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