Table 2.
Implementation Strategies Used by ICUs to Facilitate Adoption of the ABCDEF Bundle
| Implementation Strategy Categories | Implementation Strategy | N = 19 ICU n (%) |
|---|---|---|
| Category 1: Train and Educate Stakeholders | Conduct educational meetings | 18 (94.7%) |
| Develop educational materials | 17 (89.5%) | |
| Conduct ongoing training | 17 (89.5%) | |
| Distribute educational materials | 16 (84.2%) | |
| Use train-the-trainer strategies | 15 (78.9%) | |
| Make training dynamic | 14 (73.7%) | |
| Create a learning collaborative | 12 (63.2%) | |
| Conduct educational outreach visits | 10 (52.6%) | |
| Shadow other experts | 9 (47.4%) | |
| Provide ongoing consultation | 8 (42.1%) | |
| Work with educational institutions | 1 (5.3%) | |
| Category 2: Develop Stakeholder Interrelationships | Use an advisory board and/or workgroup | 18 (94.7%) |
| Identify and prepare champions | 15 (78.9%) | |
| Recruit, designate, and train for leadership | 13 (68.4%) | |
| Promote network weaving | 13 (68.4%) | |
| Involve executive boards | 13 (68.4%) | |
| Use an implementation advisor | 11 (57.9%) | |
| Inform local opinion leaders | 11 (57.9%) | |
| Organize clinician implementation team meetings | 11 (57.9%) | |
| Identify early adopters | 11 (57.9%) | |
| Develop an implementation glossary | 11 (57.9%) | |
| Capture and share local knowledge | 9 (47.4%) | |
| Conduct local consensus discussions | 9 (47.4%) | |
| Build a coalition | 8 (42.1%) | |
| Obtain formal commitments | 5 (26.3%) | |
| Visit other sites | 3 (15.8%) | |
| Develop academic partnerships | 2 (10.5%) | |
| Model and simulate change | 2 (10.5%) | |
| Category 3: Engage Consumers | Involve patients/consumers and family members | 14 (73.7%) |
| Prepare patients/consumers to be active participants | 13 (68.4%) | |
| Intervene with patients/consumers to enhance uptake and adherence | 5 (26.3%) | |
| Use mass media | 5 (26.3%) | |
| Increase demand | 1 (5.3%) | |
| Category 4: Use Evaluative and Iterative strategies | Purposely reexamine the implementation | 16 (84.2%) |
| Audit and provide feedback | 16 (84.2%) | |
| Conduct local needs assessment | 15 (78.9%) | |
| Assess for readiness and identify barriers and facilitators | 12 (63.2%) | |
| Develop and organize quality monitoring systems | 11 (57.9%) | |
| Develop and implement tools for quality monitoring | 9 (47.4%) | |
| Develop a formal implementation blueprint | 9 (47.4%) | |
| Stage implementation scale-up | 7 (36.8%) | |
| Conduct cyclical small tests of change | 6 (31.6%) | |
| Obtain and use patients/consumers and family feedback | 2 (10.5%) | |
| Category 5: Utilize Financial Strategies | Access new funding | 3 (15.8%) |
| Fund and contract for the clinical innovation | 3 (15.8%) | |
| Alter incentive/allowance structures | 1 (5.3%) | |
| Category 6: Provide Interactive Assistance | Provide clinical supervision | 10 (52.6%) |
| Facilitation | 9 (47.4%) | |
| Provide local technical assistance | 7 (36.8%) | |
| Centralize technical assistance | 3 (15.8%) | |
| Category 7: Adapt and Tailor Context | Promote adaptability | 12 (63.2%) |
| Tailor strategies | 8 (42.1%) | |
| Use data experts | 6 (31.6%) | |
| Use data warehousing techniques | 3 (15.8%) | |
| Category 8: Support Clinicians | Remind clinicians | 16 (84.2%) |
| Facilitate relay of clinical data to providers | 7 (36.8%) | |
| Create new clinical teams | 6 (31.6%) | |
| Develop resource sharing agreements | 2 (10.5%) | |
| Revise professional roles | 2 (10.5%) | |
| Category 9: Change Infrastructure | Mandate change | 13 (68.4%) |
| Change physical structure and equipment | 12 (63.2%) | |
| Change record systems | 10 (52.6%) | |
| Start a dissemination organization | 1 (5.3%) |