Form 3 Attachment C – Proactive TA Discussion Protocol

Proactive TA Discussion Protocol

Attachment C

Proactive Technical Assistance Discussion Protocol

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/XXXX

The purpose of this call is to check on your progress during the implementation period of the Guide and gather information on your successes and challenges thus far.

Implementation of the Guide

The Guide: Current Progress

1. To confirm, which tool or toolkits are you using?

   

   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 (0935-XXXX) AHRQ, 540 Gaither Road, Room #5036, Rockville, MD 20850.

   
   
   

2. Please describe what you have done related to the project over the past two months.

1. What components and strategies were you working on?

2. What tasks have you completed?

3. What materials from the Guide did you use? What part of the Guide were you focusing on?

4. [IF TOOL INVOLVES NURSES] How have nurses reacted to it?

5. [IF TOOL INVOLVES PRESCRIBING CLINICIANS] Have any of the prescribing clinicians reacted in any way? If so, how?

6. [IF TOOL INVOLVES RESIDENTS/FAMILY MEMBERS] Have you heard from residents or family members about their reactions to the tool or the use of the tool? How has that gone?

3. What were the goals or targets of the Guide implementation over the past two months? Were these goals or targets met? What happened? What were the reasons?

   

   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 (0935-XXXX) AHRQ, 540 Gaither Road, Room #5036, Rockville, MD 20850.

   
   
   

4. Did you make any changes to your plans for using the Guide during the past two months? If so, please describe the change(s).

1. What was the reason for the change?

2. What staff were involved in deciding on the change? Describe their roles and responses.

3. What are the implications, if any, that the changes will have on your efforts?

Public reporting burden for this collection of information is estimated to average 30 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 (0935-XXXX) AHRQ, 540 Gaither Road, Room #5036, Rockville, MD 20850.

 

5. Did you encounter any challenges to implementing the Guide during the past month? If so, please describe the challenges(s).
   [If necessary, probe for: system level factors (e.g., top leadership support, project visibility, availability of resources for Guide implementation), unit level factors, staff level factors (e.g., clinical champion), or patient/family level factors (e.g., types of patients seen, positive response to intervention overall or aspects of it)]

1. To what extent did you anticipate these challenges, if at all?

2. How did you try to overcome the challenges described above? To what extent have you overcome these challenges?

6. What helped you achieve your goals during the past month? What other resources did you use?
   [If necessary, probe for: system level factors (e.g., top leadership support, project visibility, availability of resources for Guide implementation), unit level factors, staff level factors (e.g., clinical champion), or patient/family level factors (e.g., types of patients seen, positive response to intervention overall or aspects of it)]

Unintended Consequences and Lessons Learned

7. Have any unintended consequences or effects—good or bad—of the Guide implementation surfaced during the past month (e.g., staff morale improved or got worse)? If so, please describe.

8. Based on what you have learned over the past month, what improvements would you make to the Guide?

9. Based on what you have learned/experienced to date, what are the lessons learned for implementing this Guide in a medical-surgical unit? If you were advising others about the Guide and its implementation, what would you most want them to know? What should they be aware of, what should they do, what should they NOT do?

Next Steps/Closing

10. What do you have planned for the Guide implementation for the next month? Please briefly describe.

11. Please share anything else you think may be important for us to know about the Guide and its implementation and use.

C-3