Table 2

Implementation strategies

Bolded columns indicate guideline implementation that resulted in no change in > 80% of indicators




Delirium, Dementia, Depression (DDD)

Diabetes Foot Care

Smoking Cessation

Venous Leg Ulcers (VLU)

Educational strategies for nurses

Paid 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 mentors

Champions 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 tools

A 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 systems

Logo, mugs, posters, name tags for nurses who completed the training

Posters, binders, pocket cards listing symptoms of DDD

Project logo, posters, articles in newsletters, voicemail messages, special flyer

Buttons, posters, laminated pocket cards summarizing the steps of ask, advise, and assist strategy

Policy Review






Smoking room policy changes


Creation of new documentation

Flow 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 suspicion

New assessment tool

Multi-disciplinary involvement

Respirologists 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 role

Strong 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 Education

Patient education toolkits with placebos, teaching booklets and laminated cards on all units

Patient education and referral resources

Patient education brochure initiated but not completed

Davies et al. BMC Health Services Research 2008 8:29   doi:10.1186/1472-6963-8-29

Open Data