Lessons learned from a failed implementation: Effective communication with patients in transmission-based precautions

Published:October 06, 2022DOI:


      • Effective communication in transmission-based precautions can avoid adverse events
      • Study showed that the effective communication is a concept not always understood
      • Lessons learned allowed us to propose suggestions for future implementations
      • When planning implementation, consider political-economic status of institution
      • Identify whether intervention fits the organization's culture in terms of demands



      Patient engagement with transmission-based precautions can be an important strategy to prevent adverse events related to isolation. Most patient education is still highly prescriptive and is thus unlikely to help. Effective communication requires behavior change, leading to a meaningful dialog between the parties involved.


      evaluate implementation process of a protocol for effective communication with patients in transmission-based precautions (Com-Efe).


      Implementation research using qualitative methods in four sequential phases: 1) nonparticipant observation in inpatient wards; 2) design of the intervention for implementation; 3) adaptation of the Com-Efe through workshops with nurses; 4) final assessment of the implementation results through interviews with nurses. Study was performed in a public, secondary, teaching hospital. Consolidated Framework for Implementation Research was used as the reference for interview design and data analysis, aiming to identify barriers and enablers of the implementation process.


      Main factors that could have facilitated adherence were beliefs and perceived advantages in using the Com-Efe by nurses. Main barriers that may have contributed to the failure were the unfavorable climate for implementation, insufficient individual and leadership commitment, and the lack of understanding of the concepts underpinning effective communication.


      Despite using a systematic approach, the Com-Efe protocol was not fully implemented. The lessons learned in this study allowed us to propose suggestions for future protocol implementations in similar contexts.



      Com-Efe (Effective Communication), SP (Standard Precautions), TBP (Transmission-Based Precautions), MO (Microorganism), HAI (Health care-associated infection), HCW (Health Care Workers), CFIR (Consolidated Framework for Implementation Research), COVID-19 (Coronavirus Disease 2019)
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