Barriers and facilitators to implementation of newborn jaundice assessment clinical practice guideline in Alberta

Introduction Alberta Health Service’s (AHS) Clinical Practice Guideline (CPG) for screening and management of newborn jaundice was implemented in 2019. The CPG follows the Canadian Pediatric Society (CPS) guideline requiring universal screening of newborns for jaundice within specified timelines using accepted protocols. The aim of this study was to identify facilitators and barriers to implementing the guideline. Methods Using a cross-sectional qualitative research design, we conducted semi-structured interviews with Public Health (PH) from each AHS zone in early 2021. Interview data was analyzed thematically using both deductive and inductive approaches. The elements of the consolidated framework for implementation research (CFIR) provided structure for the interview guide and the deductive analysis. Current findings are based on 6 interviews with 6 public health managers from all AHS zones. Results Facilitators to implementation were: the ability to adapt guideline implementation based on each zone’s local context and needs, CPG’s alignment with existing practices (following the CPS guideline), ability of zones to use existing organizational structures, the province-wide applicability of the CPG to PH and acute care, knowledge of the guideline among PH leadership/service delivery teams, and a strong commitment of public health educators. However, PH nurses thought that the guideline was focused on acute care and had limited information on parental education and infant feeding. It also lacked details on PH nurses’ roles. Barriers to implementation were: acute care and PH did not have a common understanding regarding the other’s roles and responsibilities, limited or no commitment of some community physicians to follow the CPG, communication barriers such as acute care not always following the PH protocols , delays in sending the notice of birth to PH, lack of awareness of differences in PH practices and follow-up service availability between AHS zones. Finally, some thought that PH was not sufficiently involved in the guideline’s development and the processes for guideline implementation did not take into account remote/rural challenges. Conclusion AHS’ Jaundice CPG was perceived as an important tool to standardize screening and management of newborn jaundice. CPG development needs to include the roles of all applicable healthcare providers. As well, differences between AHS zones need to be accounted for to support implementation. This can also help improve patient/caregiver experience by increasing coordination of care and reducing delays in record keeping and patient follow-up. Strong engagement from and focus on educating PH nurses were important facilitators as PH nurses do patient follow-up and record keeping.