Overcoming barriers to evidence-based patient blood management: a restricted review
Abstract Background Blood transfusions are associated with a range of adverse patient outcomes, including coagulopathy, immunomodulation and haemolysis, which increase the risk of morbidity and mortality. Consideration of these risks and potential benefits are necessary when deciding to transfuse. P...
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doaj-8d1e355ac40841309c7e9654f03b9ed12021-01-17T12:07:47ZengBMCImplementation Science1748-59082020-01-0115111310.1186/s13012-020-0965-4Overcoming barriers to evidence-based patient blood management: a restricted reviewAlana Delaforce0Jed Duff1Judy Munday2Janet Hardy3The University of Newcastle, School of Nursing and MidwiferyThe University of Newcastle, School of Nursing and MidwiferySchool of Nursing/Institute for Health and Biomedical Innovation, Queensland University of TechnologyMater Health ServicesAbstract Background Blood transfusions are associated with a range of adverse patient outcomes, including coagulopathy, immunomodulation and haemolysis, which increase the risk of morbidity and mortality. Consideration of these risks and potential benefits are necessary when deciding to transfuse. Patient blood management (PBM) guidelines exist to assist in clinical decision-making, but they are underutilised. Exploration of barriers to the implementation and utilisation of the PBM guidelines is required. This study aimed to identify common barriers and implementation strategies used to implement PBM guidelines, with a comparison against current expert opinion. Methods A restricted review approach was used to identify the barriers to PBM guideline implementation as reported by health professionals and to review which implementation strategies have been used. Searches were undertaken in MEDLINE/PubMed, CINAHL, Embase, Scopus and the Cochrane library. The Consolidated Framework for Implementation Research (CFIR) was used to code barriers. The Expert Recommendations for Implementing Change (ERIC) tool was used to code implementation strategies, and subsequently, develop recommendations based on expert opinion. Results We identified 14 studies suitable for inclusion. There was a cluster of barriers commonly reported: access to knowledge and information (n = 7), knowledge and beliefs about the intervention ( = 7) and tension for change (n = 6). Implementation strategies used varied widely (n = 25). Only one study reported the use of an implementation theory, model or framework. Most studies (n = 11) had at least 50% agreement with the ERIC recommendations. Conclusions There are common barriers experienced by health professionals when trying to implement PBM guidelines. There is currently no conclusive evidence to suggest which implementation strategies are most effective. Further research using validated implementation approaches and improved reporting is required.https://doi.org/10.1186/s13012-020-0965-4Patient blood managementConsolidated Framework for Implementation ResearchExpert Recommendations for Implementing ChangeBarrier MappingImplementation Strategies |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Alana Delaforce Jed Duff Judy Munday Janet Hardy |
spellingShingle |
Alana Delaforce Jed Duff Judy Munday Janet Hardy Overcoming barriers to evidence-based patient blood management: a restricted review Implementation Science Patient blood management Consolidated Framework for Implementation Research Expert Recommendations for Implementing Change Barrier Mapping Implementation Strategies |
author_facet |
Alana Delaforce Jed Duff Judy Munday Janet Hardy |
author_sort |
Alana Delaforce |
title |
Overcoming barriers to evidence-based patient blood management: a restricted review |
title_short |
Overcoming barriers to evidence-based patient blood management: a restricted review |
title_full |
Overcoming barriers to evidence-based patient blood management: a restricted review |
title_fullStr |
Overcoming barriers to evidence-based patient blood management: a restricted review |
title_full_unstemmed |
Overcoming barriers to evidence-based patient blood management: a restricted review |
title_sort |
overcoming barriers to evidence-based patient blood management: a restricted review |
publisher |
BMC |
series |
Implementation Science |
issn |
1748-5908 |
publishDate |
2020-01-01 |
description |
Abstract Background Blood transfusions are associated with a range of adverse patient outcomes, including coagulopathy, immunomodulation and haemolysis, which increase the risk of morbidity and mortality. Consideration of these risks and potential benefits are necessary when deciding to transfuse. Patient blood management (PBM) guidelines exist to assist in clinical decision-making, but they are underutilised. Exploration of barriers to the implementation and utilisation of the PBM guidelines is required. This study aimed to identify common barriers and implementation strategies used to implement PBM guidelines, with a comparison against current expert opinion. Methods A restricted review approach was used to identify the barriers to PBM guideline implementation as reported by health professionals and to review which implementation strategies have been used. Searches were undertaken in MEDLINE/PubMed, CINAHL, Embase, Scopus and the Cochrane library. The Consolidated Framework for Implementation Research (CFIR) was used to code barriers. The Expert Recommendations for Implementing Change (ERIC) tool was used to code implementation strategies, and subsequently, develop recommendations based on expert opinion. Results We identified 14 studies suitable for inclusion. There was a cluster of barriers commonly reported: access to knowledge and information (n = 7), knowledge and beliefs about the intervention ( = 7) and tension for change (n = 6). Implementation strategies used varied widely (n = 25). Only one study reported the use of an implementation theory, model or framework. Most studies (n = 11) had at least 50% agreement with the ERIC recommendations. Conclusions There are common barriers experienced by health professionals when trying to implement PBM guidelines. There is currently no conclusive evidence to suggest which implementation strategies are most effective. Further research using validated implementation approaches and improved reporting is required. |
topic |
Patient blood management Consolidated Framework for Implementation Research Expert Recommendations for Implementing Change Barrier Mapping Implementation Strategies |
url |
https://doi.org/10.1186/s13012-020-0965-4 |
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