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Table 3 Implementation toolkit contents

From: Development and use of a toolkit to facilitate implementation of an evidence-based intervention: a descriptive case study

Section of toolkit

Tool name

Purpose of the tool

Implementation strategy [12]

Phase during which the tool was developed

Introduction

Introduction to The Toolkita

Provide toolkit introduction including the purpose of implementation and timeframe

Develop a formal implementation blueprint

Phase 1

Definitions

Acronyms and Abbreviations

List acronyms and abbreviations used throughout the toolkit

Develop an implementation glossary

Phase 1

Engagement/communication

Chief Nursing Officer Letter of Support

Obtain a commitment from leaders to participate in the study and mandate the change

Obtain formal commitments, mandate change

Phase 1

Chief Nursing Officer Talking Points

Provide information and talking points for each chief nursing officer

Obtain formal commitments

E-mail Template for Providers

Provide a template site that coordinators can use to share information with local healthcare providers

Inform local opinion leaders; build a coalition

Indiana SBIRT Information Sheet

Summarize SBIRT and the outcomes associated with SBIRT use

Advisory Council Agenda Template

Provide a template for meetings with the advisory board

Use advisory boards and workgroups

Assessment

Capacity Self-Assessmenta b

Assess capacity, local needs, and barriers and facilitators to implementation

Assess for readiness and identify barriers and facilitators; conduct local needs assessment

Phase 1

Planning

Gantt Chart for Site Coordinatorsa

List site coordinator responsibilities and projected study activities timeline

Prepare champions

Phase 1

Information for Shared Electronic Platform

Create a common resource to assemble and share information among investigators and site coordinators

Centralize technical assistance

Site Coordinator Roles and Responsibilitiesa

Describe the study and anticipated site coordinator roles and responsibilities in order to select a site coordinator

Identify champions

How to Identify a Site Coordinator

Describe characteristics of site coordinators that may facilitate implementation

Identify champions

Phase 3

Training Initial Clinical Nurses and Providing Ongoing Training

Provide a worksheet to inform development of a process to train clinical nurses

Conduct ongoing training

Communicating with Stakeholders

Provide a worksheet to help site coordinators identify key talking points and plan for ongoing communication with stakeholders

Build a coalition; create new clinical teams

Facility Resources for SBIRT Implementation

Reflect and identify a list of supporting resources already available at the facility

Assess for readiness and identify barriers and facilitators

Back-up Plan for Site Coordinator

Develop a process to support SBIRT implementation when the site coordinator is not available

Create new clinical teams

How to Adapt the Intervention

Identify the core components of the intervention and the components of the intervention that may be adapted

Promote adaptability

Training

Pre-course Training

Provide a short introduction to SBIRT and the study before site coordinators attend the 8-h training

Develop and distribute educational materials; prepare champions

Phase 1

Training Agenda

Provide an agenda and objectives of the site coordinator training

List of Investigators

Familiarize the site coordinators with the study investigators

Create new clinical teams; prepare champions

List of Site Coordinators

Generate a list of names and contact information

Study Overview

Provide a brief description of the study that site coordinators may share with stakeholders

Distribute educational materials; use train-the-trainer strategies, prepare champions; make training dynamic

Study Timeline

Provide a timeline of all study activities including training and data collection

Study Introduction

Provide detailed information about the study

Substance Abuse Overview

Teach site coordinators about substance use disorders, including epidemiology, risk factors, and the neurobiology of addiction

SBIRT Introduction

Educate site coordinators regarding the evidence supporting SBIRT and the value of implementing SBIRT

Screening for Substances

Describe tools used to screen for drug and alcohol use and demonstrate how to screen patients

Motivational Interviewing

Describe stages of change and the principles of motivational interviewing; explain the goals and components of brief interventions

Stages of Change Exercise

Discuss different stages of change and demonstrate potential responses

System Issues and Implementation

Guide discussion regarding implementation at each facility

Additional SBIRT Resources

List websites, online videos, and other resources that provide additional information about substance abuse and SBIRT

Documentation Process

Describe a standard process to document SBIRT in the electronic medical record and provide examples of documentation

Protocol for Missed Site Coordinator Training

Describe the steps to complete training if the site coordinator was unable to attend the 8-h training session

Patient Education Brochure- Ordering Info

Provide information to order patient education brochures

Brief intervention Cheat Sheet

Provide a one-page guide to motivational interviewing

Distribute educational materials; capture and share local knowledge; Tailor strategies

Phase 2

Brief Intervention Guide Using the 5 A’s

Provide a guide to intervening using (Ask, Assess, Advice, Assist, and Arrange)

Documentation Badge Reference

Provide a quick guide to documentation that can be worn with the nurse’s identification badge

REWARD Smoking Cessation

Provide patient education using the REWARD acronym with benefits of quitting smoking

Education Express

Notify direct care nurses of the new SBIRT process and go-live date

Motivational Interviewing Article

Provide additional details about motivational interviewing

Conduct ongoing training, distribute educational materials

Phase 3

Evaluation of training

SBIRT Knowledge Assessmentb

Assess knowledge of SBIRT after the completion of training

Distribute educational materials; use train-the-trainer strategies, prepare champions

Phase 1

Brief Intervention Adherence and Competence Scaleb

Demonstrate competency providing a brief intervention using motivational interviewing techniques

Distribute educational materials; capture and share local knowledge

Policy and procedure for training (non-localized)

SBIRT Documentation Form

Provide a paper document for completion of the screening tools and brief intervention (note: SBIRT is not located in the electronic medical record at this time)

Distribute educational materials; use train-the-trainer strategies, prepare champions

Phase 1

SBIRT Flowchart

Provide a step-by-step flowchart of the components of SBIRT

Evaluation of implementation and intervention fidelity

Chart Data Abstraction Tool

Collect data from patient’s electronic medical records regarding screening, brief intervention, and referral to treatment

Audit and provide feedback

Phase 1

Implementation Fidelityb

Assess fidelity to the implementation process

Monthly Meeting Agenda Template

Provide a template for the monthly site coordinator/investigator meeting

Create a learning collaborative; capture and share local knowledge; ongoing consultation; organize clinician implementation team meetings

Monthly Worksheet**

Collect information regarding site coordinator time spent implementing SBIRT, barriers/facilitators to change, and lessons learned from implementation

Identify barriers and facilitators; capture and share local knowledge

SBIRT Fidelityb

Assess fidelity to the SBIRT process

Develop and implement tools for quality monitoring

Policy and procedure (localized)

SAMSHA-Approved Providers

List treatment centers (including the address and phone number) throughout the state

Tailor strategies

Phase 1

SBIRT Process 2 (localized to a specific facility)

Describe the process for completing SBIRT, including the people responsible and hand-off between providers

Promote adaptability

Phase 2

Documentation Form with Barcode (multiple versions localized to different facilities)

Provide a document for completion of the screening tools and brief intervention (note that screening tools are not located in the electronic medical record at this time)

Promote adaptability; change record systems; tailor strategies

SBIRT Process (multiple versions localized to different facilities)

Describe the process for completing SBIRT, including the people responsible and hand-off between providers

Promote adaptability; tailor strategies

Fiscal and funding

SBIRT Reimbursement Resources

List billing codes that have been used for SBIRT

Make billing easier

Phase 2

  1. aModified in phase 3
  2. bAlso used in prior SBIRT study [32]