Table 4 Strategies for MAQI2 implementation endorsed by stakeholder group
Implementation strategy | Additional details | Targeted determinant of implementation success |
|---|---|---|
Create new teams | These customized teams (including pharmacists, nurses, technologists, and/or administrative assistants) at each center will tailor workflow that best meets the needs of each anticoagulation clinic staff and culture | Clinician authority and autonomy AND Staffing and scheduling |
Create new guidelines, update policies, and revise professional roles | These updates will focus on clinic-lead medication changes for unsafe DOAC dosing that minimize reliance on referring physicians | Clinician authority and autonomy |
Develop note and communication templates | Ensure these templates are easy to use for communicating with physician colleagues within and outside each MAQI2 hospital | Documentation, administrative needs, and performance evaluation |
Capture and share local knowledge | Share notes developed at other sites, especially early adopter sites. Leverage the learning collaborative to share these tools. | Documentation, administrative needs, and performance evaluation |
Develop and organize a quality monitoring system | Build into EHR a means for monitoring DOAC Dashboard use and impact to quantify staff work. | Documentation, administrative needs, and performance evaluation |
Alter performance measures | Engage clinic leadership to alter staff performance measures that include DOAC Dashboard use | Documentation, administrative needs, and performance evaluation |
Access new funding | Use additional funding to support additional team members to work with or support DOAC Dashboard use. This will require robust metrics to demonstrate return on investment. | Staffing and scheduling |
Stage scale up | To address the initial volume of alerts, temporary staff or a planned role out over time can be used to reduce burden | Staffing and scheduling |
Provide and prioritize local technical assistance | Alert information technology teams months in advance of required implementation needs to allow for appropriate prioritization | Technology integration |
Centralize technical assistance | A single developer with provide technical assistance to all MAQI2 sites | Technology integration |
Early adopter demonstration | Use data from the early adopter sites to demonstrate the accuracy of the DOAC Dashboard | Technology integration |
Trialability and customization | Allow sites to try out the DOAC Dashboard and make customizations (e.g., which patients are included, thresholds for alerts). | Technology integration |
User-centered design approach | Follow a user-centered design approach to initial development of the DOAC Dashboard based on early adopter site feedback. Improve layout and load time of the tool. Build the tool directly within EHR to maximize workflow integration and security. | Technology integration |