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From:
Published online Feb 2, 2008. doi: 10.1186/1472-6963-8-29
Table 2
Implementation strategies
Bolded columns indicate guideline implementation that resulted in no change in > 80% of indicators
StrategiesAsthmaBreastfeedingDelirium, Dementia, Depression (DDD)Diabetes Foot CareSmoking CessationVenous Leg Ulcers (VLU)

Educational strategies for nursesPaid time
2 core sessions of 2 hours each for separate groups of nurses-inpatient and emergency
Pre-learning package
Articles about the project in internal newsletters
Placebos to practice skills
Paid time
Core 4-hour training session off site
Written material team teaching, non-didactic, focus on attitudes, beliefs and values, use of stories by mother/baby dyads
Additional short in-services held
Paid time
2–3.5 hours
Powerpoint slides, facilitator guide, handouts, case studies, a game to review materials, standardized assessment tools
Paid time
Hospital: 1 session 30 to 60 minutes, as a lunch and learn, handouts, self-learning package
Visiting nurses: 6 sessions for 1.5 hours each, practice sessions, word game, refresher training
Paid time
2 hours, Powerpoint slides, informal and interactive, stages of change theory
Use of case scenarios depending on group e. g. in- patient, outpatient, long term care
Paid time
Manual (basic wound and VLU care) and CD for self-directed learning, individual 2-hour session with quiz, demonstration and bandaging practice by nurses Discussion of newsletters (not mailed)
hospital nurses had demonstrations on bandaging and products
Champions (Local opinion leaders)Encouraged stronger nurses to sign up early to be advocates and mentorsChampions on each unit, part of the steering committee with role to raise issues in day to day rounds and to encourage the nurses to use the recommended assessment toolsA senior leader physician champion
Several clinical resource nurses with one on each unit
Resource people trained in both community and hospital settings
Mentoring by consultants at client's home
Reminder systemsLogo, mugs, posters, name tags for nurses who completed the trainingPosters, binders, pocket cards listing symptoms of DDDProject logo, posters, articles in newsletters, voicemail messages, special flyerButtons, posters, laminated pocket cards summarizing the steps of ask, advise, and assist strategy
Policy ReviewyesYesYesYesYes
Smoking room policy changes
yes
Creation of new documentationFlow sheets
Patient pathways
Newborn critical pathways chart
New charting tools and discharge sheets
Trigger questions added to initial pt assessment forms to help nurses maintain an index of suspicionNew assessment tool
Multi-disciplinary involvementRespirologists very supportive but emergency physicians reluctant due to concern for nurses' workload"Little involvement of other disciplines"
Conflict with dieticians in public health unit about 6 months excusive breast feeding
Steering group formed with both hospital and community reps but did not have an active ongoing roleStrong senior physician champion 'interdisciplinary work was amazing...the camaraderie between the disciplines and meeting everyone else from the different sites was one of the major benefits"Steering committee
Community physician support
Patient EducationPatient education toolkits with placebos, teaching booklets and laminated cards on all unitsPatient education and referral resourcesPatient education brochure initiated but not completed
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