Setting Up Your First PDSA

What change will you implement by next Tuesday?

PDSA

PDSA Testing Change

• Plan- a specific planning phase

• Do- a time to try the change and observe what happens

• Study- an analysis of the results of the trial

• Act- devising next steps based on analysis

• Berwick, Boushon,& Roessner, 2007

AIM: State your overall goal you would like to reachExample: By March 31, 2009 we will have reduced undocumented and unintentional discrepancies by 75% or greater of baseline on Medical Unit #1.

Describe your first (next) test of change Person Responsible

When to be done

Where to be done

Test a BPMH process and data collection form with the next resident admitted

John RN Sept 12/08

Resident

Admission Room

Rapid Cycle Testing

List the tasks needed to set up this test of change

Person Responsible

When to be done

Where to be done

1. Understand components of a BPMH

2. Write a rough draft steps in a BPMH and select a current form for use

3. Select a Resident and time

4. Conduct a BPMH and use the information to compare with AMO

5. Arrange a huddle with 2 other team members

6. Complete the “testing” worksheet

Mary RN

Jane Team Lead

Susan Unit Manager

Mary RN

Susan Unit Manager

John RN

Today

Sept 10

Sept 10

Sept 12

Sept 12 @ 1430

Sept 12 before 1500h

Here

Med Unit #1

Med Unit #1

Med Unit #1

Conference Rm Med Unit #1Conference Rm Med Unit #1

Plan

Predict what will happen when the test is carried out

Measures to determine if prediction succeeds

1. Guideline and form will be used

2. Guideline and form will need refinements

3. There will be at least 1 medication discrepancy

4. The huddle will identify new change ideas for testing

1. Self Report Y/N

2. Discussed and recorded in huddle

3. Recorded on form

4. Yes/No

Plan

• Do: Describe what actually happened when you ran the test– The protocol failed to account for poor historians so more collateral

information was required.

• Study: Describe the measured results and how they compared to the predictions– Guideline and form need revisions based on RNs feedback, there were

2 undocumented intentional and 2 unintentional discrepancies. The team leader suggested improvements for the BPMH form

• Act: Describe what modifications to the plan will be made for next time.– The guideline and form will be modified, and another test planned with

the next resident admitted on September 15

Completing Test of Change

As you move thru cycles increase size of the test:

– 1 Resident, 1 RN, 1Pharmacist, 1 Physician

– 2 Residents, 2 RNs, 1Pharmacist, 1 Physician

– 5 Residents, 2 RNs, 1Pharmacist, 1 Physician

– 25 Residents, 10 RNs, 2Pharmacist, 3 Physician

Rapid Cycle Change

A PS D

A PS D

A PS D

APSD

Change Ideas

Learning From Data

Very Small test

Follow up tests

Wide Scale tests of change

Implementation of Change

Changes Result in Improvement

Testing to Implementing

• Initiation of Rapid Cycle tests is dependent on getting the first test of change started

• Do Not try to Perfect the change then implement…consider your work a masterpiece in progress

• Failure is a great Opportunity to plan to do better next time…

• Frequency of Testing determines the speed of the process improvement ie daily testing = improvement in weeks; weekly = improvement in 3-4 months

Rapid Cycle Change

• Select a change idea

• Complete the Plan

• Conduct the test in your work setting

• Complete the Do, Study, Act sections

• Post your PDSA worksheet to the Community of Practice

Exercise