Understanding clinical implementation coordinators’ experiences in deploying evidence-based interventions

Author:

Hernandez Sara E1,Solomon Demetrius2,Moon Jukrin1,Parmasad Vishala3,Wiegmann Douglas2,Bennett Nick T4,Ferren Ryan S5,Fitzsimmons Alec J6,Lepak Alexander J3,O’Horo John C7,Pop-Vicas Aurora E3,Schulz Lucas T8,Safdar Nasia3

Affiliation:

1. School of Pharmacy, University of Wisconsin–Madison , Madison, WI , USA

2. Department of Industrial and Systems Engineering, University of Wisconsin–Madison , Madison, WI , USA

3. School of Medicine and Public Health, University of Wisconsin–Madison , Madison, WI , USA

4. Antimicrobial Stewardship Program, Saint Luke’s Health System , Kansas City, MO , USA

5. University of Texas Medical Branch , Galveston, TX , USA

6. Department of Medical Research, Gundersen Health System , La Crosse, WI , USA

7. Mayo Foundation for Medical Education and Research , Rochester, MN , USA

8. Department of Pharmacy, University of Wisconsin Health , Madison, WI , USA

Abstract

Abstract Purpose The fluoroquinolone restriction for the prevention of Clostridioides difficile infection (FIRST) trial is a multisite clinical study in which sites carry out a preauthorization process via electronic health record–based best-practice alert (BPA) to optimize the use of fluoroquinolone antibiotics in acute care settings. Our research team worked closely with clinical implementation coordinators to facilitate the dissemination and implementation of this evidence-based intervention. Clinical implementation coordinators within the antibiotic stewardship team (AST) played a pivotal role in the implementation process; however, considerable research is needed to further understand their role. In this study, we aimed to (1) describe the roles and responsibilities of clinical implementation coordinators within ASTs and (2) identify facilitators and barriers coordinators experienced within the implementation process. Methods We conducted a directed content analysis of semistructured interviews, implementation diaries, and check-in meetings utilizing the conceptual framework of middle managers’ roles in innovation implementation in healthcare from Urquhart et al. Results Clinical implementation coordinators performed a variety of roles vital to the implementation’s success, including gathering and compiling information for BPA design, preparing staff, organizing meetings, connecting relevant stakeholders, evaluating clinical efficacy, and participating in the innovation as clinicians. Coordinators identified organizational staffing models and COVID-19 interruptions as the main barriers. Facilitators included AST empowerment, positive relationships with staff and oversight/governance committees, and using diverse implementation strategies. Conclusion When implementing healthcare innovations, clinical implementation coordinators facilitated the implementation process through their roles and responsibilities and acted as strategic partners in improving the adoption and sustainability of a fluoroquinolone preauthorization protocol.

Publisher

Oxford University Press (OUP)

Subject

Health Policy,Pharmacology

Reference35 articles.

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2. Vital signs: improving antibiotic use among hospitalized patients;Fridkin;MMWR Morb Mortal Wkly Rep,2014

3. Essential resources and strategies for antibiotic stewardship programs in the acute care setting;Doernberg;Clin Infect Dis,2018

4. Uncovering middle managers’ role in healthcare innovation implementation;Birken;Implement Sci,2012

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