28 The LTCF staff that were consulted provided insight on how
the strategies could be designed and delivered. For example, they emphasized that the program should allow for different formats for education, such as shorter sessions or huddles to accom- modate time constraints, to reach more staff. The LTCF staff members felt that all proposed strategies would be appropriate and feasible to execute. The 2 LTCFs also provided feedback including proposed changes to resources developed to support each implementation strategy. Table 3 summarizes the implementation strategies (with definitions) selected for the program, the target audience, the
Table 3. Description of Implementation Strategies for the UTI Program
Implementation Strategy
Organizational policies & procedures
Description
Align policies and procedures with the 5 practice recommendations
Target Audience/Details on Delivery
Target audience: Staff involved in the assessment and management of UTIs When/How often: At program initiation Applicable PHO resources: Guidance and sample policy for the assessment and management of UTIs
Rationale and Benefits
∙ Ensures that LTCF policies and procedures align with recommended practice changes
∙ Eliminates outdated practices ∙ Helps address barriers around role clarity ∙ Establishes documentation processes for resident symptoms
∙ Demonstrates an organizational commitment to support practice changes
∙ Supports frontline staff communicate the new practice changes
∙ Supports a sustained commitment to best practice when new staff are brought into the organization
Champions
Select staff members who will dedicate themselves to supporting and facilitating practice change implementation; help overcome resistance and engaging other staff to strengthen buy-in
Target audience: Administrative staff (eg, director of care) and staff involved in the assessment and management of UTIs When/How often: Ongoing Applicable PHO resources: Assessment algorithm for UTI in medically stable non-catheterized residents, fact sheets
Local opinion leaders
Individuals perceived to have influence within the facility (eg, physicians, nurse practitioners); involve leaders in supporting practice change
Target audience: Administrative staff and frontline staff When/How often: Ongoing Applicable PHO resources: Local opinion leaders have access to a range of program resources (eg, Assessment algorithm for UTIs in medically stable noncatheterized residents, fact sheets, and Frequently Asked Questions resource).
∙ Individual dedicated to help staff overcome challenges and resistance to practice changes related to concerns about the consequences of not providing antibiotics
∙ Supports improvements to communication practices
∙ Supports new policies and procedures ∙ Helps establish a supportive organizational culture ∙ Ensures practice changes are sustained following educational sessions, including updating new staff that are brought into the organization
∙ Dedicated role that can help establish buy-in to the practice changes amongst staff in the organization
∙ Supports new processes such as defining who is responsible for the assessment of symptoms
∙ Helps establish a supportive organizational culture for the practice changes
∙ Provides a trusted source of leadership to help others overcome concerns about the consequences of not providing antibiotics and manage concerns related to ongoing pressures to prescribe antibiotics in the absence of accepted signs and symptoms of a UTI.
Local consensus processes
Identifying opportunities (eg, meetings, events) to discuss the problem and practice changes with staff to ensure agreement
Target audience: Administrative staff and staff providing care to residents in the assessment and management of UTIs
When/How often: Ad hoc (eg, aligned with existing staff meetings) Applicable PHO resources: Program educational resources (eg, assessment algorithm for UTIs in medically stable noncatheterized residents, fact sheets, and Frequently Asked Questions resource) can be used to support consensus processes.
∙ Provides opportunities to increase staff knowledge on the problem, best practices (can involve staff who are missed by classroom education), and new procedures
∙ Address beliefs and concerns about the consequences of not providing antibiotics to residents with nonspecific symptoms
∙ Reviews practices that may be contributing to the overuse of antibiotics for ASB
∙ Helps establish a supportive organizational culture for practice changes and secures buy-in to the practice recommendations
Andrea Chambers et al
timing of delivery, and the applicable resources developed by Public Health Ontario to support the strategy. A program implementation guide was developed to support LTCFs in tai- loring and implementing the program within their facility.29
Discussion
A systematic and stepped approach was used to develop a new provincial program to help LTCFs identify symptomatic UTIs and minimize the treatment of ASB. A description of the results
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