<p>Preoperative Anemia and Iron Deficiency Screening, Evaluation and Management: Barrier Identification and Implementation Strategy Mapping</p>

Abstract

Introduction and aims: Patients undergoing major surgery risk significant blood loss and transfusion, which increases substantially if they have pre-existing anemia. Preoperative Anemia and Iron Deficiency Screening, Evaluation and Management Pathways (PAIDSEM-P) outline recommended blood tests and treatment to optimize patients before surgery. Documented success using PAIDSEM-P to reduce transfusions and improve patient outcomes exists, but the reporting quality of such studies is suboptimal. It remains unclear what implementation strategies best support the implementation of PAIDSEM-P. Method: Maximum variation, purposive sampling was used to recruit a total of 15 participants, including a range of health professionals and patients for semi-structured interviews. Data analysis utilized a deductive approach informed by the Consolidated Framework for Implementation Research (CFIR) for barrier identification and the Expert Recommendations for Implementing Change (ERIC) for reporting recommended implementation strategies. A modified version of the Action, Actor, Context, Target and Time (AACTT) framework assisted with conceptualisation and targeted strategy selection. Results: The analysis revealed five barriers: access to knowledge and information, patient needs and resources, knowledge and beliefs about the intervention, available resources, and networks and communications, which had strong ERIC recommendations, including conduct educational meetings, develop educational materials, distribute educational materials, obtain and use patients/consumers family feedback, involve patients/consumers/family members, conduct a local needs assessment, access new funding, promote network weaving, and organize clinician implementation team meetings. Conclusions: Mapping the barriers and strategies using the ERIC framework on the basis of individual actor categories proved to be useful in identifying a pragmatic number of implementation strategies that may help in supporting the utilisation of the PAIDSEM-P and other evidence-based healthcare implementation problems more broadly.

Scaling up Quality Improvement for Surgical Teams (QIST)—avoiding surgical site infection and anaemia at the time of surgery: a cluster randomised controlled trial of the effectiveness of quality improvement collaboratives to introduce change in the NHS

“…Qualitative work specifically focussing on the barriers and facilitators to the implementation of preoperative anaemia optimisation pathways has reported similar findings [ 14 , 23 – 26 ].…”

A Theoretically Informed Approach to Support the Implementation of Pre-Operative Anemia and Iron Deficiency Screening, Evaluation, and Management Pathways: Protocol for a Type Two Hybrid-Effectiveness Study

“… Complete – earlier phases of this research completed the execution of this strategy. 23 Knowledge and beliefs about the intervention Conduct educational meetings The implementation facilitator will ensure all the perioperative medicine team and preoperative admissions team are educated on the intervention during a launch week, and as needed where compliance issues arise. ● Available resources Access new funding Funding has been obtained for a preoperative anaemia care coordinator to ensure the pathway is being followed.…”

“…The intervention delivery will be further supported using theoretically informed implementation strategies selected based on results from a previously described qualitative investigation. 23 The summarised results and delivery of the implementation strategies are outlined in Table 2 , below:…”

“…This study uses a theoretically informed change package that consists of an intervention and supporting implementation strategies. 23 The intervention is the implementation of a Preoperative Anemia and Iron Deficiency Screening, Evaluation and Management Pathway (PAIDSEM-P), delivered by a Pre-operative Anemia Care Coordinator (PACC). This intervention will be supported by implementation strategies that were selected in a previously reported study.…”

“…The study identified barriers using the Consolidated Framework for Implementation Research (CFIR), which were then mapped to the Expert Recommendations for Implementing Change (ERIC) framework. 23–25 …”