Form 6 Appendix F: Topic guide for Telephone Protocol- Guide Pr

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OMB No. xxxx-xxxx
Exp. Date xx/xx/xxxx

Appendix F: Topic guide for Telephone Protocol - Guide Practice Champions

May 9, 2016

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

Implementation of the Guide strategies

Implementation: Current Progress

1. Please describe what you have done related to the Guide implementation over the past two weeks.

1. What strategies were you working on?

2. What materials from the Guide have you used? What part or parts of the Guide or which strategies have you been focusing on?

3. Please describe any interactions with senior management about implementation of the Guide strategies. How did these interactions affect implementation?

4. Please describe any interactions with clinical staff about implementation of the Guide strategies. How have these interactions affected implementation?

2. What were the goals of or targets for implementation over the past two weeks? Were these goals or targets met? Why or why not?

3. Did you make any changes to your plans for using the tools and materials in the Guide during the past two weeks? 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 role and response.

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

4. Did you encounter any challenges to implementing the Guide strategies during the past two weeks? If so, please describe the challenges(s).

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?

5. What helped you achieve your goals during the past two weeks? What other resources did you use?

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6. How have staff responded to implementation thus far? What feedback have you heard?

Lessons Learned

7. Have any unintended consequences or effects (positive or negative) of implementation surfaced during the past two weeks (e.g., staff morale improved or got worse)? If so, please describe.

8. Based on what you have learned over the past two weeks, what improvements would you make to the Guide strategies, tools, and materials?

9. Based on what you have learned/experienced to date, what are the lessons learned for implementing these strategies 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 implementation of the Guide strategies for the next two weeks? 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.

Burden – 30 minutes per practice champion (n=1) per month for 6-months