Spread and Sustain

Spread involves replicating a successful implementation process more broadly throughout an organization or to other organizations.23 It is informed by lessons learned during implementation such as infrastructure issues (space, equipment, staff), sequencing of tasks, managing upstream and downstream impacts, and helping people adapt to a new way of working. Plan-Do-Study-Act cycles can be used to help with the spread and sustainability of the project. They support different areas in adapting the change to unique aspects of their work and demonstrate that change is an improvement. Organizations and individuals are encouraged to share their improvement work so that others may learn from their experience.

U for Units: Sustaining Change

After implementation was completed in each area, the data collection and peer comparison feedback process was repeated two more times at four month intervals as a reminder to prescribers of the expected practice. Key messages from the in-service education program were incorporated into a medication ordering standards online education module that new medical staff were expected to complete. The ‘no fill’ policy was incorporated into existing policies. The order form was changed to include a reminder about the organization’s expected practice regarding the use of abbreviations.

The project team is now assessing whether the initiative needs to be expanded to address the issue of how the abbreviation U is used in charting, or whether there is a need to address other abbreviations that are commonly used in medication ordering.
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U for Units: Sustaining Change

After implementation was completed, the data collection and peer comparison feedback process was repeated two more times at four month intervals as a reminder to prescribers of the expected practice. Transcription of insulin orders was reviewed and reported to staff at the same time. Key messages from the in-service education program were incorporated into a medication ordering standards online education module that new nursing, pharmacy and attending physicians were expected to complete. The ‘no fill’ policy for insulin was incorporated into existing policies. The order form was changed to include a reminder about the organization’s expected practice regarding the use of abbreviations.

The project team is now assessing whether the initiative needs to be expanded to address the issue of how the abbreviation U is used in charting, or whether there is a need to address other abbreviations that are commonly used in medication ordering.

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