Factors Influencing Implementation of Blood Transfusion Recommendations in Pediatric Critical Care Units

Risks of red blood cell transfusion may outweigh benefits for many patients in Pediatric Intensive Care Units (PICUs). The Transfusion and Anemia eXpertise Initiative (TAXI) recommendations seek to limit unnecessary and potentially harmful transfusions, but use has been variable. We sought to identi...

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Bibliographic Details
Published in:Frontiers in pediatrics 2021-12, Vol.9, p.800461-800461
Main Authors: Steffen, Katherine M, Spinella, Philip C, Holdsworth, Laura M, Ford, Mackenzie A, Lee, Grace M, Asch, Steven M, Proctor, Enola K, Doctor, Allan
Format: Article
Language:English
Subjects:
clinical practice guideline
critical care
erythrocyte transfusion
implementation science
pediatric intensive care unit
Pediatrics
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Summary:Risks of red blood cell transfusion may outweigh benefits for many patients in Pediatric Intensive Care Units (PICUs). The Transfusion and Anemia eXpertise Initiative (TAXI) recommendations seek to limit unnecessary and potentially harmful transfusions, but use has been variable. We sought to identify barriers and facilitators to using the TAXI recommendations to inform implementation efforts. The integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework guided semi-structured interviews conducted in 8 U.S. ICUs; 50 providers in multiple ICU roles completed interviews. Adapted Framework analysis, a form of content analysis, used the iPARIHS innovation, recipient, context and facilitation constructs and subconstructs to categorize data and identify patterns as well as unique informative statements. Providers perceived that the TAXI recommendations would reduce transfusion rates and practice variability, but adoption faced challenges posed by attitudes around transfusion and care in busy and complex units. Development of widespread buy-in and inclusion in implementation, integration into workflow, designating committed champions, and monitoring outcomes data were expected to enhance implementation. Targeted activities to create buy-in, educate, and plan for use are necessary for TAXI implementation. Recognition of contextual challenges posed by the PICU environment and an approach that adjusts for barriers may optimize adoption.
ISSN:2296-2360
2296-2360
DOI:10.3389/fped.2021.800461