PDSA Worksheet Template
Phase Phase Activities To be completed “by next Tuesday”
-What are you testing?
-Who is conducting the test?
-Who are you testing the change on?
-When and where are your testing?
-What do you predict will happen?
-What data do you need to collect?
-Who will collect the data?
DO -What happened?
STUDY -Summarize the data.
-What did you learn?
-Compare results to your predictions.
ACT -Are you ready to implement change?
-What will you do before the next
-What will be the next cycle?
Adapted for the Medication Reconciliation Learning Session for Rural Hospitals from materials developed by the
Institute for Healthcare Improvement.