 The National Institutes of Health require data safety monitoring boards, DSMBs, for all phase 3 clinical trials, as well as the National Heart, Lung and Blood Institute for certain trials. This has led to the formation of DSMBs for many implementation trials, but without much thought given to whether they are appropriate or if there should be any modifications made to them. We discuss the unique features of implementation trials and consider how these may affect the use of DSMBs. We also look at some of the key questions related to the justification of DSMBs and their potential roles and monitoring targets within implementation trials. This article was authored by Kevin Fisela, Michelle Sanders, Tamair Holder, and others.