Carbapenem-Resistant Enterobacteriaceae (CRE) Control and Prevention Toolkit

Section 6. Implementing and Sustaining Your Intervention

Before rolling out your intervention, it is helpful to present your program and its objectives to relevant standing committees of the hospital (infection control committee, performance improvement and quality management committee, medical staff committee, and nursing leadership committee) for formal endorsement. Similarly, meet with the nursing director and the chief medical officer to ensure they are aware of the timing of your rollout and to renew their continuing support of your program. Endorsement by the governing structure of the hospital will aid acceptance of your initiative by direct caregivers who will be impacted by the program, and helps assure them that your planning process has been thorough and appropriate and has been carefully reviewed before its initiation.

The actual rollout will take time, at least several weeks, and you should view this initial phase as a "testing the waters." Your program requires multidisciplinary participation and is a complex process with many moving parts. It will take some time to "iron out the wrinkles" until everyone's tasks are integrated into their normal workflow patterns. The project leadership will need to be patient and flexible in rethinking some project design issues, and should spend a great deal of time overseeing this critical period of the rollout process. Rolling out large-scale interventions will almost certainly require a dedicated team approach with daily followup and tracking of each step in the process. Identification of "bottlenecks," poor coordination of activities, and failure to accomplish assigned tasks may require coaching to help participants achieve their tasks and thus enable the overall success of the program. The more you can incorporate each participant's tasks into their normal work routine, the more likely that your program will succeed.

Initiating your rollout should take advantage of already existing meetings and conferences that the involved direct caregivers already attend, such as grand rounds and unit-based nurse manager/nursing staff meetings. This is an effective way to achieve general awareness of your program. Your team should also meet with unit staff for a detailed briefing on their participation and roles. These meetings should be open ended, and participants should be encouraged to ask questions and point out design issues they anticipate. These meetings should "recruit" the participants to all become team members and to take ownership of the program.

These localized rollout meetings are most effective if they: 

  1. Educate staff about the epidemiology and emerging threat of KPC.
  2. Stress the importance and necessity of this initiative for their clinical practice.
  3. Introduce the overall design of the intervention.
  4. Identify specific tasks and responsibilities for each participant.
  5. Remind them that they must pay close attention to hand hygiene and contact isolation compliance.
  6. Reassure them that the intervention team will provide close collaboration and support during the rollout. 

Consider scheduling meetings in the early morning to simultaneously capture staff from day and night shifts, or videotaping one of the meetings for presentation to staff working off-hour shifts. During initial rollout, the intervention team should visit units daily at sample pickup times to ensure complete sampling of target patients. Team members also will need to track laboratory testing turnaround times, reporting of positive patients to the units, and the speed at which patients are placed on contact isolation.

It is important to give participants periodic feedback about achieving intervention performance metrics. The previous paragraph outlines some metrics you need to track. It is important to share successes with participants to ensure their continued engagement and enthusiasm. In addition, analyze the intervention clinical outcome data periodically and also share these metrics with participants. Sharing success will help sustain the intervention and provide clinical relevance for participants. Make certain that hospital leadership recognizes and appreciates their success for its importance to the well-being of the hospital's patients and the institution.

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Page last reviewed April 2014
Page originally created March 2014
Internet Citation: Section 6. Implementing and Sustaining Your Intervention. Content last reviewed April 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/cretoolkit/cretoolkit6.html