# Developing an Intervention for Safe Hospital Insulin Use for Older Adults With Diabetes Undergoing Surgical Admission (SHINE Study): A Co‐Design Study

## TL;DR

This study co-designed a safety intervention to improve insulin use for older adults with diabetes during hospital surgery, involving patients and healthcare staff in the process.

## Contribution

A co-designed logic model (SHINE wheel) for safer insulin use in surgical admissions, developed with direct input from older adults and healthcare professionals.

## Key findings

- A co-designed logic model called the SHINE wheel was developed to address insulin safety during surgical admissions.
- Eight actions and twelve outputs were identified as components of the intervention model.
- Prototypes for patient and staff education tools were created to support empowerment and preparedness.

## Abstract

Insulin errors in inpatients with diabetes occur frequently during surgical admissions. Older adults have higher risks. There is a need for service user involvement in developing complex interventions to improve insulin safety in hospitals.

To develop a logic model for a system‐based safety intervention to support safer insulin use for older adults with diabetes undergoing surgical hospital admission.

A co‐design approach combining systems thinking and design thinking methods was employed. Purposive sampling was employed. Older adults with diabetes and multiprofessional staff working across perioperative care were involved as co‐designers and decision makers throughout the iterative process of intervention development. An initial exploratory phase included semi‐structured interviews with service users (n = 10), hospital staff (n = 23) and non‐participatory observations (n = 3) which informed subsequent collaboration. Initial findings validated in separate service user and staff workshops and engagement activities. The resulting data were presented at joint stakeholder workshops (n = 3) to confirm the final intervention components needed to develop the model. In total, n = 10 older adults and n = 11 healthcare professionals working across the perioperative pathway participated in the co‐design process between October and December 2024.

Co‐designers were engaged and collaborative. Multiple interacting components at patient, staff and context level identified. Through an iterative process, a co‐designed logic model known as the SHINE (safe‐hospital‐insulin‐use) wheel was constructed, addressing two prioritised areas: transitions of care and right insulin, time and way. The model also identifies eight actions and twelve separate outputs as components. Solution‐related themes centred around: it is all so connected; right insulin, right time, right way; safer transitions of care; empowerment; organisation and provision of care; developing and supporting the workforce. Two prototypes of tools for patient and staff education to support empowerment and increase patient preparedness for hospital admission were developed.

Multiple interacting components influence hospital insulin safety. System‐based, non‐linear safety approaches are required. This co‐design study identified priorities of older adults with diabetes and healthcare professionals to be addressed in system‐wide insulin safety interventions for surgical admissions. Tools developed provide tangible outputs for application in clinical practice.

People with diabetes with recent lived experience of surgical hospital admission were integrally involved as co‐designers and decision makers in this study. They contributed towards interpretation and analysis of findings through discussion, feedback and validation in workshops and through means accessible to them. They were decision makers in the identification of priorities for intervention development and in identifying and validating the content of the toolkit developed.