qualitative study. Physicians, nurses and pharmacists practising at the Centre Hospitalier Universitaire de Sherbrooke (CHUS) for at least 2 years were invited to join focus groups on safe insulin treatment. Themes up for discussion were roles of professionals in insulin therapy, problems encountered, solutions put forward and strengths of the hospital. The Quality Hyperglycemia Score (QHS) was assessed using an existing cohort of inpatients who were prescribed insulin.
  
  
  RESULTS
  A total of 5 focus groups were held in February and March of 2012, involving 31 healthcare professional participants. Several groups pointed out the same problems, namely, lack of access to useful information for optimal management of insulin therapy and lack of communication among personnel on different work shifts. Results of the QHS suggest room for improvement in blood glucose control at our institution.
  
  
  CONCLUSIONS
  These focus groups allowed better identification of the management problems related to the use of insulin in our health institution and possible interventions to solve them. The QHS will be reassessed to measure quality of inpatient glycemic control over time.
authors.affiliation: Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada.
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Rousseau
authors.affiliation: Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada; Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Centre de recherche du CHUS, Sherbrooke, Quebec, Canada.
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Beauchesne
authors.affiliation: Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada.
authors.forename: Alex-Sandra
authors.initials: AS
authors.lastname: Naud
authors.affiliation: Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Leblond
authors.affiliation: Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada.
authors.forename: Benoît
authors.initials: B
authors.lastname: Cossette
authors.affiliation: Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada; Division of Internal Medicine, Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Luc
authors.initials: L
authors.lastname: Lanthier
authors.affiliation: Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Grondin
authors.affiliation: Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada; Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Centre de recherche du CHUS, Sherbrooke, Quebec, Canada. Electronic address: frederic.bernier@usherbrooke.ca.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Bernier
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D002170:Canada / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D005260:Female; D017144:Focus Groups; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007297:Inpatients; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D033183:Interdisciplinary Communication; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D009741:Nursing Staff, Hospital; D010595:Pharmacists; D010820:Physicians; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: amélioration de la qualité; diabetes; diabète; hyperglycemia; hyperglycémie; hypoglycemia; hypoglycémie; inpatient glycemia control; insulin; insuline; patient safety; quality improvement; régulation de la glycémie des patients hospitalisés; sécurité des patients