Abstract
Purpose: 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.Materials and Methods: 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.Results: 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.Conclusions: 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.
Highlights
Red blood cell (RBC) transfusions can be lifesaving when administered for hemorrhagic shock or severe anemia; mounting evidence suggests that unnecessary transfusions have more risks than benefits [1,2,3,4,5]
We developed an interview guide based on iPARIHS [31] to examine barriers and facilitators to using the Transfusion and Anemia eXpertise Initiative (TAXI) recommendations in the ICU (Supplementary File 1); interviews covered all topics, interviewers asked follow-up questions to explore topics fully
Providers in each role were interviewed at each site, with the exception of fellow or resident trainees, who were not present in all units
Summary
Red blood cell (RBC) transfusions can be lifesaving when administered for hemorrhagic shock or severe anemia; mounting evidence suggests that unnecessary transfusions have more risks than benefits [1,2,3,4,5]. The Transfusion and Anemia eXpertise Initiative (TAXI) developed evidence-based and expert-informed recommendations to limit unnecessary and potentially harmful RBC transfusions in critically ill children [26]. Despite the evidence and publication of these recommendations, multiple studies have documented only partial adoption of restrictive transfusion strategies [14, 27, 28], exposing children to transfusion risks without benefit [9, 14, 27,28,29,30]. Additional efforts are required to integrate these recommendations into practice in pediatric intensive care units (PICUs)
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