Barriers and facilitators to the national scale-up of a preterm standardised parenteral nutrition system: A...

Standardising parenteral nutrition (PN) care for preterm infants is recommended to enhance safety, outcomes and efficiency, however implementation at scale remains challenging. In 2021, Ireland scaled-up a standardised parenteral nutrition (SPN) system comprising SPN formulations and dosing protocol. We evaluate national scale-up to identify contextually relevant factors to optimise implementation.

A sequential explanatory mixed-methods process evaluation was conducted. Phase 1 comprised a cross-sectional survey of healthcare professionals (HCPs) across nine neonatal units (NUs), alongside analysis of PN purchasing data. Phase 2 included a focus group with the national implementation team and semi-structured interviews with HCPs from three NUs. Qualitative data were analysed using framework analysis guided by the Consolidated Framework for Implementation Research.

For Phase 1, we analysed 158 survey responses (27.6% response rate). All NUs had adopted the SPN system; 95% HCPs reported 'Always' or 'Often' using the protocol. SPN accounted for 95% of PN purchased nationally, increasing from 56% pre-implementation. Usability and sustainment scores were significantly higher among trained HCPs (p = 0.026; p < 0.001). Protocol adaptations were reported by 21%, and 16% reported receiving no training. Phase 2 (1 focus group; 16 interviews) developed seven themes describing factors influencing scale-up. Key enablers included the perceived relative advantage of the intervention and strong national networks. Barriers included local policy misalignment, limited evidence in specific populations and hierarchical decision-making.

Scale-up of SPN interventions is achievable in practice, however contextual factors influenced how the intervention was used. System-level infrastructure including training and ongoing monitoring is required to optimise implementation and equitable sustainment.