Table 2.

Ten footprints implementation strategies

Challenge	Implementation strategy	Description
Low visibility of paper forms	Print on brightly coloured green paper	The Footprints Form was printed on bright green paper as a visual prompt.
No accountability for form distribution	Involve the unit communication clerk	The unit communication clerks placed the blank Footprints Form in each new patient’s chart on admission.
Lack of form availability	Make the form available in patient room	Blank Footprints Forms were hung from the Whiteboard with a note attached for families ‘Please take a form to complete and return to the nurse’.
Lack of form availability	Make the form available in waiting room	The Footprints Forms were also placed in the ICU waiting room inviting family completion.
Not part of routine care	Include in Daily Goals Checklist23	A Footprints completion prompt was added to the Daily Goals Checklist.
Lack of nurse motivation	Share family feedback with nurses via email	A synopsis and stories about Footprints family feedback were periodically emailed to each bedside RN.
Staff forgetfulness	Remind staff about Footprints in ICU newsletter	The Footprints Project was featured in the ‘Practice Polisher’ newsletter.
Staff forgetfulness	Role-modelling use of Footprints in practice	Team members more attentively used the Footprints Form and Whiteboard in practice to encourage uptake.
Staff forgetfulness	Include verbal reminders during huddles with bedside staff	In small group huddles and ICU walk-abouts, the research team gave ongoing verbal reminders about Footprints.
Lack of awareness	Ongoing interprofessional engagement	The research team collaborated with ICU clinicians, palliative care and liaison psychiatry colleagues for feedback and improvement suggestions.
Lack of nursing time to complete form	Introduce volunteer to engage families to replace former step*	Twice weekly, a volunteer (former ICU nurse) checked patient rooms for completed Footprints and Whiteboards, distributing blank forms to family members as needed, encouraging their completion and return to the bedside nurse.

*In July 2017, the 10th step was changed from ‘A reminder will be given to the nurses to distribute the Footprints Form and complete the Whiteboard as part of the ICU safety briefing’ to the volunteer-led family engagement.

ICU, intensive care unit.