Dr. Erica Lau is a postdoctoral research fellow in the Department of Emergency Medicine at the University of British Columbia. Dr. Lau is interested in improving the quality and impact of behavioural health and health service interventions. Her research has focused on identifying barriers and facilitators to integrating evidence-based health interventions into real-world settings, developing effective implementation strategies, and advancing methods to monitor and evaluate program implementation, scale-up and sustainability. Dr. Lau’s research is supported by the Michael Smith Health Research BC – Research Trainee Award.
Adverse drug events (ADE) are a leading cause of emergency department visits and hospital admissions in Canada [1, 2]. ActionADE aims to prevent repeat ADE by enabling clinicians to document and communicate standardized ADE information across care settings. We describe a 5-month facilitation intervention to promote uptake of ActionADE in four hospitals in British Columbia, Canada.
In this multiple case study, we used a four-step iterative facilitation process : i) conduct formative evaluation to identify barriers to use, ii) generate site-specific implementation plan using the Consolidation framework for implementation research-Expert Recommendations for Implementing Change (CFIR-ERIC) implementation strategy matching tool , iii) co-create functions and forms  of the implementation strategies with site champions, and iv) execute, monitor process and evaluate outcomes. Implementation outcomes included the number and types of implementation strategies, changes in the number of monthly ADE reports and active users before (Jun to Oct 2021) and after (Nov 2021 to Mar 2022) the facilitation process.
Through the facilitation process, we identified four functions (create tension for change, support integration, provide access to intervention information and increase clinician’s awareness, knowledge and skills) and 4 to 8 corresponding forms for each site (e.g., engage and prepare additional champions, 1-on-1 follow-ups). Sites’ responses to the facilitation process varied. The number of monthly ADE reports increased substantially in sites A (+700%) and B (+84%) and declined in sites C (-29%) and D (-8%). The number of active users increased in site A (+47%) and D (+68%) and declined in sites B (-7%) and C (-23%). Contextual factors that influenced the facilitation process (e.g., staff shortage, roles of champions) also varied by site.
This study illustrates a systematic process for researchers and stakeholders to prospectively co-create core functions and forms of implementation interventions according to local contexts’ characteristics.