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

Can J Diabetes. 2018 Oct;42(5):459-464.e1. doi: 10.1016/j.jcjd.2017.10.059. Epub 2018 Feb 1.


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.

Keywords: amélioration de la qualité; analyse qualitative; basal bolus insulin; glycemic control; inpatient diabetes management; insulin therapy; insulinothérapie; prise en charge du diabète en milieu hospitalier; qualitative analysis; quality improvement; régulation de la glycémie; schéma insulinique de type basal-bolus.

MeSH terms

  • Adult
  • Attitude of Health Personnel
  • Communication Barriers*
  • Critical Care / psychology
  • Critical Care / standards
  • Diabetes Mellitus* / blood
  • Diabetes Mellitus* / drug therapy
  • Diabetes Mellitus* / nursing
  • Female
  • Focus Groups
  • Health Knowledge, Attitudes, Practice*
  • Health Personnel* / psychology
  • Humans
  • Inpatients
  • Insulin / administration & dosage*
  • Insulin Infusion Systems / psychology*
  • Interdisciplinary Research
  • Male
  • Qualitative Research
  • Quality Improvement
  • Wearable Electronic Devices / psychology


  • Insulin