Reference Number: _______________________
The Improvement Model
1. Developing objectives for improvement work
You may find it useful to identify what you want to achieve from your improvement work. The Improvement Model’s three fundamental
questions for achieving improvement provide a useful framework for developing your objectives.
Q1. What are we trying to accomplish?
What is the overall aim of what we are doing? What are we hoping to improve?
e.g. increase the range of ways in which patients can access care, improve how we use skills of team members, use our appointment
Make sure that HF patients, along with other patients having chronic disease review by nurses, have their repeat prescribed drugs
On moving to EMIS, we found a large number, approx ¼ of our 5000 patients on repeat prescribing had not had an up to date
Nurse chronic disease review entails a review of disease specific drugs but it would seem that many patients are not having other
medications reviewed by a doctor. This has important safety implications in HF e.g. potential adverse effects of repeat use of NSAID
drug or a soluble analgesic with high concentrations of sodium.
Q2. How will we know that a change is an improvement?
What will tell us that our changes make things better than they were before? What can we measure that will demonstrate that our changes are actually
an improvement? What data (opinions, observation, process data and results) will be useful?
Reduction in numbers of patients with overdue repeat reviews.
A clear procedure for managing this process.
Q3. What changes can we make that will lead to an improvement?
Include all the ways that you can work towards your objective, so that you can develop plans for PDSA cycles. Think about what has worked for other
people, what ideas you have yourself and innovative approaches.
Nurses should be able to hand over responsibility to doctors to review non QOF drugs on repeat.
Repeat reviews are better done by a doctor that knows the patient. Currently, this is done by the on call Dr in the afternoon who will
not know most of the patients whose repeats are given to him/ her to review.
We need to come up with a new proforma sheet that can be used by nurses and admin staff and put into individual doctors’ baskets to
allow them to make a clinical decision on repeat review.
Reference Number: ______________
PDSA cycle planning sheet Date: Oct 2010____________
Overall objective that this cycle links to:___ Production of proforma sheet and clear system for its use
Specific objective for this cycle
What are you going to do? Who is going to do it? By when Where
Oct 2010 Alva HC
Rewrite repeat prescribing proforma sheet/ clinical pathway GH
How are you going to do this(list the tasks/actions involved) Who is going to do it? By when Where
Meet with other partners/ 3 practice nurses and discuss with 4
key admin staff.
What do you think will be the outcome? How are you going to measure this cycle?
Refinement of my ideas through discussion with colleagues. Acceptance of new proforma and effectiveness in allowing repeat
Need to try out on a few patients updates to be done
Resistance to change.
PDSA cycle progress sheet
Describe what happened?
Decision for usual Dr to do review accepted by other partners.
Nurses confirm lack of expertise in reviewing non QOF drugs and agree need means of passing responsibility to doctors.
New proforma sheet allows nurses to request Dr input after chronic disease clinic review completed. Pile to be left in treatment
rooms for use.
New sheet allows Dr to update or issue other specific instruction e.g. appointment with GP/ bloods etc.
Instructions to admin staff added to bottom of sheet e.g. to record review date/ any specific instruction as a data entry/ scan form.
Having gathered your data describe the measured results and compare with predictions
Agreement in principal followed on to trial of use. Initially had thought to trial it on a few patients but consensus was to try it out fully.
After 2 weeks, not all nurses clear about how they should be using the form.
Admin staff confused by instruction re exact repeat update to be applied.
Requests for updates going to usual Dr though rather than on call person.
Admin staff confident that all patients requesting repeats with overdue review dates are being picked up by the new system. This
should lead to steady reduction in numbers of overdue repeats.
What will you will take forward from this cycle, or do differently next time. What other tests or cycles will you do?
Need to discuss the new system again with nurses at next Dr/
Nurse meeting next week. Ask Admin to also remind in meantime.
May need to change wording on proforma to make instruction re exact review date clearer.