Exploring the complexity of safe insulin management during transfer of care using qualitative methods.

Aims: Managing insulin during care transfers requires improvement. Understanding factors that impact insulin management during this process improves the likely effectiveness of interventions. This study aimed to map the processes involved in managing insulin during transfers of care and the factors that affect them to identify potential areas for safety improvement interventions.

Methods: A qualitative, case study approach was used to undertake documentary analysis, interviews, focus groups and observation. Participants included people with diabetes who use insulin, caregivers and primary and secondary care healthcare professionals. A framework approach guided analysis and subtheme categorisation under the domains of people, tools, tasks or environments.

Results: Insulin management during transfers of care was mapped across hospital admission and discharge along with factors that impact this process. Six stages of the care transfer process were identified. Workforce pressures and demand impacted safe insulin management. Four themes were identified: (1) People with diabetes hold vital information not otherwise available, (2) their ability to manage their diabetes care in hospital was limited, (3) healthcare staff lacked confidence managing insulin and (4) people anticipated and acted to prevent known issues.

Conclusions: A detailed picture of factors impacting insulin management during the transfer of care was developed. Incorporating the expertise of people who use insulin and removing barriers to insulin self management across the care pathway, ensuring staff have adequate knowledge, skills and confidence in the management of insulin and promoting proactive interventions to support safe outcomes represent key interventions to improve safety for people who use insulin.