1. 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

2. System of Profound Knowledge
Deming 2000

3. 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.

4. 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

5. 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?

6. 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 – – – –

7. 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

8. Model for Improvement
The Improvement Guide Langley J et al 2009