Form #3 Form #3 Pre-Implementation Semi-Structured Interview Protocol

Attachment E: Pre-Implementation Semi-Structured Interview Protocol

Form Approved
OMB No. XXXX-XXX
Exp. Date XX/XX/XXXX

Pre-Implementation Semi-Structured Interview Protocol

Approach

When selecting participants, individuals will be categorized (1) leadership and champion staff; (2) frontline nursing staff (e.g., RN’s and LPN/LVNs), and (3) attending in-house clinicians.

We have assumed 15-60 minutes for each interview.

Objectives

The purpose of these interviews is to obtain information on the following:

• The role of the person being interviewed

• A description of quality improvement (QI) processes

• Description of managing infections

• Reactions to the training

• Reasons for implementing the Loeb Criteria

Public reporting burden for this collection of information is estimated to average 60 minutes per response, the estimated time required to complete the interview. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (XXXX-XXXX) AHRQ, 540 Gaither Road, Room #5036, Rockville, MD 20850.

Purpose of the Interview(s)

The purpose of these set of questions is to gain an understanding of the role and perspective of the person who is being interviewed and of how this individual and the department(s) and/or wider facility perceive quality improvement, in general. We also hope to gain a better understanding of the amount of experience in QI and the processes for handling infections. Finally, we hope to obtain general reactions regarding the training on the Loeb criteria.

For Site Visits

Nursing home name:
Name	Title

Testing materials checklist

Interview guide

Interviewer clock

Audio recording equipment (2)

Batteries

Verify audio recording equipment

Pens

Informed consent forms (1 copy for participant to sign, plus 1 copy for participant to keep)

I. Introduction [use this intro for all staff]

Welcome

Hello. My name is {FIRST NAME} and I work for the American Institutes for Research, or AIR, which is a non-profit research organization in Washington, DC. I am here with {NOTE TAKER} who will be taking notes.

Background and Disclosures

• Background. Our discussion today is part of a research project sponsored by the Agency for Healthcare Research and Quality, or AHRQ. AHRQ is the federal government agency charged with improving the quality and safety of health care for all Americans. AHRQ is funding two projects that seek to standardize antibiotic use in long term care settings.

• Purpose. We are here today to learn about your nursing home’s quality improvement processes, infection processes, and your reactions to the training on the Loeb criteria communication and order form.

• Confidentiality. When we write our report, we will not include your name or the nursing home’s name.

• Consent. Before we begin, here are two consent forms, one for you to sign and give back and one for you as a copy.

[GO APPROPRIATE SECTION AND BEGIN RECORDING]

II. Leadership Questions

Questions for the Administrator, the Director of Nursing, the Assistant Director of Nursing, or the Champion of the Tool.

1. Please tell me about your current position.

1. What is your title?

2. How long have you been in this position? At this facility?

3. What are your main / primary roles and responsibilities?

4. What types of experiences have you had with quality improvement initiatives

2. I would like to start with getting a sense of how your facility is structured. Please tell me how is your facility structured? For example, who makes the major decisions? Who carries out these decisions?

3. We would like to understand how your facility documents and manages infections.

1. How does your home document the infection? Is it in a hard copy or electronic format?

2. Is there an infection log? Where is it located?

3. How often do you review the infection log? Who reviews it?

4. Now I would like to talk about infections specifically. What information do you provide to the clinician when a resident has a potential infection?

1. How do you give the information to the clinician? Call, fax, electronic or is she or he on-site/

2. Are there any guidelines or specific protocols for communicating the information?

3. Is there a form? Is it possible to get a copy of the form?

4. Are there market, regulatory or other external pressures that encourage greater reductions in infections?

5. I would also like to understand any quality improvement activities you may have done in the past year or so regarding infections. Please give me an example of a quality improvement effort that your facility has implemented recently.

1. Does your facility have a system-wide or facility-wide quality improvement initiative?

2. What prompted your initiative?

3. What are the broad goals of the initiative?

6. How did you or your facility decide to implement the Loeb Criteria Communication and Order Form?

1. Who made the decision?

2. What were the reasons for choosing to do it?

3. Who are the champions? What are their titles? What do they do?

7. How supportive are the staff of Loeb Criteria Communication and Order Form initiative? How do they demonstrate their support?

   1. Nurses

   2. Nurse leadership (supervisors)

   3. Nurses assistants

   4. Administration

8. Now I would like to hear about the training. You received a presentation to use for the training and you underwent the training. How did your training go?

   1. Who conducted the training?

   2. How many trainings occurred?

   3. How many staff were trained per training?

   4. Did you measure the training effectiveness? [IF YES] What were the findings?

   5. Who did the training?

   6. How long was the training?

   7. Based on the training, how supportive did the staff seem for the Loeb Criteria Communication and Order Form initiative? How did they demonstrate their support? For example, what did they say or do that made you think they supported the initiative?

9. I would like to understand your reactions and possible changes to the training. Did the training differ from the training that was provided? How so?

   1. Thinking about other quality improvement trainings, how did Loeb Criteria training compare to these other approaches?

   2. Was there anything you would have liked to add to the training that you felt was missing?

   3. Was there anything you would have liked to have removed or that you found unnecessary?

   4. How could the training be improved?

10. How do you plan to implement it on the facility level?

    1. What were the overall facility goals and time frame for the implementation of the communication and order form?

    2. How will you train new staff?

    3. Who are the champions of the Tool on the floor(s)?

    4. Will the tool be a standalone form, integrated into another currently used form, part of an electronic form, or something else? If you have a new form, can you give us a copy?

II. RN and LPN Questions

1. Please tell me about your current position.

1. What is your title?

2. How long have you been in this position? At this facility?

3. What are your main / primary roles and responsibilities?

4. What types of experiences have you had with quality improvement initiatives

2. Please describe your interactions with management and/or senior staff. How often do you interact with management staff in your facility?

1. How much of these interactions involve or are about quality improvement activities and/or approach?

3. To whom do you report? Who has primary responsibility for the department? To whom do they report?

1. Who is in charge of your department?

2. Would you say you have formal and/or informal leaders? Who are these leaders/champions? Are any of them nurses or aides? What does each type of leader do? To what extent do they collaborate or compete/complement one another? Are there any leadership relationships that result in tensions or conflict?

3. When implemented in your department, who leads QI projects?

4. In your opinion, how much support do you receive from senior staff/organizational leadership to pursue or implement quality improvement activities at your level?

5. Did you attend the training? [IF YES:] How long ago was the training?

6. [IF TRAINED] What were the main points of the training?

7. [IF TRAINED] What were your reactions to the training on the Communication and Order Form?

8. Have you had a chance to use the form yet? Tell me about it.

   1. How difficult or easy was it to fill out the form?

   2. [IF TRAINED] Do you think you had enough information from the training to fill out the form?

9. [IF NOT TRAINED] Did anyone tell you about the form? Who? What is her title? What did they say?

III. Clinician Questions

1. Please tell me about your current position.

1. What is your title?

2. What types of experiences have you had with quality improvement initiatives?

3. What do you do for the residents of this facility?

4. How many hours a week do you work with this facility?

5. Are you ever on-site at this facility? For how long?

1. I would like to understand a little about the decision-making process for initiating a course of antibiotics for a resident. What information do you receive from the facility that helps you decide?

1. What information do you want to know to make a decision about a potential UTI?

2. What about a skin or soft tissue infection?

3. A lower respiratory infection?

4. What if there is a fever of unknown origin. How do you handle that?

5. Do you use any clinical practice guidelines for decision-making? Which ones?

6. Have you heard of the Loeb Criteria for initiating antibiotics?

3. How did you hear about the Loeb Criteria Communication and Order Form?

4. Were you notified about how to use the Loeb Criteria Communication and Order Form?

5. How did you first react when hearing of the facility’s decision to implement Loeb Criteria Communication and Order Form in your department? Why did you feel this way? Did you play a role in this decision? Please tell me about that.

6. Did you receive any supporting documentation? An article or something describing the criteria? What were your reactions to the Loeb Criteria?

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