4 Implementation assessment

AHRQ Safety Program for Improving Surgical Care and Recovery

Attachment H_Implementation assessment_Data collection instrument_20170727

Readiness and Implementation assessment

OMB: 0935-0239

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Implementation Assessment




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Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

AHRQ Safety Program for Improving Surgical Care and Recovery Implementation Assessment

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Public reporting burden for this collection of information is estimated to average 60 minutes per response, the estimated time required to complete the survey. 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, 5600 Fishers Lane, # 07W41A, Rockville, MD 20857.






PART 1: Interview Format


  1. I am interested in hearing about your experience with the implementation of enhanced recovery practices so far.

    1. What has gone well?

    2. What has not gone well?


  1. To what extent have the elements of the program’s pathway been implemented as planned?


  1. Have any of these pathway elements been adapted to fit your local setting? Can you please describe these adaptations?


  1. Were any pathway elements not implemented? Why not?


  1. What resources has your institution provided for implementing enhanced recovery?

    1. [PROBE: added staff, time, finances, EHR changes, data reporting]


  1. Has your hospital’s executive team played an active role in the implementation process?

  1. [IF YES]: How so?

  2. [IF NO]: What barriers may have prevented them from engaging more fully?


  1. Can you describe the process of how an enhanced recovery-related issue is escalated up the chain of command? How are updates/information then fed back to the frontline?


  1. How often did the program’s implementation team meet? Did all discipline champions regularly attend the meetings? If not, did the anesthesia, nurse, or surgeon champion send someone to cover for them?

  2. Who do you think has been most influential in supporting program-related efforts in your hospital? What about these individuals made them influential (e.g., their role, specific behaviors)? Were any of these influential individuals not official project champions?


  1. Who do you think has been most influential in challenging program-related efforts in your hospital? Can you describe what strategies have and haven’t worked in terms of bringing these “resistors” on board?


Consult calls with ISCR nurse consultant <name>.

  1. Did you speak with <name> during the enrollment phase of this program? Did you find that conversation helpful? If so, what about the call was helpful?


ISCR training events

  1. Did you participate in the training event in New York City (Y N), or another training event hosted by a coordinating entity (Y N)? If so, did you find that training helpful? What about the training did you like/dislike?


Safety Culture Survey

Safety Culture Survey

Did you complete the following through this program?

If yes, did this help with implementing the enhanced recovery elements? How?

Safety culture survey administration

Yes____ No____



Safety culture survey debrief

Yes____ No____




ISCR Program tools

Tools

Did you use any of the following program tools?

If yes, was it helpful and why?

If no, why was the tool not used?

Building your core team

Yes____ No____




ISCR Pathway

Yes____ No____




ISCR Implementation Guide

Yes____ No____




Sample ISCR Pathway Checklist 

Yes____ No____




Engaging Frontline Staff with Process and Outcome Data

Yes____ No____



Sample Pathway Grid for Staff Education

Yes____ No____



Sample Patient Education Booklet

Yes____ No____



Sample Enhanced Recovery Poster

Yes____ No____



Sample ISCR Pocket Card

Yes____ No____




Guide to Engaging Patients and Families in ISCR

Yes____ No____



Sample Presentation for Senior Executive 

Yes____ No____



Red light, green light: An overview of common enhanced recovery implementation barriers and facilitators

Yes____ No____




ISCR Webinars

Webinars

Did you or your team members participate in the following program webinars?

If yes, how many team members participated on average?

If yes, did you find the webinar helpful? How was it helpful? What would you change or add?

If no, why was your team not able to attend?

Welcome webinar

Yes____ No____





Coaching calls

(monthly)

Yes____ No____


If yes, circle number of events attended:

1-2 3-4 5-6

7-8 9 or more




Ask ISCR calls

(monthly)

Yes____ No____


If yes, circle number of events attended:

1-2 3-4 5-6

7-8 9 or more




National Leaders Webinars*

Yes____ No____


If yes, circle number of events attended:

1 2 3 4 5




* (e.g., Strategies for harnessing the EHR for enhanced recovery; Multimodal analgesia: How I do it; Perioperative glucose management: Making it work for enhanced recovery; Tips for working with the C suite from the other side; Patient and family engagement strategies)






ISCR Evidence Reviews

Evidence Reviews

Did you use any of the following program tools?

If yes, was it helpful and why?

If no, why was the tool not used?

Evidence Review Anesthesia

Yes____ No____




Evidence Review Surgery

Yes____ No____




Evidence Review_Adaptive

Yes____ No____






  1. Do you have any suggestions for any changes or additions to the ISCR program and materials that would make it most useful?

  1. Did you use any of the Sharing Library Tools (Y N)? If yes, which tools were most helpful?

  2. Did you implement learning from defects? If yes, has it been useful? If not implemented, was there a reason?

  1. Is the experience of working on enhanced surgical care and recovery like other improvement efforts the hospital has undertaken, or different? How so?


  1. Have you made any plans for sustaining enhanced surgical care and recovery over the long term?


  1. Lastly, what would you recommend to other hospitals trying to implement enhanced surgical care and recovery?


  1. Thank you for your time. Is there anything else you would like to share?




PART 2: Survey format


Which of the following enhanced recovery pathway elements has your hospital implemented:


Intervention component

Most of the time

Some of the time

About 50% of the time

Infrequently

Almost never

Preoperative

1

Patient Education

Immediate Preoperative

2

Preoperative Mechanical Bowel Prep and

Preoperative Oral Antibiotics 

3

Preoperative Bathing

4

Reduced Fasting

5

Carbohydrate Loading








6

Multimodal Pre-Anesthesia Medication

7

Mu Opioid Antagonists (Alvimopan)

8

Glucose Control

9

Normothermia

Intraoperative

10

Prophylactic Antibiotics

11

Preoperative VTE Prophylaxis 

12

Skin Preparation with an alcohol-containing agent 

13

Euvolemia 

- Fluids/Goal-Directed Fluid Therapy

14

Normothermia

15

Avoid Drains/nasogastric tubes 

16

Use of Regional Anesthesia-

Standard Intraoperative Anesthesia Pathway  


Postoperative

17

First Postoperative VTE Chemoprophylaxis Dose 

18

Standard Postoperative Multimodal Analgesic Regimen

19

Early postoperative feeding 

20

Early postoperative day 1 mobilization  

21

Early Urinary Bladder Catheter Removal postoperative day 1 

22

Early IV Fluid Discontinuation postoperative day 1 



9. In the past nine months, how often did each of the following factors slow your team's progress in implementing the enhanced surgical care and recovery pathway?



Never/

Rarely

Occasionally

Frequently

Almost Always

Insufficient knowledge of evidence supporting interventions

Leadership support issues

Not enough leadership support from executives

Not enough leadership support from surgeons

Not enough leadership support from anesthesiologists

Not enough leadership support from nurses

Insufficient autonomy/authority

Team skills and cohesion issues





Lack of quality improvement skills

Confusion about how to proceed with enhanced surgical care and recovery activities

Lack of team member consensus regarding goals

Inability of team members to work together

Stakeholder push-back issues





Not enough buy-in from surgery staff

Not enough buy-in from anesthesiology staff

Not enough buy-in from nursing staff

Not enough buy-in from other staff

Workload and time issues





Not enough time

Staff turnover on unit

Data collection burden for staff

Problems with data systems

Competing priorities or distractions (e.g., new EMR, accreditation visit)


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