An example for acute care

Objective

To implement the elements of the Best Practice Statement:

• Pressure ulcer risk assessment takes place within 6 hours of admission, which includes time in an Accident and Emergency department, or following a change in condition or treatment.

Plan

Questions: How can we ensure total compliance with completion of a pressure ulcer risk assessment on each admission to the care setting?
 
Prediction: Adding cues to the admission packet would help ensure compliance with identification of patients at risk of pressure ulcers on admission.

Plan for change or test

• Who: Nominated member of nursing staff
• What: Add a risk assessment tool to admission packet
• Where: Make up 3 admission packets for the test of change to include a risk assessment tool
• When: Set a date 

Plan for collection of data 

• Who: Nominated member of nursing staff
• What: Risk assessment carried out within 6 hours of a patient’s admission
• Where: Specify care area (ie Ward 1)
• When: Set a date

Do

• Carry out change or test.
• Collect data and begin analysis.
• Nominated member of nursing staff to implement the change
• Ask a nursing colleague to audit the patient’s notes after 6 hours of admission

Study: Complete analysis of data

• How did or didn’t the results of this cycle agree with the predictions that were made earlier?
• Did each patient who was admitted by the nominated Nurse have their pressure ulcer risk assessed within 6 hours of their admission?
• Summarise what worked / didn’t work in this cycle (ie assessments of pressure ulcer risk were completed by a nominated Nurse for three patients within 6 hours of their admission to the ward).

Act

• List actions will be taken as a result of this cycle.
• Test for all admissions to the ward within a 24 hour period by every nurse.
• Plan for the next cycle (adapt change, another test, implementation cycle?) See if additional cues are needed.

This example shows how a ‘start small’ change using the PDSA cycle enabled a Nurse and nursing colleagues to implement a Best Practice Statement in one ward.  The cycle gives opportunity to think about how an improvement could be made and then plan and quickly translate the idea into action.