Before Implementation |
Identify key personnel: a dedicated project champion and a core project team; recommend both an infectious disease and critical care clinician |
Identify required data elements (ex: monthly number of endotracheal aspirate cultures) |
Examine the unit’s baseline performance of the metric of interest before implementation and establish a system for how to analyze that data in each phase of the project |
Understand the current/baseline approach to the test of interest in the unit (the current drivers of testing use, and potential barriers or facilitators to changing practice), via survey, focus groups, or interviews |
Reach out to key stakeholders whose perspectives and buy-in will be important for your new approach (e.g., leadership, relevant consultants, nurses, respiratory therapists, advance practice providers). |
Create the new tool/algorithm for your stewardship initiative that reflects key drivers/barriers/facilitators and stakeholder perspectives |
Establish the balancing metrics and unintended consequences of your practice change and how to monitor for those after implementation |
Implementation |
Develop one or more strategies for disseminating the new tool/algorithm to the appropriate end-users (ie, clinicians, laboratory personnel, etc) in your ICU (e.g., emails, posters, check-lists, educational seminars) |
After Implementation |
Analyze the use of the test of interest on a weekly or monthly basis to monitor progress, using a run or control chart if possible |
Share this data with the appropriate end-users that your tool/algorithm targeted, using feedback to help drive behavior change |
Monitor for adherence to the new guidelines and for unintended consequences of the practice change |
Revise the clinical approach or implementation plan if initial results are suboptimal |