Barriers to Implementing Iron Targets for Dialysis Dependent Patients & to the Acceptance of a New Iron Protcol
Background: The CARI implementation project has recently reviewed iron protocols throughout Australia, highlighting best practice models for iron management in dialysis patients. Although Clinical Practice Guidelines provide health professionals with a framework for interventions and clinical management to improve patient outcomes, implementation of guidelines may be suboptimal due to cultural and practice barriers.
Methods: The CARI implementation project involved a review of North West Dialysis patient’s and identified areas where changes could be made in patient surveillance and management that might result in increased numbers of patients achieving recommended iron targets. This resulted in the development of a nurse driven proactive iron protocol based on patients’ iron parameters in accordance with CARI guideline targets. The aim of this project was to identify potential barriers in the introduction of this modified iron protocol. To do this we reviewed the barriers observed during the development of the modified protocol.
Results: Barriers identified during the construction process included ignorance of need for change, comfort with existing reactive protocol, variation in nephrology and pharmacy documentation, preference for one iron protocol with two products and the logistics of consulting and educating large staff numbers.
Conclusion: In acknowledging the identified barriers, we have recognised the importance of including various organisational groups and divisions during the developmental process. Gaining the interest, participation and support of relevant stakeholders is a major part of implementation and acceptance of a new policy. On-going audits will be an important means of measuring implementation and effectiveness of the new iron protocol.