What is the role of Plan-Do-Study-Act (PDSA) in nursing practice?

From the Guidelines

The Plan-Do-Study-Act (PDSA) cycle is a crucial quality improvement framework in nursing practice that enables systematic testing and implementation of changes to improve patient care, as evident from the most recent study in 2024 1. To implement PDSA effectively, nurses should first identify a specific problem area and develop a clear plan with measurable goals.

Key Components of PDSA

• In the Plan phase, nurses define the objective, make predictions, and determine data collection methods.
• During the Do phase, they implement the planned change on a small scale and document observations.
• The Study phase involves analyzing collected data against predictions and summarizing lessons learned.
• Finally, in the Act phase, nurses determine modifications needed before the next cycle or decide if the change is ready for broader implementation. PDSA cycles are typically conducted in rapid succession, with each cycle building on knowledge gained from previous ones, as supported by the study in 2004 1.

Benefits of PDSA

• This approach is valuable because it allows nurses to test changes in real clinical settings with minimal risk.
• It promotes team collaboration and creates evidence-based improvements tailored to specific practice environments.
• The use of PDSA cycles has been employed in various studies, including a review of trends in guideline implementation in 2022 1, demonstrating its effectiveness in quality improvement. For maximum effectiveness, nurses should keep each cycle focused, involve frontline staff, document thoroughly, and celebrate small wins to maintain momentum throughout the improvement process.

Best Practices for Implementation

• Nurses should prioritize the "study" stage, encouraging a disciplined approach to testing and monitoring changes over time, as emphasized in the 2024 study 1.
• The PDSA cycle should be used in conjunction with other quality improvement frameworks and theories, such as the theoretical domains framework and social cognitive theories, to provide a comprehensive understanding of implementation aspects.

From the Research

PDSA in Nursing Practice

• The Plan-Do-Study-Act (PDSA) cycle is a popular approach to conducting tests of change to support quality improvement in healthcare 2.
• Using PDSA cycles can help clinicians deliver improvements in patient care through a structured experimental approach to learning and tests of change 2.
• The PDSA approach facilitates individual, team, and organisational learning, making it an essential tool for quality improvement in healthcare 2, 3.

Benefits and Challenges of PDSA

• The PDSA cycle method can be challenging to use, and low fidelity of published accounts of the method has been reported 3.
• Challenges to achieving greater fidelity reflected problems with understanding the PDSA methodology, intention to use, and application in practice 3.
• QI strategies that evolved to overcome these challenges included project selection process, redesign of training, increased hands-on support, and investment in training QI support staff 3.

Evaluation of PDSA Cycles

• A study evaluated the completion, achievement of goal, content quality, and enablers and barriers associated with completion of high-quality PDSA cycles in cardiovascular disease management in general practices 4.
• The study found that 77% of the cycles were completed and 68% achieved the planned goal, but content quality was low, with a median score of 56% 4.
• Lack of interprofessional engagement was a barrier to implementation, and human or capital resources and organisational support may be critical for the completion and cycles achieving the planned goals 4.

Nursing Workflow and PDSA

• There is limited evidence on the impact of PDSA on nursing workflow, but a study on automated medicine dispensing units found that it can change nursing workflow due to queueing, interruptions from other staff, and increased walking 5.
• Nurses from general wards were more satisfied with the system than those from specialty areas, prompting consideration of redesign to improve suitability 5.

Medication Administration Errors

• A study on medication administration errors in nursing homes using an automated medication dispensing system found that medication administration is prone to many errors, with a frequency of 21.2% 6.
• The most frequently occurring types of errors were use of wrong administration techniques and wrong time errors, and potential risk factors included female gender, ATC medication class antibiotics, and medication crushed 6.