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PubMed2001

Implementation intentions and facilitation of prospective memory.

Forming detailed implementation intentions for a future behavior can increase the probability that the behavior is actually completed. We investigated whether this intention effect could be used to improve prospective memory in older adults. As expected, participants who formed an implementation intention were more than twice as likely to self-initiate the intended behavior (writing down the day of the week on every sheet of paper received during the experiment) compared with participants who either were merely instructed to do so or actively rehearsed the instruction. Forming an implementation intention, however did not improve performance on a task that required a response to salient cues. We conclude that detailed implementation intentions facilitate prospective memory on tasks that lack salient cues and require self-initiation.

Aged↗

PubMed2005

Implementing a national treatment service for dependent smokers: initial challenges and solutions.

BACKGROUND: Before 1999, few treatment services for nicotine-addicted smokers existed in England. When national treatment services were introduced, those responsible for setting them up liaised closely with primary care health services. Setting up an entirely new national service, treating a new category of patient (smokers motivated to stop) was an ambitious aim and this paper documents the problems encountered in the early stages of this process. OBJECTIVES: To describe the principal challenges encountered and solutions employed by those setting up the services during the initial period of smoking cessation service implementation. METHODS: Qualitative, semistructured interviews with 50 smoking cessation staff in two former English health regions conducted in autumn 2001. FINDINGS: Two principal factors which slowed the initial development of smoking cessation services were: (i) the lack of a work-force with experience in smoking cessation methods and (ii) the fact that services were set up outside existing primary and secondary care health services in England. As few training courses in smoking cessation were available, many services provided their own in-house training for staff appointed as smoking cessation advisers. Consequently, senior service staff devoted a lot of effort to training new staff which meant that they had less time to spend on other important tasks which were necessary for service implementation. Smoking cessation services needed to develop relationships with primary care health services in order to generate referrals and find venues for the delivery of smoking cessation interventions. Liaising with primary care physicians was time-consuming, however, and some primary care physicians were opposed to the ideas that service staff had for the interface between primary care and smoking cessation services. As new smoking cessation services were not set up within existing primary or secondary health care services, service staff had to spend large amounts of time on this process of negotiation and overcoming scepticism from some primary health care physicians. CONCLUSIONS: If smoking cessation services are set up in other countries, rapid implementation would be facilitated by ensuring that adequate numbers of health professionals trained in smoking cessation methods are available to staff services. Additionally, locating new smoking cessation services within existing health providers' services may speed up service implementation, but this option may not suit all health systems.

Humans↗

PubMed2005

An exploration of factors affecting the implementation of a randomized controlled trial of a transitional discharge model for people with a serious mental illness.

Information about the contexts in which trials are carried out helps to identify confounding influences on the application of a trial. Furthermore, the ways in which context and implementation of trials influence participation are particularly important for trials which utilize people as part of the intervention. This is particularly likely in the mental health and psychosocial fields. The researchers used mixed methods to identify quality issues encountered during the conduct of a trial, aiming to explore process and contextual factors encountered during its implementation in a mental health setting. Staff and peer volunteers who contributed to the intervention provided information on implementation via diaries and group meetings. Findings in this paper relate to staff feedback. By providing an insider view, researchers were able to highlight the importance of obtaining feedback on implementation. Findings relate to the context of the study, particularly organizational, practitioner and trial preparation issues and illustrate the importance of building quality assurance mechanisms into research plans, such as monitoring and feedback processes. The issue of 'people involvement' in trial delivery requires sensitive management and flexibility in both preparation and delivery.

Feedback↗

PubMed2005

Impact of insecticide-treated bed nets implementation on the genetic structure of Anopheles arabiensis in an area of irrigated rice fields in the Sahelian region of Cameroon.

Variation at 12 microsatellite loci was investigated to assess the impact of the implementation of insecticide-treated bed nets (ITNs) on the genetic structure of Anopheles arabiensis in Simatou, a village surrounded by irrigated rice fields in the Sahelian area of Cameroon. The An. arabiensis population of Simatou was sampled twice before ITN implementation, and twice after. Effective population size estimates (N(e)) were similar across each time point, except for the period closely following ITN introduction where a nonsignificant reduction was recorded. Hence, we believe that ITN implementation resulted in a temporary bottleneck, rapidly followed by a demographic expansion. The genetic diversity of the population was not significantly affected since different genetic parameters (allele number, observed and expected heterozygosities) remained stable. Low estimates of genetic differentiation between the populations from Simatou and Lagdo, separated by 300 km, suggested extensive gene flow among populations of An. arabiensis in the Sahelian region of Cameroon. A decrease in the susceptibility to deltamethrin was observed following ITN introduction, but no kdr mutation was detected and a metabolic resistance mechanism is probably involved. The temporary effect of ITNs on the genetic structure of An. arabiensis population suggests that, to optimize the success of any control programme of this species based on ITNs, the control area should be very large and the programme should be implemented for a long period of time.

Animals↗

PubMed2005

Survey of the implementation of the recommendations in the Health Service Circular 2002/009 'Better Blood Transfusion'.

This report describes the results of questionnaire surveys in 2003 and 2004 on the implementation of the recommendations of the Health Service Circular (HSC) 'Better Blood Transfusion' 2002/009 for improving transfusion practice. These followed a similar survey in 2001 to determine the progress with the implementation of recommendations in the previous Health Service Circular (HSC) 'Better Blood Transfusion' 1998/224. There was a disappointing response rate (47%) to the 2003 survey and evidence for incomplete compliance with the action plan. It was repeated in April 2004 with a systematic approach to encouraging returns, and the response rate was 95%. The results indicate progress in the implementation of Better Blood Transfusion between 2001 and 2004 in relation to increases in the proportion of hospitals with Hospital Transfusion Committees, the training of some staff groups, the number of hospitals with transfusion practitioners, the development of protocols for the use of blood and audit activity. However, the results also indicate the need for further progress in the training of some staff groups, particularly nurses and doctors, the development of Hospital Transfusion Teams, the development of protocols for the appropriate use of blood, the provision of information to patients and the use of peri-operative cell salvage. This information should be used to plan further local, regional and national initiatives to implement the Better Blood Transfusion action plan and improve transfusion practice.

Accreditation↗

PubMed2005

Does the implementation of a clinical information system decrease the time intensive care nurses spend on documentation of care?

BACKGROUND: The number of intensive care units (ICU) using a clinical information system (CIS) is increasing. It is believed that replacing manual charting with an automatic documentation system allocates nurses more time for patient care. The objective of this study was to measure changes in nurses' working time utilization after the implementation of a CIS in a polyvalent ICU of a large Finnish central hospital. METHODS: An activity analysis-based comparison of the ICU nurses' working time utilization before and after the implementation of a CIS. RESULTS: After the implementation of a CIS the total time the nurses spent on documentation of nursing care increased by 3.6% (NS), 15 min per shift of 8 h per nurse. The total time they spent on patient care increased by 5.5% (P < 0.05), 21 min. Intensive care nursing activities increased by 3.7% (P < 0.05), 14 min. The length of the nurses' ICU experience had some effect on these figures. The demand for nurse labor remained constant. CONCLUSIONS: After the implementation of a CIS, an increase in the time nurses spent on documentation of care was detected, which suggests a need for further development of the system. As all the measured time changes were relatively small, any plans to reduce the ICU staff number with the aid of computers were not justified.

Clinical Laboratory Information Systems↗

PubMed2004

Implementing computerised workload data collection in rural primary health care.

OBJECTIVE: Describes the implementation of a computerised information system to collect workload data and discusses feedback from staff evaluation of use and value. DESIGN: Feedback interviews following service implementation. SETTING: Remote rural primary health care, Scotland. SUBJECTS: Thirty-three primary health care staff. MAIN OUTCOME MEASURES: Not relevant, as the study was service development with qualitative evaluation. RESULTS: Findings of evaluation interviews indicate a number of themes common to remote rural practice that make implementing a computerised information system problematical. These include: logistical problems caused by small practice teams and wide areas covered; inadequate allowance for recording of blurred roles and the wide range of non-clinical duties carried out; lack of local contextual and cultural information, which is necessary to make sense of data collected. Remote rural health professionals found reports from the system of limited value as they felt they already had good knowledge of local activities and had few opportunities, due to small teams, to use data for service redesign. CONCLUSION: Remote rural primary care is underpinned by a number of organisational and philosophical features that require understanding when considering the implementation of initiatives developed in an urban working environment.

Attitude of Health Personnel↗

PubMed2006

Quality improvement implementation and hospital performance on quality indicators.

OBJECTIVE: To examine the association between the scope of quality improvement (QI) implementation in hospitals and hospital performance on selected indicators of clinical quality. DATA SOURCES: Secondary data from 1997 mailed survey of hospital QI practices, Medicare Inpatient Database, American Hospital Association's Annual Survey of Hospitals, the Bureau of Health Professions' Area Resource File, and two proprietary data sets compiled by Solucient Inc. containing data on managed care penetration and hospital financial performance. STUDY DESIGN: Cross-sectional study of 1,784 community hospitals to assess relationship between QI implementation approach and six hospital-level quality indicators. DATA COLLECTION/ABSTRACTION METHODS: Two-stage instrumental variables estimation in which predicted values (instruments) of four QI scope variables and control (exogenous) variables used to estimate hospital-level quality indicators. PRINCIPAL FINDINGS: Involvement by multiple hospital units in QI effort is associated with worse values on hospital-level quality indicators. Percentage of hospital staff and percentage of senior managers participating in formally organized QI teams are associated with better values on quality indicators. Percentage of physicians participating in QI teams is not associated with better values on the hospital-level quality indicators studied. CONCLUSIONS: Results supported the proposition that the scope of QI implementation in hospitals is significantly associated with hospital-level quality indicators. However, the direction of the association varied across different measures of QI implementation scope.

Cross-Sectional Studies↗

PubMed2006

The role of formative evaluation in implementation research and the QUERI experience.

This article describes the importance and role of 4 stages of formative evaluation in our growing understanding of how to implement research findings into practice in order to improve the quality of clinical care. It reviews limitations of traditional approaches to implementation research and presents a rationale for new thinking and use of new methods. Developmental, implementation-focused, progress-focused, and interpretive evaluations are then defined and illustrated with examples from Veterans Health Administration Quality Enhancement Research Initiative projects. This article also provides methodologic details and highlights challenges encountered in actualizing formative evaluation within implementation research.

Benchmarking↗

PubMed2005

ISBT Code 128 implementation at a regional blood center.

BACKGROUND: Application specifications for ISBT 128 bar code symbology and the International Council for Commonality in Blood Bank Automation (ICCBBA) were created in 1994. By June 2000, the FDA considered ISBT 128 a standard for uniform labeling of blood and blood components. Our blood center initiated a change process for ISBT 128 implementation and "went live" in 2003. STUDY DESIGN AND METHODS: The intention to adopt ISBT 128 symbology with hospitals was actively communicated in October 2001. A Codabar-ISBT label cross-reference book was developed, FDA approval for the fullface label format in April 2002 was requested, and FDA approval was received in March 2003. In December 2002, donor identification labels and number sets were ordered, and an integration test plan was subsequently developed with departmental process flowcharts for each of the nine affected departments. Each step was tested, the labeling changes were approved in May 2003, training was completed in June 2003, and ISBT bar code symbology was implemented on July 1, 2003. A written survey was sent to hospital transfusion services in April 2004. RESULTS: Implementation went smoothly except for an unanticipated high rate of "no-reads" on some analyzers in the testing lab. The hospitals spent an average of 18 hours preparing for changes, 14 hours on validation, 4 hours on documentation and procedure development, and 8 hours on training. CONCLUSION: ISBT bar code symbology was successfully implemented. Hospital transfusion services made some adjustments and, overall, readily accepted the new bar code symbology.

Blood Banks↗

PubMed2001

Implementation and refinement of the emergency severity index.

OBJECTIVES: To implement a new five-level emergency department (ED) triage algorithm, the Emergency Severity Index (ESI), into nursing practice, and validate the instrument with a population-based cohort using hospitalization and ED length of stay as outcome measures. METHODS: The five-level ESI algorithm was introduced to triage nurses at two university hospital EDs, and implemented into practice with reinforcement and change management strategies. Interrater reliability was assessed by a posttest and by a series of independent paired patient triage assignments, and a staff survey was performed. A cohort validation study of all adult patients registered during a one-month period immediately following implementation was performed. RESULTS: Eight thousand two hundred fifty-one ED patients were studied. Weighted kappa for reproducibility of triage assignments was 0.80 for the posttest (n = 62 nurses), and 0.73 for patient triages (n = 219). Hospitalization was 28% overall and was strongly associated with triage level, decreasing from 58/63 (92%) of patients in triage category 1, to 12/739 (2%) in triage category 5. Median lengths of stay were two hours shorter at either triage extreme (high and low acuity) than in intermediate categories. Outcomes followed a-priori predictions. Staff nurses rated the new program easier to use, and more useful as a triage instrument than previous three-level triage. They provided feedback, which resulted in significant revisions to the algorithm and educational materials. CONCLUSIONS: Triage nurses at these two hospitals successfully implemented the ESI algorithm and provided useful feedback for further refinement of the instrument. Emergency Severity Index triage reproducibly stratifies patients into five groups with distinct clinical outcomes.

Adolescent↗

PubMedDate not supplied

An evaluation guide to assist with implementation of nursing diagnosis.

Nursing diagnosis is increasingly recognized as an integral component of professional nursing practice. Implementation of nursing diagnosis impacts on all elements of professional practice: the philosophy, purpose, and objectives of an organization; care planning; quality assurance; staff education; performance standards; the nursing care delivery system; documentation; and patient classification. A guide organized around these elements has been developed to assist with the implementation of nursing diagnosis. This guide can be used to gather information to plan for the implementation of nursing diagnosis or as a post-test to judge the success of the implementation process.

Humans↗

PubMed2002

Efficacy of training and fidelity of implementation of the life skills training program.

This study assessed the effectiveness of a model for diffusing the Life Skills Training (LST) Program into middle schools, examined implementation fidelity, and explored factors associated with involvement in training and program implementation. A convenience sample of master trainers (n = 44) and teachers (n = 45) from 16 Kentucky counties participated. Teachers were observed for content and process fidelity, and trainers and teachers completed questionnaires to assess factors related to training and program implementation. More than one-fourth (27%) of master trainers conducted training sessions, and 60% of teachers taught the curriculum. While implementation fidelity was relatively high, teachers were less likely to use the more innovative elements of the program. Trainers and teachers who conducted training and/or taught the LST Program were more enthusiastic toward the program than those who did nothing beyond being trained.

Adolescent↗

PubMedDate not supplied

Development and implementation of clinical pathways for the management of four trauma diagnoses.

Clinical pathways are similar to the production algorithms developed by industry. They are being adapted for use in healthcare to reduce resource utilization, decrease variability, and control expenditures. At Boston Medical Center we identified four trauma diagnoses that we believed to be amenable to the design and implementation of clinical pathways: closed head injury, penetrating wound to the abdomen, penetrating wound to the chest, and penetrating wound to an extremity. Upon implementation of these pathways, appropriate nonoperative, single-system, short-stay trauma patients were enrolled in them. This article details the process by which the four diagnoses were identified and the pathways designed, implemented, and evaluated. Preliminary data demonstrate a significant decrease in resource utilization following implementation of the pathways, without an adverse impact on readmission rates, length of stay, or mortality.

Algorithms↗

PubMed2003

Guidance document on delivery, treatment planning, and clinical implementation of IMRT: report of the IMRT Subcommittee of the AAPM Radiation Therapy Committee.

Intensity-modulated radiation therapy (IMRT) represents one of the most significant technical advances in radiation therapy since the advent of the medical linear accelerator. It allows the clinical implementation of highly conformal nonconvex dose distributions. This complex but promising treatment modality is rapidly proliferating in both academic and community practice settings. However, these advances do not come without a risk. IMRT is not just an add-on to the current radiation therapy process; it represents a new paradigm that requires the knowledge of multimodality imaging, setup uncertainties and internal organ motion, tumor control probabilities, normal tissue complication probabilities, three-dimensional (3-D) dose calculation and optimization, and dynamic beam delivery of nonuniform beam intensities. Therefore, the purpose of this report is to guide and assist the clinical medical physicist in developing and implementing a viable and safe IMRT program. The scope of the IMRT program is quite broad, encompassing multileaf-collimator-based IMRT delivery systems, goal-based inverse treatment planning, and clinical implementation of IMRT with patient-specific quality assurance. This report, while not prescribing specific procedures, provides the framework and guidance to allow clinical radiation oncology physicists to make judicious decisions in implementing a safe and efficient IMRT program in their clinics.

Algorithms↗

PubMed2004

Implementation of evidence based guidelines for paediatric asthma management in a teaching hospital.

AIMS: To evaluate a systematic approach to the development and implementation of evidence based asthma management guidelines. METHODS: Comparative study of children (2-18 years) with acute asthma; a control cohort (cohort 1) was recruited before implementation of the guidelines and two cohorts were recruited after implementation (cohorts 2 and 3). RESULTS: There was no difference in the proportion of patients who reattended in the six months following initial presentation for cohort 1 (21.5%), cohort 2 (27.8%), or cohort 3 (25.4%) and no difference in readmission rates (11.4%, 11.3%, 11.0% respectively). There was no difference in measures of asthma morbidity between the cohorts at 3 and 6 months across three domains: interval symptoms, exercise limitation, and bronchodilator use. Of those who did not have a management plan before presentation, one was provided to 46.9% of cohort 1, 74.8% of cohort 2, and 81.1% of cohort 3. There was no difference comparing cohort 2 or cohort 3 with cohort 1 regarding quality of life for either the subjects or their parents. CONCLUSIONS: Implementation of our evidence based guidelines was associated with the improved provision of asthma management plans, but there was no effect on reattendance or readmission to hospital, asthma morbidity, or quality of life. Future efforts to improve asthma management should target specific components of asthma care.

Acute Disease↗

PubMed2000

Implementation methods for vision related quality of life questionnaires.

AIM: To determine the most reliable and consistent method and time interval over which to implement a vision impairment quality of life assessment tool. METHODS: 117 patients with low vision aged 9-101 years were assigned into three age, sex, and visual function matched groups (n = 39 in each) to answer the Low Vision Quality of Life (LVQOL) questionnaire by post, telephone, or in person. The LVQOL questionnaire was completed on four occasions, each separated by four weeks. RESULTS: Postal implementation was the most cost effective method, showed the highest internal consistency of LVQOL items, but resulted in a lower apparent quality of life score than either telephone or in-person interviews (p<0.001). There was no difference in test-retest reliability between the three methods of implementation (p = 0.12). The profile of LVQOL scores showed a trend towards reduced quality of life scores 3 months after the baseline measures, although this was not significant. CONCLUSION: Posting may be the method of choice for clinical measurement of vision related quality of life. Patients with greater visual impairment were no less likely to complete a questionnaire when implemented by post and there was no apparent bias from other people assisting them. The quality of life measure can occur at any time up to 2 months after low vision rehabilitation for the progressive nature of conditions causing low vision not to cause a decreased baseline score. The LVQOL was shown to be a highly internally consistent and reliable method for measuring quality of life in the visually impaired.

Adolescent↗

PubMed2001

Evaluation of implementation and effect of primary school based intervention to reduce risk factors for obesity.

OBJECTIVES: To implement a school based health promotion programme aimed at reducing risk factors for obesity and to evaluate the implementation process and its effect on the school. DESIGN: Data from 10 schools participating in a group randomised controlled crossover trial were pooled and analysed. SETTING: 10 primary schools in Leeds. PARTICIPANTS: 634 children (350 boys and 284 girls) aged 7-11 years. MAIN OUTCOME MEASURES: Response rates to questionnaires, teachers' evaluation of training and input, success of school action plans, content of school meals, and children's knowledge of healthy living and self reported behaviour. RESULTS: All 10 schools participated throughout the study. 76 (89%) of the action points determined by schools in their school action plans were achieved, along with positive changes in school meals. A high level of support for nutrition education and promotion of physical activity was expressed by both teachers and parents. 410 (64%) parents responded to the questionnaire concerning changes they would like to see implemented in school. 19 out of 20 teachers attended the training, and all reported satisfaction with the training, resources, and support. Intervention children showed a higher score for knowledge, attitudes, and self reported behaviour for healthy eating and physical activity. CONCLUSION: This programme was successfully implemented and produced changes at school level that tackled risk factors for obesity.

Child↗