Using implementation science methods in critical care nursing – Part 3: Implementation strategy design

Methods in FocusUsing implementation science methods in critical care nursing -Part 3: Implementation strategy design Evidence-based practices (EBPs) in critical care nursing, such as early mobilization, delirium prevention, and family engagement, require proactive implementation or de-implementation of low-value care.Such (de-)implementation efforts imply changes in practice, including in team workflow or behaviors, the physical environment, materials or equipment.A conscious use of implementation strategies that support these change processes is essential to ensure that barriers to EBP use are effectively addressed.In critical care, context-specific strategies are particularly important due to the complex, high acuity environment [1].In this part of the series, we would like to highlight methods for designing implementation efforts, which aim to ensure that EBPs achieve their full system impact and benefit for critically ill patients and their families. Understanding implementation strategiesImplementation strategies can be defined as "methods or techniques used to enhance the adoption, implementation, and sustainability of an EBP or practice" [2].They are provider-or system-facing, can be discrete (single action) or multifaceted (combined actions), and aim to address implementation barriers at multiple levels -individual, team, and organization -to ensure that EBPs are delivered with high fidelity [3][4][5][6].Useful implementation strategy taxonomies exist, such as the Expert Recommendations on Implementing Change (ERIC) [7], which organizes over 73 implementation strategies into several domains.Examples include adaptation and tailoring of EBPs, change of infrastructure, consumer and key person engagement, or training and education [7].Strong evidence on the effectiveness of implementation strategies remains limited but several strategies have been shown to be of promise in health care [3-6], including (1) educating and training, (2) proactively providing support, coaching and facilitation, (3) engaging in audit and feedback; and (4) tailoring to local contexts.Efforts are more likely to succeed when they bundle discrete strategies into a multifaceted, multilevel approach.