We all know change is occurring rapidly, sometimes faster than we can keep up. With rapid change, the effectiveness or the evaluation of change occasionally gets dropped due to a perceived lack of time and/or implementation of more changes. Yet we know that critical elements can be missed without a proper process. One way of managing change is using a quality improvement (QI) framework of PDSA: Plan-Do-Study-Act.

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PDSA works well on both large- and small-scale projects conducted by the perioperative nurse in the OR setting. The process is used as a small test of change and helps to answer three questions:

* What are we trying to achieve?

* What determines whether or not the change is an improvement?

* What changes will result in an improvement?1

Below is an example of implementing change using the PDSA process in the perioperative setting.

Plan

A perioperative nurse notes distractions occurring during closing counts and recognizes this as a potential risk to the patient for a retained foreign object. She intends to use a PDSA methodology to implement change.

The perioperative nurse works with the team to determine the objective (decrease distractions), answer who, what, where, and when, and decides on the method for data collection to determine if the change is effective.1,2

The team establishes that the root cause of the issue needing change requests from the surgical team. The nurse and the team decide to implement a "time out" during the closure pause in which there are no interruptions.

Do

The perioperative nurse and team implement the change.

Study

In this phase, the results are evaluated, and the effectiveness of the solution is determined.

Act

When the desired outcome has been attained in the small test of change, it can be transferred and standardized to other areas or in the OR.

It is within the perioperative nurse's role and responsibility to enhance patient outcomes by using a QI process. Implementing changes using a PDSA identifies clear outcomes, demonstrates that the process can be repeated, and avoids poor outcomes.3

Elizabeth M. Thompson, MSN, RN, CNOR

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Editor-in-Chief Nursing Education Specialist Mayo Clinic, Rochester, Minn. [email protected]

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