ObjectiveVariable rate intravenous insulin infusions (VRIII) is a high-risk medication that has a potential to cause significant patient harm if used in error. Complex preparation of VRIII in clinical areas and the need for frequent monitoring and adjustment increase the complexity of using VRIII. An emerging approach, called Resilient Healthcare, proposes understanding complexity of work by exploring how work is assumed to be done and compare it with everyday work. This study aimed to explore how VRIII is perceived to be used by healthcare practitioners, focusing on one aspect of Resilient Healthcare: understanding how work is assumed to be done, using a method called hierarchical task analysis (HTA).DesignA qualitative study using document analysis and focus groups.SettingA vascular surgery unit in an acute National Health Service teaching hospital in the UK.ParticipantsStakeholders/users in different professional roles involved in the process of using VRIII.ResultsThe HTA showed the complexity of using VRIII and highlighted more than 115 steps required to treat elevated blood glucose. The process of producing hospital-specific guidelines was iterative. Careful consideration was taken to coordinate the development and implementation of guidelines. Documents provided detailed clinical instructions related to the use of VRIII but practitioners selectively used them, often in deference to senior colleagues. Intentional adaptations, for example, proactively asking for a VRIII prescription occurred and were acknowledged as part of providing individualised patient care.ConclusionUsing VRIII to treat elevated blood glucose is a complex but necessary process mediated by a range of factors such as organisational influences. Adaptive strategies to mitigate errors were common and future research can build on insights from this study to develop a broader understanding of how VRIII is used and to understand how adaptations are made in relation to the use of VRIII.

BackgroundIntravenous insulin infusions are considered the treatment of choice for critically ill patients and non-critically ill patients with persistent raised blood glucose who are unable to eat, to achieve optimal blood glucose levels. The benefits of using intravenous insulin infusions as well as the problems experienced are well described in the scientific literature. Traditional approaches for improving patient safety have focused on identifying errors, understanding their causes and designing solutions to prevent them. Such approaches do not take into account the complex nature of healthcare systems, which cannot be controlled solely by following standards. An emerging approach called Resilient Healthcare proposes that, to improve safety, it is necessary to focus on how work can be performed successfully as well as how work has failed.Methods and analysisThe study will be conducted at Oxford University Hospitals NHS Foundation Trust and will involve three phases. Phase I: explore how work is imagined by analysing intravenous insulin infusion guidelines and conducting focus group discussions with guidelines developers, managers and healthcare practitioners. Phase II: explore the interplay between how work is imagined and how work is performed using mixed methods. Quantitative data will include blood glucose levels, insulin infusion rates, number of hypoglycaemic and hyperglycaemic events from patients’ electronic records. Qualitative data will include video reflexive ethnography: video recording healthcare practitioners using intravenous insulin infusions and then conducting reflexive meetings with them to discuss selected video footage. Phase III: compare findings from phase I and phase II to develop a model for using intravenous insulin infusions.Ethics and disseminationEthical approvals have been granted by the South Central—Oxford C Research Ethics Committee, Oxford University Hospitals NHS Foundation Trust and University of Reading. The results will be disseminated through presentations at appropriate conferences and meetings, and publications in peer-reviewed journals.

Objectives: Pharmacovigilance is considered a useful tool in detecting, assessing, understanding and preventing Adverse drug reactions (ADRs) to ensure the safety of medications and protect consumers from ADRs. Consequently, the progression and expansion of pharmacovigilance is urgent for safe and effective clinical practice; therefore, in this study, we aimed to compare the awareness and knowledge of the community and hospital pharmacists toward reporting ADRs in different regions of Saudi Arabia. Methods: This cross-sectional study was conducted from January 2016 to March 2016 in Saudi Arabia. A validated and structured questionnaire was distributed by hand or via Internet to 263 hospital and community pharmacists. The questionnaire collected pharmacists' demographic information and pharmacists' understanding and knowledge of the pharmacovigilance system and reporting of ADRs. Results: A total of 263 pharmacists responded to the questionnaire with 208 (79.09%) pharmacists from hospital pharmacy sites and 55 (20.91%) pharmacists from community pharmacy responding to the questionnaire. There is a significant difference in the pharmacovigilance concept (p<0.05) between the hospital and community pharmacists. Most community pharmacists were unfamiliar with the existence of a pharmacovigilance center in Saudi Arabia. Furthermore, community pharmacists were unaware of where they could get an ADR reporting form, but hospital pharmacists were aware of this (p<0.05). Conclusion: The results of this study demonstrated that pharmacists who work at hospitals among different regions in Saudi Arabia had a higher awareness of the pharmacovigilance system than that of community pharmacists who worked at the community pharmacy.

Background: Pharmacists' perception toward their role in reporting of Adverse Drug Reactions (ADRs) and their understanding of the importance of reporting ADRs are essential keys to be assessed and studied in order to determine the factors that may predispose to underreporting of ADRs in Saudi Arabia. Therefore, in this study, we aimed to asses and compare the perception of community and hospital pharmacists toward reporting of ADRs in different regions of Saudi Arabia. Method: A structured, validated questionnaire was used to conduct a cross-sectional study. A total of 263 pharmacists were enrolled. The questionnaire included the demographic data of the pharmacists and 11 questions to measure pharmacists' perceptions of ADRs reporting of reporting ADRs. All statistical analysis done by using Statistical Package for the Social Sciences (SPSS) version 21 and Survey Monkey system. Result: the result shows that community and hospital pharmacists strongly agree about that reporting of ADRs allow to measure the incidence of ADRs 29 (55.77%), 121 (58.45) and to identify previously unrecognized ADRs 30 (57.69%), 116 (56.59%) and enable safe drugs to be identified 39 (70.91%), 129 (62.32%), respectively with no significant difference (p>0.05). Besides, both hospital pharmacists 116 (55.77%) and community pharmacists 31 (60.78%) strongly agree about their important role in the pharmacovigilance system. However, only 67 (32.52%) of hospital pharmacists strongly agreed about the physician's responsibility in reporting ADRs compared to community pharmacists 29 (52.73%) with a significant difference between groups (p<0.05). However, 37 (17.87%) of hospital pharmacists were uncertain about drug companies' role in pharmacovigilance system with a significant difference between community pharmacists with (p<0.05). Conclusion: The result of this study demonstrated that both community and hospital pharmacists among Saudi Arabia had a very goods of perception about the importance of ADRs reporting and their role in reporting ADRs.

A BSTRACT Introduction: Cardiovascular diseases (CVDs) are one of the leading causes of morbidity and mortality worldwide. Although genetics could contribute to the incidence of CVD, they are mostly acquired conditions. Management of precipitating factors such as hyperlipidemia can prevent CVD. Therefore, clinical guidelines have been used as a tool to improve patient outcomes and minimize practice variation. Objective: The objective of this study was to assess health-care providers’ (physicians and clinical pharmacists) awareness about the latest edition of the American College of Cardiology/American Heart Association (ACC/AHA) guidelines of dyslipidemia management. Materials and Methods: To meet the study objective, a self-administered questionnaire was designed based on the recommendations of the latest edition of the ACC/AHA guidelines for dyslipidemia management. After validation, the questionnaire was distributed to physicians and clinical pharmacists in Al-Ahsa province of Saudi Arabia. Results: Validation of the questionnaire was carried on 10 participants (Cronbach’s alpha = 0.816). Seventy-seven participants completed the questionnaire (acceptance rate = 51.33%). The majority of participants knew about the release of the ACC/AHA 2013 guidelines for dyslipidemia (77% of the physicians and 48% of the clinical pharmacist). Inadequate knowledge of the major changes in the dyslipidemia management was observed in both study groups with no significant difference between them (the median score for physicians and pharmacists was 4 out of 10 with a range of 1–9, Z = −0.15, P = 0.88). Conclusion: Inadequate level of knowledge about practice-changing recommendations of the recent ACC/AHA guidelines for dyslipidemia management was observed among the study participants. This level of knowledge could result in clinical malpractice and worsen management outcomes. Thus, efforts should be in place to raise awareness about the evidence-based management of dyslipidemia and monitor compliance to guidelines and their implementation outcomes.