Introduction of a Preoperative Protocol for Management of Iron-Deficiency Anemia in Patients

117 Pages·2017·1.57 MB·English

by  Edel Marie Quinn

Royal College of Surgeons in Ireland
e-publications@RCSI
Masters theses/dissertations - taught courses Theses and Dissertations
1-1-2016
Introduction of a Preoperative Protocol for
Management of Iron-Deficiency Anemia in
Patients undergoing Elective Colorectal Surgery
Edel Marie Quinn
Royal College of Surgeons in Ireland
Citation
Quinn EM. Introduction of a Preoperative Protocol for Management of Iron-Deficiency Anemia in Patients undergoing Elective
Colorectal Surgery [MSc Thesis]. Dublin: Royal College of Surgeons in Ireland; 2016.
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Introduction of a Preoperative Protocol for
Management of Iron-Deficiency Anaemia in
Patients undergoing Elective Colorectal
Surgery

Edel Marie Quinn

A Dissertation submitted in part fulfilment of the degree
of MSc Healthcare Management, Institute of Leadership,
Royal College of Surgeons in Ireland

2016

Student ID: 14108844
Submission Date: 12th May 2016
Word Count: 16,500
Facilitator: Mr Ricky Ellis
Table of Contents

Page
Declaration 7
Acknowledgements 8
Glossary 9

Abstract 12

Chapter One - Introduction
1.1 Background 14
1.1.1 Organisational Context 14
1.1.2 Rationale for the Project 15
1.2 Aims and Objectives 17
1.3 Planned Process 18
1.3.1 Setting and Timeframe 18
1.3.2 Patient Selection and Stratification 19
1.3.3 Intravenous Iron Replacement 19
1.4 Planned Evaluation 20
1.5 Potential threats to Implementation 20
1.6 Ethical Approval 21
1.7 Conclusion 22

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Chapter Two - Systematic Review of the Literature
2.1 Introduction 24
2.2 Search Strategy 25
2.3 Review of themes 26
2.3.1 One - The Effects of Correcting Preoperative Iron Deficiency 26
2.3.2 Two - Modalities of Iron Administration 32
2.3.3 Three - Timing of Iron Deficiency Detection and Correction 35
2.4 Implications for the Project 37
2.5 Summary and Conclusion 38

Chapter Three - Organisational Development Process
3.1 Choice of Organisational Development Model 41
3.2 OD Process Implementation 43
3.2.1 Stage 1(a): Diagnose the Current Situation 43
3.2.2. Stage 1(b): Develop a Vision for Change 46
3.2.3 Stage 2 - Gain Commitment to the Vision 48
3.2.4 Stage 3 -Develop an Action Plan 55
3.2.5 Stage 4 - Implement the Plan 57
3.2.6 Stage 4 - Assess and Reinforce Change 61
3.3 Summary 63

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Chapter Four - Evaluation
4.1 Importance of Healthcare Evaluation 65
4.2 Evaluation Methods 66
4.3 Evaluation Results 67
4.4 Summary 78

Chapter Five - Discussion
5.1 Introduction 80
5.2 Organisational Impact of Introducing Change 80
5.3 Patient Outcomes as a Result of the Change Project 83
5.4 Strengths and Limitations 86
5.5. Recommendations for Future Improvements 88
5.6 Conclusion 89
References 90

Appendix 1: Tables and Figures 98
Appendix 2: IV Iron Information Leaflet 110
Appendix 3: Gantt Chart 112
Appendix 4: Poster Presentation 114
4
List of Figures
Page
Figure 1: Organisational Development Model 99
Figure 2: Process Map 101
Figure 3: Initial Proposed Patient Pathway 102
Figure 4: Final Patient Pathway 103
Figure 5: Stakeholder Analysis 105
Figure 6: Responsibility Chart 106

5
List of Tables
Page
Table 1: PESTLE Analysis 100
Table 2: Data from Pre-Intervention Audit 107
Table 3: Point of Detection of Anaemia Pre- and Post-Intervention 108
Table 4: Post-Intervention Results 109
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Ireland Bahrain Dubai
RCSI Reservoir House, PO Box 15503, 4th Floor A/P25,
Ballymoss Road, Building No. 2441, Dubai Healthcare City,
Sandyford, Road 2835, Dubai,
Dublin 18, Busaiteen 436, PO Box 505095,
Ireland. Kingdom of Bahrain. United Arab Emirates

Declaration Form

Declaration:

“I hereby certify that this material, which I now submit for assessment in part fulfilment of
the degree of MSc Healthcare Management is entirely my own work and has not been
submitted as an exercise for assessment at this or any other University.”

Student’s Signature(s): Edel Marie Quinn
Date: 09/05/2016

Student’s Number (s): 14108844

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Acknowledgements

I wish to acknowledge a number of people who have helped me on the journey to
complete this thesis, without whom this project would not have been possible.

Firstly, I wish to thank the staff at my organisation, particularly John Anderson, Ellen
Meland, Christine Cranstoun, Vivien Adair, Stacy McGinn, and all the colorectal
consultants, without whom implementation of this project would not have been
achievable. Their help and enthusiasm has been key to the success of this project.

Secondly, I wish to acknowledge the help and support offered by my peers at RCSI,
specifically Ceire, Mary, Ann and Sanober, who have all offered words of wisdom at
various points throughout the completion of this project. A particular thanks must be
offered to our group facilitator, Ricky Ellis, who was always available to provide
advice, encouraging us to reflect on our experiences and use them to improve our
projects on a continual basis.

Finally, I wish to thank my parents, who have always supported me in my academic
endeavours and my partner, Niall, who has been patient and understanding when
this project has been demanding of my time and always encourages me to achieve
my goals.
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