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

Coherence

- Alignment with evidence based practice

- Standardising practice – incorporation into routine activity

- Drawing on evidence base in other specialties^a

- Resistance: Breaking down entrenched surgical dogmas^a

- 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 diaries^a

- Pre-operative assessment unit

- Staff education^a

- 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 – palatability^a

- Merger – aligning different ward cultures

- Patients going to non-ERAS departments – ICU^a

- Spread within the hospital

- Health issue^a

- Segmental approach

Reflective Monitoring

- Data collection and feedback

- Adapting the care pathway