Form 4 Attachment D – Post-Intervention Interview Protocols

Post-Implementation Interview Protocol

Attachment D

Post-Implementation Interview Protocol

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

Post-Implementation Semi-Structured Interview Protocol

Approach

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

We have assumed 60 minutes for each interview.

Objectives

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

• The impacts of the The Guide or tools from the Guide implementation to date

• The sustainability of the The Guide or tools from the Guide implementation to date

• The dissemination of information about The Guide or tools from the Guide implementation or impacts

• Lessons learned from The Guide or tools from the Guide implementation

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.

Purpose

The purpose of this interview is to gain information on the impact of The Guide or tools from the Guide. Specifically, we would like to know about both anecdotal information and systematic data collected on the impacts of The Guide or tools from the Guide. Similarly, we hope to gain a better understanding of the facility’s view on the business case for The Guide or tools from the Guide.

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 supported the project to evaluate the Guide to Nursing Home Antimicrobial Stewardship, or the Guide.

Purpose. We are here today to learn about your nursing home’s implementation of the Guide.

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

Consent. Did you receive the consent forms? Did you have any questions about it?

1. In your opinion, how successful or unsuccessful was the implementation of the Guide or tools from the Guide in your facility?

   1. How do you define “success” for this activity?

   2. Would others in facility describe using tools from the Guide as a success or not? Please tell me about this.

2. Has the implementation changed from it started? Please describe the reasons for these changes.

3. What additional training and/or resources were provided to staff after the initial training? Resources might include team meetings, resources from laboratories, contacting someone from AIR or TMF Health Quality Institute.

4. Thinking back on the initial implementation of the Guide or tools from the Guide, what were the 2 or 3 greatest challenges? [FOR EACH CHALLENGE ASK:]

   1. Did you or your staff anticipate these problems? If so, please describe.

   2. Who tackled these challenges? Was a particular staff member assigned to address the challenge?

   3. How did you seek overcome these challenges? What did you do specifically? How successful were these efforts? Please describe the issue.

5. [IF NECESSARY] Did you have any challenges at the facility level, such as lack of visibility and resources, lack of leadership, challenges of implementing in a nursing home, disruption of patient care?

6. [IF NECESSARY] Did you have any challenges at the floor- or unit-level, such as competing demands?

7. [IF NECESSARY] Did you have any challenges at the staff level for example, resistance to the intervention?

8. [IF NECESSARY] Did you have any challenges at the individual prescribing clinician-level for example, resistance to the intervention or resistance to the use of the Loeb Criteria?

9. [IF NECESSARY] Did you have any challenges at the patient level for example, lack of infections?

10. Thinking back on the initial implementation of the Guide or tools from the Guide, what were the 2 or 3 greatest facilitators?

    1. What helped you and/or your facility implement and/or make progress with your tools from the Guide project? POSSIBLE PROBES (for each facilitator):

    2. What resources made The Guide or tools from the Guide easier to implement at the organizational/departmental/or project level?

    3. How did you access to this / these resources?

11. [IF NECESSARY] Did you have facilitators at the project team level such as infection expertise, coaching, interest in championing?

12. [IF NECESSARY] Did you have facilitators at the department level such as leadership, type or size of practice?

13. [IF NECESSARY] Did you have facilitators at the individual staff level such as enthusiasm about intervention?

14. [IF NECESSARY] Did you have facilitators at the individual prescribing clinician level such as interest in the intervention?

15. Please describe any surprises or unintended consequences—good or bad—of the intervention and its implementation (e.g., staff morale improved or got worse, found new ways to utilize advanced practice nurses) surfaced during the implementation process? If so, please describe.

16. Please describe the impacts or outcomes of the Guide or tools from the Guide implementation. What has changed since The Guide or tools from the Guide implementation? Have these changes been positive or negative? Please describe these impacts.

17. In your opinion, is there a reason to use the Guide to reduce costs, in other words, a business case? Why or why not? By business case, we mean whether the Guide or tools from the Guide work and result in enough benefits to the facility in a sufficient time frame for this facility and others to continue to use it.

18. What makes you say that? How did you determine you reduced costs?

19. To date, is the Guide or tools from the Guide still being implemented in your facility?

20. What do you think are the challenges to the sustainability of the Guide or tools from the Guide in both the department and the facility?

    1. What about things that facilitate sustainability?

21. How, if at all, have you been involved in the sharing of information about The Guide or tools from the Guide work and spread of The Guide or tools from the Guide techniques? Please consider dissemination to other staff, other departments within your facility, other facilities, and/or the general public. POSSIBLE PROBES:

    1. How, if at all, did individuals or other facilities react to what you told them about The Guide or tools from the Guide? Please tell me about this.

    2. Have other departments or facilities adopted the information you have disseminated? Have the practices been spread and implemented?

22. Based on what you have learned to date, what are the insights and/or lessons learned for your own facility and practices? If you were advising other nursing homes about the tool that you used, what would you most want them to know? What should they be aware of, what should they do, what should they NOT do?

23. Do you have any additional thoughts you’d like to share with us about The Guide or tools from the Guide in your facility? Decision to pursue, implementation, sustaining it?

Thank you for your time.

D-7