Table 2 Implementation strategies
Bolded columns indicate guideline implementation that resulted in no change in > 80% of indicators | ||||||
|---|---|---|---|---|---|---|
Strategies | Asthma | Breastfeeding | Delirium, Dementia, Depression (DDD) | Diabetes Foot Care | Smoking Cessation | Venous Leg Ulcers (VLU) |
Educational strategies for nurses | Paid time 2 core sessions of 2 hours each for separate groups of nurses-inpatient and emergency Pre-learning package Articles about the project in internal newsletters Placebos to practice skills | Paid time Core 4-hour training session off site Written material team teaching, non-didactic, focus on attitudes, beliefs and values, use of stories by mother/baby dyads Additional short in-services held | Paid time 2–3.5 hours Powerpoint slides, facilitator guide, handouts, case studies, a game to review materials, standardized assessment tools | Paid time Hospital: 1 session 30 to 60 minutes, as a lunch and learn, handouts, self-learning package Visiting nurses: 6 sessions for 1.5 hours each, practice sessions, word game, refresher training | Paid time 2 hours, Powerpoint slides, informal and interactive, stages of change theory Use of case scenarios depending on group e. g. in- patient, outpatient, long term care | Paid time Manual (basic wound and VLU care) and CD for self-directed learning, individual 2-hour session with quiz, demonstration and bandaging practice by nurses Discussion of newsletters (not mailed) hospital nurses had demonstrations on bandaging and products |
Champions (Local opinion leaders) | Encouraged stronger nurses to sign up early to be advocates and mentors | Â | Champions on each unit, part of the steering committee with role to raise issues in day to day rounds and to encourage the nurses to use the recommended assessment tools | Â | A senior leader physician champion Several clinical resource nurses with one on each unit | Resource people trained in both community and hospital settings Mentoring by consultants at client's home |
Reminder systems | Logo, mugs, posters, name tags for nurses who completed the training | Â | Posters, binders, pocket cards listing symptoms of DDD | Project logo, posters, articles in newsletters, voicemail messages, special flyer | Buttons, posters, laminated pocket cards summarizing the steps of ask, advise, and assist strategy | Â |
Policy Review | yes | Yes | Yes | Yes | Yes Smoking room policy changes | yes |
Creation of new documentation | Flow sheets Patient pathways | Newborn critical pathways chart New charting tools and discharge sheets | Trigger questions added to initial pt assessment forms to help nurses maintain an index of suspicion | New assessment tool | Â | Â |
Multi-disciplinary involvement | Respirologists very supportive but emergency physicians reluctant due to concern for nurses' workload | "Little involvement of other disciplines" Conflict with dieticians in public health unit about 6 months excusive breast feeding | Â | Steering group formed with both hospital and community reps but did not have an active ongoing role | Strong senior physician champion 'interdisciplinary work was amazing...the camaraderie between the disciplines and meeting everyone else from the different sites was one of the major benefits" | Steering committee Community physician support |
Patient Education | Patient education toolkits with placebos, teaching booklets and laminated cards on all units | Â | Â | Patient education and referral resources | Â | Patient education brochure initiated but not completed |