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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]