Abstract
BackgroundImplementation of evidence-based clinical interventions in real-world settings becomes a futile effort when effective strategies to foster adoption are not used. A toolkit, or a collection of adaptable documents to inform and facilitate implementation, can increase the use of evidence-based interventions. Most available toolkits provide resources about the intervention but lack guidance for adaptation to different contexts or strategies to support implementation. This paper describes the development and use of a toolkit to guide the implementation of an evidence-based intervention to identify and intervene for people with risky substance use.MethodsA descriptive case study describes the development and use of a toolkit throughout a two-year study. Investigators and site coordinators from 14 acute care hospitals developed tools and engaged external stakeholders as they prepared for implementation, integrated the clinical intervention into practice, and reflected on implementation.ResultsThe final toolkit included 54 different tools selected or created to define the intervention, engage and communicate with stakeholders, assess for readiness and plan for implementation, train clinical nurses and other stakeholders, evaluate training and implementation effectiveness, create policies and procedures for different contexts, and identify opportunities for reimbursement. Each tool corresponds to one or more implementation strategies.ConclusionThe approach used to develop this implementation toolkit may be used to create resources for the implementation of other evidence-based interventions.
Highlights
Introduction to The ToolkitaProvide toolkit introduction including the purpose of implementation and timeframeDevelop a formal implementation blueprint Phase 1 DefinitionsAcronyms and AbbreviationsList acronyms and abbreviations used Develop an implementation glossary Phase 1 throughout the toolkitEngagement/ Chief Nursing Officer communication Letter of SupportObtain a commitment from leaders to participate in the study and mandate the changeObtain formal commitments, mandate changeChief Nursing Officer Provide information and talking points Obtain formal commitments
Several toolkits exist to facilitate the implementation of evidence-based interventions; attention to implementation strategies and context is often lacking
The toolkit described in this paper provides a compilation of tools to provide information or guidance to support implementation of SBIRT in acute care settings
Summary
Introduction to The ToolkitaProvide toolkit introduction including the purpose of implementation and timeframeDevelop a formal implementation blueprint Phase 1 DefinitionsAcronyms and AbbreviationsList acronyms and abbreviations used Develop an implementation glossary Phase 1 throughout the toolkitEngagement/ Chief Nursing Officer communication Letter of SupportObtain a commitment from leaders to participate in the study and mandate the changeObtain formal commitments, mandate changeChief Nursing Officer Provide information and talking points Obtain formal commitments. This gap between evidence and practice is potentially detrimental and may result in preventable morbidity and mortality for healthcare recipients [9,10,11] To address this gap between evidence and practice, Powell and colleagues have identified several strategies to support the implementation of evidence-based interventions, including identification of champions, assessment for adoption readiness, identification of barriers, and promotion of the adaptability of the intervention [12]. Toolkits may include documents which may be used individually or collectively, such as educational material, timelines, agenda templates, and assessment tools [13], and the tools may often be customized based on context [14], helping to bridge the translation gap between evidence and practice These tools may be used throughout the implementation process to support adoption (the decision to use the intervention), implementation (incorporation of the intervention into practice), and sustainment (continued use of the intervention)
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