Implementing best practice guidelines: The RNAO Toolkit

A Summary of

Registered Nurses' Association of Ontario. (2012). Toolkit: Implementation of Best Practice Guidelines (2nd ed.). Toronto, ON: Registered Nurses' Association of Ontario.

Relevance for Public Health

This tool supports users in developing an implementation plan to move best practice guidelines into practice. A comprehensive resource with checklists, resources and case scenarios, this resource supports groups in working with stakeholders and assessing organizational resources to implement a practice change.

Description

The Registered Nurses's Association of Ontario (RNAO) developed this resource to help organizations implement best practice guidelines to improve practice and health outcomes. Revised from the original Toolkit (2002) with new additions and resources, Toolkit: Implementation of Best Practice Guidelines provides a systematic, evidence-based approach to implementing best practice guidelines.

The Toolkit is based on the Knowledge-to-Action Framework (Straus, Tetroe & Graham, 2009), which was adapted for implementation of best practice guidelines. This resource provides templates, case examples and resources for each step of the framework as follows:

  • Step 1: Identify problem, review and select knowledge
  • Step 2a: Adapt knowledge to local context
  • Step 2b: Stakeholder analysis
  • Step 2c: Resource assessment
  • Step 3: Assess facilitators and barriers to knowledge use
  • Step 4: Select, tailor and implement intervention and implementation strategies
  • Step 5: Monitor knowledge use and evaluating outcomes
  • Step 6: Sustain knowledge use

This toolkit can be used alongside an online module available from the Canadian Institutes of Health Research, Moving into action: We know what practices we want to change, now what? An implementation guide for health care practitioners.

Accessing the Method/Tool


Language(s)

  • English
  • French

Format(s)

On-line Access

Cost

Not Specified

Implementing the Method/Tool


Time for Participation/Completion

Information not available

Additional Resources and/or Skills Needed for Implementation

None

Steps for Using Method/Tool

The following steps and resources are outlined in this toolkit:

Step 1: Identify problem, review and select knowledge

  • Identify practice need/gap using quality improvement process data
  • Identify new best practice guidelines
  • Appraise guidelines using AGREE II tool
  • Select guideline
  • Assess gap between current and recommended practice using Gap Analysis Tool

Step 2A: Adapt knowledge to local context

  • Use ADAPTE process (The ADAPTE Collaboration, 2009) to systematically adapt guidelines to local context
  • See Appendix D: The ADAPTE Process Framework
  • Set up infrastructure to implement best practice guideline

Step 2B: Stakeholders

  • Define stakeholders and vested interests
  • Perform a stakeholder analysis
  • Complete the Stakeholder Influence & Support Grid

Step 2C: Resources

  • Create a campaign strategy
  • Develop a business case - see Business Case Development Checklist
  • Create a plan to attract resources
  • Pool resources/build partnerships with stakeholders

Step 3: Assess facilitators and barriers to knowledge use

  • Assess facilitators and barriers related to: evidence/guideline, target audience (individuals, teams), resources (environment), organization
  • Maximize facilitators
  • Make a plan - see Appendix 3.1 Guiding Questions for Facilitators and Barriers
  • See resource: Individual-level barriers to change

Step 4: Select, tailor and implement interventions and strategies

  • Select from the comprehensive list of implementation strategies
  • Understand the change process during implementation
  • See resource: Change management toolkit

Step 5: Monitor knowledge use and evaluate outcomes

Step 6: Sustain knowledge use

  • Develop a positive attitude for sustainable evidence-based practice
  • Conduct interprofessional reflective practice
  • Ensure appropriate leadership
  • See Appendix 6.2 - Sustainability Action Plan

Who is involved

Various roles and stakeholders would be involved in developing and carrying out an implementation plan to change practice.

Conditions for Use

The appropriate credit or citation must appear on all copied materials.

Evaluation and Measurement Characteristics


Evaluation

Information not available

Validity

Not applicable

Reliability

Not applicable

Methodological Rating

Not applicable

Method/Tool Development


Developer(s)

Toolkit Development Panel:
Barbara Davies
Donna Rothwell
Deb McAuslan
Nancy Bauer
Ian Graham
Lynn McCleary
Lynn Kachuik
Gloria Morris
Karen L. Ray
Baiba Zarins

Registered Nurses' Association of Ontario Staff:
Irmajean Bajnok
Althea Stewart-Pyne
Patricia Hogg
Heather McConnell
Josephine Santos
Erica D'Souza

Method of Development

The Registered Nurses' Association of Ontario (RNAO) assembled a Review Panel of expert nurses and researchers to review the original Toolkit (published in 2002). The panel considered new evidence and made revisions to ensure the resource provides a systematic, evidence-based approach to implementing best practice guidelines.

Release Date

2012

Contact Person/Source

Registered Nurses' Association of Ontario
International Affairs and Best Practice Guidelines Centre
158 Pearl St
Toronto, ON M5H 1L3
Phone: (416) 599-1925

These summaries are written by the NCCMT to condense and to provide an overview of the resources listed in the Registry of Methods and Tools and to give suggestions for their use in a public health context. For more information on individual methods and tools included in the review, please consult the authors/developers of the original resources.

Resources

Title of Primary Resource Toolkit: Implementation of best practice guidelines (2nd edition)
File Attachment None
Web-link
Reference

Registered Nurses' Association of Ontario. (2012). Toolkit: Implementation of Best Practice Guidelines (2nd ed.). Toronto, ON: Registered Nurses' Association of Ontario.

Type of Material Toolkit
Format On-line Access
Cost to Access None.
Language English, French
Conditions for Use

The appropriate credit or citation must appear on all copied materials

Title of Supplementary Resource Guideline adaptation: A resource toolkit
File Attachment None
Web-link
Reference

The ADAPTE Collaboration (2009). The ADAPTE Process: Resource Toolkit for Guideline Adaptation. Version 2.0.

Type of Material Toolkit
Format On-line Access
Cost to Access None.
Language English
Conditions for Use

© 2010 Guideline International Network

Title of Supplementary Resource A toolkit to facilitate the implementation of clinical practice guidelines in healthcare settings
File Attachment None
Web-link
Reference

DiCenso, A., Virani, T., Bajnok, I., Borycki, E., Davies, B., Graham, I., et al. (2002). A toolkit to facilitate implementation of clinical practice guidelines in healthcare settings. Hospital Quarterly, 5 (3), 55-60.

Type of Material Journal
Format Periodical
Cost to Access None.
Language English
Conditions for Use

© 2002 Longwoods Publishing Corp.

Title of Supplementary Resource Changing nursing practice: Evaluating the usefulness of a best-practice guideline implementation toolkit
File Attachment None
Web-link
Reference

Dobbins, M., Davies, B., Danesco, E., Edwards, N., & Virani, T. (2005). Changing nursing practice: Evaluating the usefulness of a best-practice guideline implementation toolkit. Nursing Leadership, 18 (1), 34-45.

Type of Material Journal
Format Periodical
Cost to Access None.
Language English
Conditions for Use

© 2005 Longwoods Publishing Corp.

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