PCA: PDSA Worksheet

When introducing change, pilot test the interventions you are planning to introduce on a small scale first to find out whether they work. Break the intervention into small steps, and test each one. Analyse the results and refine your intervention. Ask all the staff involved for their feedback and ideas on how to improve the interventions, and provide feedback to them on the results achieved. Even the smallest changes take time, so make sure that you allocate sufficient time for the trial, analysis and refinement of the intervention.

This commonly used approach to testing and adapting changes in order to achieve the desired improvements is called the Plan-Do-Study-Act (PDSA) method:

 Plan what you are going to do, e.g. include a section for patient signature on the assessment form. Decide who is going to do what, how and when, e.g. educate nursing staff in one pilot ward about section on the admission form and explain when and how staff are expected to fill it in.  Do it, e.g. introduce new section on the patient admission form for one week in one pilot ward.  Study it, e.g. get feedback from users about how it worked, monitor how often and how appropriately it was filled in.  Act on the feedback and measurement to amend, implement more widely or abandon the concept being tested.

Act Plan

Study Do

By continually doing this you get Continual Improvement. The PDSA model is underpinned by three improvement questions1.  What are we trying to accomplish?  What change could be made that might lead to an improvement?  How will we know that a change is actually an improvement?

For more information see these You Tube clips from IHI http://www.youtube.com/watch?v=SCYghxtioIY&feature=related http://www.youtube.com/watch?v=6MIUqdulNwQ&NR=1 http://www.youtube.com/watch?v=QgmtXRoVVc0&feature=related

1 Langley GJ, Nolan KM, Nolan TW, et al. The improvement guide: a practical approach to enhancing organizational performance. San Francisco: Jossey-Bass; 1996.

PCA: PDSA Worksheet Page 1 of 7 The answers to these questions are used to plan the PDSA cycles. Try answering the questions and create your own PDSA cycle.

What are we trying to accomplish? Example: To increase the percentage of patients who have a holistic and patient centred assessment within 48 hours of admission to the service ______

What change could be made that might lead to an improvement? Example: Conduct in-service training sessions about the assessment process with nursing staff and allied health staff from one ward ______

How will we know that a change is actually an improvement? Example: Measure the percentage of admitted patients with completed holistic and patient centred assessments in one ward

______

See: NSW Health. Easy guide to clinical practice improvement. A guide for health professionals. North Sydney: NSW Health Department; 2002. Available at: http://www.health.nsw.gov.au/resources/quality/cpi_easyguide_pdf.asp

Example: Introduction of a new pain scale

PCA: PDSA Worksheet Page 2 of 7 1. What are we trying to accomplish? Improve our assessment of patient pain. Introduce a new pain scale for one week in Ward A. 2. How will we know that a change is an improvement? Pain scores in the medical record 3. What changes can we make that can lead to an improvement?  Meet with staff and explain the benefits of measuring pain (Development PDSA)  Ask nursing staff to try the new pain scale (Test PDSA)  Meet with staff to discuss the results and develop ideas on improving pain assessment

Cycle No. 1 Start Date 3rd May 2011 Duration: One week Cycle Objective (what question do we To develop, test or implement a change want to ask in this particular PDSA?) To test the use of the new pain scale in the ward by nurses What exactly will you do? PLAN We will ask the nursing staff to use the new pain scale when assessing pain Distribute the pain scale to all nurses on the ward Train them in the use of the scale at handover and ask the nurses to use it for all patients when doing patient rounds Act Plan We will try this for one week Who will carry out the plan? Ward nurses Study Do When will it take place? Next week, commencing on Monday 9th May Where? In Ward A on all shifts Predict how this change will lead to an improvement Nurses are not assessing pain regularly, so we expect to see an increase in the recording of pain in the records What data/information will you collect to know whether there is an improvement? Who will collect the data? Who will analyse it? The number of patient records with a pain score recorded. There are four patients in ward A. The medical student will collect the data and analyse it. Was plan executed? Document any unexpected events or DO problems The was a agency nurse on Monday for two of the shifts and again on Wednesday and Friday, so they did not use the new pain scale. All staff who used the pain scale provided useful Act Plan feedback and appeared happy with it. Two staff were away on sick leave and we need to tell them about the trial. Study Do

Analyse the data and compare to your predictions.

PCA: PDSA Worksheet Page 3 of 7 STUDY Summarise and reflect on what was learned Because of the agency staff, the recording of pain scores in the records was inconsistent, but on the days where we had the full complement of usual staff, there were twice as many records of pain scores as in the previous week. Interviews with staff showed that they found the tool easy Act Plan to use The medical student has written a brief summary of the results for the noticeboard. Study Do

Was plan executed? Document any unexpected ACT events or problems We need to make someone responsible for briefing agency staff on the use of the new pain scale. We are going to continue the trial for another week, to get more feedback from staff on how to increase its use, before trialling it in Ward B. Act Plan We need a reminder in the patient record about measuring pain and using the new tool…Could try a sticker in the records of the four Ward A patients Study Do We need to feed back to staff at the team meeting on the results to date. (Lots of ideas for new PDSA cycles)

PCA: PDSA Worksheet Page 4 of 7 Worksheet

1. What are we trying to accomplish?

2. How will we know that a change is an improvement?

3. What changes can we make that can lead to an improvement?

Cycle No. Start Date Duration: Cycle Objective To develop, test or implement a change

What exactly will you do? PLAN

Act Plan Who will carry out the plan? Study Do When will it take place? Where?

Predict how this change will lead to an improvement

What data/information will you collect to know whether there is an improvement? Who will collect the data? Who will analyse it?

Was plan executed? Document any DO unexpected events or problems

Act Plan

Study Do

PCA: PDSA Worksheet Page 5 of 7 Analyse the data and compare to your STUDY predictions. Summarise and reflect on what was learned

Act Plan

Study Do

Was plan executed? Document any ACT unexpected events or problems

Act Plan

Study Do

PCA: PDSA Worksheet Page 6 of 7 TIPS for PDSAs2

Make sure your ‘Plan’:  Contributes to your overall aim in question 1; What are we trying to accomplish?

 Incorporates any training or required knowledge on the part of participants so they can play their part effectively

 Is contributed to by people who will be impacted by the change or are implementing the change

 Is one of the ideas you used to answer the 3rd fundamental question: What changes can we make that will lead to an improvement?

 Tests the idea on a small scale

 Predicts how you expect the change will lead to an improvement

 Collects data that clearly tells you if your prediction is correct or not

 Is carried out by a small group of willing participants (or one person) who will give constructive feedback

Then make sure your ‘Do’:  Records any unexpected events that were not a part of the plan and that could have an impact on the data

 Records your observations of people’s reactions, particular difficulties or ease of use

Then make sure your ‘Study’:  Compares the data with the prediction – did the idea work?

 Summarizes what you have learned

 Reflects on what you have learned

Then make sure your ‘Act’:  Is based on what you learned

 Enables you to make the decision to:

o Implement, Abandon, Modify or Test the idea under other conditions

2 From the Australian Primary Care Collaboratives Model for Improvement Kit.

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