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Table 2 Facilitating factors and challenges of implementing an ERAS programme by NPT construct

From: Healthcare professionals’ views of the enhanced recovery after surgery programme: a qualitative investigation

NPT construct Facilitating factors Challenges
Coherence - Alignment with evidence based practice
- Standardising practice – incorporation into routine activity
- Drawing on evidence base in other specialtiesa
- Resistance: Breaking down entrenched surgical dogmasa
- Standardisation affecting personalised patient care
Cognitive Participation - Cohesive, visible leadership amongst surgeons and nurses
- Teamwork – engagement of all relevant stakeholders
- ERAS meetings
- Buy-in of relevant stakeholders
- Keeping ERAS visible
Collective Action - Patient involvement and education – ERAS diariesa
- Pre-operative assessment unit
- Staff educationa
- Resources attached to obtaining CQUIN money (e.g. data collectors, ring fence nursing time)
- Ward layout – protected beds
- Information provision to patients – volume affecting retention
- Resources
 - Staff (being short staffed, high turnover, lack of weekend workers)a
 - Lack of time (to attend meetings, educate staff and patients)
 - Lack of management support
 - Ending (e.g. money attached to CQUINs)
- Nutritional drinks – palatabilitya
- Merger – aligning different ward cultures
- Patients going to non-ERAS departments – ICUa
- Spread within the hospital
- Health issuea
- Segmental approach
Reflective Monitoring - Data collection and feedback
- Adapting the care pathway
 
  1. aNutritionally related