1. Setting Up Your First PDSA

2. What change will you implement by next Tuesday? PDSA

3. 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

4. AIM: State your overall goal you would like to reach Example: 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 changePerson Responsible When to be done Where to be done Test a BPMH process and data collection form with the next resident admitted John RNSept 12/08 Resident Admission Room Rapid Cycle Testing

5. 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 12 Sept 12 @ 1430 Sept 12 before 1500h Here Med Unit #1 Conference Rm Med Unit #1 Plan

6. 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

7. 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

8. 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

9. AP SD AP SD AP SD AP SD 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

10. 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

11. 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