Overview
The purpose of the threaded discussions is to promote dialogue among students and faculty throughout the course. This discussion is intended to allow you to show evidence toward achievement of the following course learning outcome(s):
Apply quality and safety measures in the plan of care.
Expand each section below to review the details of this discussion, paying careful attention to the requirements and scoring criteria.
Initial Post
Select ONE of the following scenarios.
Review Plan-Do-Study-Act (PDSA) Directions and Examples (AHRQ).Links to an external site.
Your response should include an explanation for each of the steps in PDSA.
PDSA Scenario 1
A community health center needs to increase the percentage of patients over 65 years old who receive a pneumococcal vaccine.
The practice plans to increase the number of patients over 65 years old who have and pneumococcal vaccine from 7% to 20% in 3 months by having the nurses or Medical Assistant (MA) discuss with the patients the importance of getting the vaccine. The practice will make sure to have the vaccine in stock and will also provide staff education on the importance of immunization. The change will be measured by having the Quality Improvement (QI) director and patient care coordinator run a report and asking the pharmacy how many vaccines are being ordered.
The vaccine is ordered, and the staff attends training about the importance of the pneumococcal vaccine in patients over 65. The clinic has 50 doses of the vaccine on hand.
Over the next three months, the nurses and MAs remember to discuss the vaccine with 60% of patients over 65. As a result, only 30 doses of the vaccine are used. The QI director and patient care coordinator run the report that shows the 50 vaccines ordered.
PDSA Scenario 2
A family practice aims to increase foot exams for patients with diabetes.
For patients with diabetes, a team member will place a sticker on the patient’s chart. Registration staff will identify those patients and will give pamphlets for comprehensible education mentioning the importance of foot care to those patients while they are waiting.
The foot exam will be documented in a chart, dated, and timed. High-risk diabetics will be identified and referred to podiatrists. The practice will measure success by reviewing the charts six months after starting the process.
A yellow sticker is placed on all diabetic patient’s charts by the staff. At each appointment, a staff member gives the diabetic patient a pamphlet on foot care as they check in. The nurse practitioner or physician then does a patient foot examination during the visit and refers the diabetics who are at high risk to a podiatrist.
After six months, a chart review is done on diabetic patients. 98% of all high-risk diabetics were referred to a podiatrist, and only 80% of all diabetic patients received information on foot care due to not having enough pamphlets printed.
Four scholarly references.
Enhancing Pneumococcal Vaccination Rates in Patients Aged 65 and Above: A Comprehensive Application of the Plan-Do-Study-Act (PDSA) Cycle
Introduction
Pneumococcal disease poses a significant health risk, particularly among individuals aged 65 and older. Vaccination remains the most effective preventive measure against this condition. Despite this, vaccination rates within this demographic often fall short of public health targets. The Plan-Do-Study-Act (PDSA) cycle offers a structured methodology for implementing and evaluating quality improvement initiatives in healthcare settings. This paper critically examines the application of the PDSA cycle to enhance pneumococcal vaccination rates among patients over 65, providing a detailed analysis of each phase, supported by relevant theories, statistical evidence, and literature.
Plan-Do-Study-Act (PDSA) Cycle Overview
The PDSA cycle, rooted in the scientific method, is a four-step iterative process designed to test changes in real-world settings:
Plan: Identify an objective and devise a plan to achieve it, including defining the change to be tested, formulating hypotheses, and establishing metrics for success.
Do: Implement the plan on a small scale to collect data and observe outcomes.
Study: Analyze the collected data to assess the effectiveness of the change, comparing results against the expected outcomes.
Act: Based on the analysis, decide whether to adopt, modify, or abandon the change, and plan the next cycle accordingly.
This cyclical approach facilitates continuous improvement by allowing healthcare teams to test interventions, learn from outcomes, and refine processes iteratively.
Minnesota Department of Health
Application of PDSA to Increase Pneumococcal Vaccination Rates
Plan
Objective: Increase the percentage of patients over 65 receiving the pneumococcal vaccine from 7% to 20% within three months.
Strategies:
Staff Education: Conduct training sessions for nurses and medical assistants (MAs) on the importance of pneumococcal vaccination in older adults.
Patient Engagement: Instruct nurses and MAs to discuss the benefits of vaccination with patients during visits.
Vaccine Availability: Ensure an adequate stock of vaccines, with an initial inventory of 50 doses.
Measurement:
Process Metrics: Track the percentage of patients over 65 who receive information about the vaccine.
Outcome Metrics: Monitor the increase in vaccination rates and the number of doses administered.
Do
The clinic implemented the planned strategies:
Staff attended educational sessions on pneumococcal vaccination.
Nurses and MAs were instructed to discuss vaccination with eligible patients.
An initial stock of 50 vaccine doses was secured.
Over the subsequent three months, nurses and MAs discussed vaccination with 60% of patients over 65.
Study
Findings:
30 out of 50 vaccine doses were administered, indicating a 60% utilization rate of the available stock.
The overall vaccination rate increased from 7% to approximately 12%, falling short of the 20% target.
Analysis:
While staff engaged 60% of eligible patients in discussions, only half of these patients proceeded with vaccination, suggesting potential patient hesitancy or insufficient persuasion.
The shortfall in reaching the target indicates that additional or alternative strategies may be necessary to achieve desired outcomes.
Act
Recommendations:
Enhanced Patient Education: Develop comprehensive educational materials addressing common concerns and misconceptions about the vaccine to improve patient acceptance.
Reminder Systems: Implement electronic health record (EHR) prompts to remind staff to discuss vaccination with every eligible patient, aiming to increase the discussion rate beyond 60%.
Follow-Up: Establish a follow-up protocol for patients who decline vaccination initially, providing additional information and addressing specific concerns.
Community Outreach: Engage in community-based initiatives to raise awareness about the importance of pneumococcal vaccination among older adults.
These actions should be tested in subsequent PDSA cycles to evaluate their effectiveness in increasing vaccination rates.
Supporting Theories and Literature
Health Belief Model (HBM)
The HBM posits that an individual's likelihood of engaging in a health behavior, such as vaccination, is influenced by their perceptions of susceptibility, severity, benefits, and barriers. In this scenario, patients may perceive low susceptibility to pneumococcal disease or have concerns about vaccine efficacy and safety, acting as barriers to vaccination. Educational interventions aimed at modifying these perceptions can enhance vaccine uptake.
Theory of Planned Behavior (TPB)
The TPB suggests that behavioral intentions are shaped by attitudes, subjective norms, and perceived behavioral control. Applying this theory, interventions that positively influence patients' attitudes toward vaccination, leverage social norms (e.g., recommendations from trusted healthcare providers), and enhance patients' confidence in their ability to receive the vaccine can improve vaccination rates.
Statistical Evidence and Literature Support
A study published in BMJ Open Quality demonstrated that assigning a designated nurse to review patient charts and pre-order pneumococcal vaccines significantly increased vaccination rates among patients aged 65 and older. This intervention aligns with the "Plan" phase of the PDSA cycle, emphasizing the importance of pre-visit planning and staff involvement in quality improvement initiatives.
Furthermore, a scoping review in Human Vaccines & Immunotherapeutics identified that multimodal educational tools and primary care interventions, such as periodic health examinations and electronic medical record reminders, were associated with improved pneumococcal vaccine uptake among older adults. These findings support the implementation of
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