Scottish Improvement Skills Planning a test of change using the PDSA framework: Case study and plan for project SIS: Group D Using the PDSA framework Measurement: Module – Planning with PDSA case study and project: Participant

System of Profound Knowledge Deming 2000

Planning a test of change using the PDSA framework By the end of this session you will be able to: explain all stages of the PDSA framework to others (planning, including theory and prediction; analysing results; applying learning to next cycles) use all stages of the PDSA cycle in your improvement work.

ICU Length of Stay Aim Primary Driver Secondary Driver Change idea Reduce average length of stay in Central General ICU by 20% by March 2015 Assessment and management of sedation and agitation Improved management of delirium Validated sedation tool Appropriate sedation Incidence of acute cognitive dysfunction Structured daily sedation breaks Staff information leaflets Staff training sessions Improve multidisciplimary team communication Assess sedation and agitation using the RASS tool (Richmond Agitation Sedation Scale) Use ear plugs to improve sleep Use Dexmedetomidine as alternative to benzodiazipines Develop and follow guidelines for daily sedation breaks Assess for delirium using CAM-ICU (Confusion Assessment Method for ICU patients) Investigate and correct underlying causes Include delirium as part of safety brief Medical staff and family jointly keep an ICU diary Improved identification of delirium Validated delirium tool Staff education Care bundle initiated within 2 hours of diagnosis Engage with patient/family/carer Mobilise patients earlier and more frequently

Testing change: ICU examples Sequence the 5 PDSA reports What links do you identify from one cycle to the next? What do you notice about the scale of the tests? How many different measures were used? How did theory change through the cycles? How did qualitative data inform subsequent tests?

Qualitative and quantitative data “Why did you use the hand gel?” “Because it’s the start of my shift – I’ve just come from home.” Which of the following are occasions when you use hand gel? At the start of a shift Between patients After lunch etc On what percentage of occasions do you use hand gel at the start of your shift? 0 – 20 21 – 40 41 – 60 61 – 80 81 - 100

Project work: plan a test of change Create an aim for your first test of change: how good, by when? Start small Match your questions to your predictions and measures Plan tasks Complete who/when/where

Model for Improvement The Improvement Guide Langley J et al 2009