Table 1 Implementation strategies mapped to barriers/facilitators

 Understanding of the burden of sepsis in TASH-ED

Educational meetings, included local sepsis data

 Lack of fit of sepsis protocols with the TASH-ED context

Protocol adapted to local antibiotic sensitivities and special considerations for TB/malaria and tailored to context

 Protocol will act as a memory aid/reminder

 Hard to break “habits”

Hard copy reminders (posters and pocket card)

 Lack of human and material resources

Protocol includes alternative antibiotic choices to address medication availability, time to procurement, and patient ability to pay

 Heavy workload due to high patient acuity and volumes

Protocol included a “triage trigger” to address high patient volumes, which could lead to delayed care

 Lack of computer/Internet access

Hard copy reminders posted in acute care areas and pocket cards for easy reference

 Modeling and endorsement by senior clinicians important for implementation success

Local opinion leader and senior clinicians, part of study/implementation team, and endorsed protocol and project during educational meetings

 Belief that protocol is needed and will improve patient care and outcomes

 Belief that use of protocol will improve efficiency

Educational meetings: included local sepsis data, outlined evidence base of protocol including adaptation to local data, and tailoring to local resources

 Concerns that resource barriers will limit implementation success

 Endorsement by leadership will support uptake

Local opinion leader and senior clinicians, part of study/implementation team, and endorsed protocol and project during educational meetings