Table 1 Factors affecting implementation
PICU organisational characteristics | Unit size and staffing | Number of beds; staff ratios; skill mix; educational provision; night-time medical staffing |
|---|---|---|
PICU staff characteristics | Perceived need for intervention | Extent to which the proposed intervention is relevant to local needs |
Perceived benefits of intervention | Extent to which the intervention will achieve benefits desired at the local level | |
Self-efficacy | Extent to which staff feel they will be able to do what is expected | |
Skill proficiency | Possession of the skills necessary for implementation | |
Characteristics of the intervention | Compatibility | Extent to which the intervention fits with the PICU’s priorities and needs. |
Organisational capacity | Positive work climate | Staff views about trust, collegiality, and methods of resolving disagreements |
Organisational norms regarding change | Engagement in research and previous trials, openness to change | |
Integration of new intervention | Extent to which the unit can incorporate the intervention into its existing practices and routines | |
Shared vision | Consensus, commitment, staff buy-in | |
Usual care processes | Pain and sedation management | Pain, sedation and withdrawal assessment tools in current use, frequency of assessment and compliance. Sedation protocols, sedatives used, nurses’ role in sedation titration. Use of sedation and neuromuscular blockade holidays |
Ventilator weaning practice | Weaning protocols, types of weaning, usual methods employed, nurses’ engagement in weaning process | |
Other practices and processes | Shared decision-making | The extent to which staff collaborate in determining what will be implemented and how |
Communication | Effective mechanisms encouraging frequent and open communication | |
Formulation of tasks | Procedures that enhance planning and contain clear roles and responsibilities relative to implementation | |
Specific staffing considerations | Leadership | Extent to which senior staff clearly support and encourage providers during implementation |
Programme champion | An individual who is trusted and respected by staff and administrators, and who can rally and maintain support for the innovation, and negotiate solutions to problems that develop | |
Intervention support system | Training | Approaches to ensure staff proficiencies in the skills necessary to conduct the intervention |
Research assistance | Resources available once implementation begins, research nurse availability, provision for training, training of new staff, and mechanisms to promote local problem-solving efforts | |
Prior experience | Barriers and facilitators to previous trial implementation |