{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T15:41:06Z","timestamp":1782834066072,"version":"3.54.5"},"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Foundation of European Nurses in Diabetes","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}]},{"name":"Herefordshire and Mid-Powis Diabetic Care Fund","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}]},{"name":"NovoNordisk UK Research Foundation"},{"name":"Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care Staff Development Fund"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Aim<\/jats:title>\n<jats:p>To explore multiprofessional hospital staff\u2019s experiences and perspectives of insulin use and safety review in older or frail adults with diabetes undergoing surgery.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Method<\/jats:title>\n<jats:p>Twenty-three semi-structured interviews amongst multiprofessional staff supporting four surgical wards (elective and emergency) at a single NHS Trust in a rural county in England. Interviews were recorded, transcribed and analysed using framework analysis approach.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Six main themes identified: (1) Transitioning through care: Misalignments across insulin related interacting components contribute to insulin errors (2) Coping with complexity, changes and ambiguity; at clinical, operational and organisational levels (3) Staff knowledge and confidence gaps affect insulin safety (4) Fostering patient empowerment; patient empowerment can be hindered by staff assumptions and inflexibility of hospital environment (5) Staff support systems; communication, power dynamics influence insulin safety (6) System learning as a cultural challenge; absence of systems approach and reactive to harm.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This study provides valuable insights into reported complexities of managing insulin-related interacting components during surgical admission. Findings could inform how managers, leaders and organisations approach and consider multiple components implicated in safe hospital insulin use to build system resilience. Future research can build on insights from this study to develop interventions supporting system-based approaches to hospital insulin safety.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0332088","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T17:39:25Z","timestamp":1759858765000},"page":"e0332088","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["\u201cIt is a false safety net\u201d: A qualitative exploration of multiprofessional staff experiences of insulin management in hospitalised older or frail adults with diabetes undergoing surgery"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8575-9670","authenticated-orcid":true,"given":"Christina","family":"Lange Ferreira","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hellena","family":"Habte-Asres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angus","family":"Forbes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsty","family":"Winkley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,10,7]]},"reference":[{"key":"pone.0332088.ref001","volume-title":"IDF Diabetes Atlas 2025 - 11th Edition","author":"International Diabetes Federation","year":"2025"},{"key":"pone.0332088.ref002","first-page":"559","article-title":"In-Hospital Treatment and Surgery in People with Diabetes","author":"K Dhatariya","year":"2024","journal-title":"Textbook of Diabetes"},{"key":"pone.0332088.ref003","unstructured":"NHS Digital. 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