At ASPH we are passionate about supporting and empowering our staff to learn about and participate in QI projects. We encourage them to use the IHI Model for Improvement as a framework to guide their improvement work and you can read more about this here.
Although this framework is easy to understand and use, a lot of people still find starting their first QI project really daunting. There are a variety of reasons why this might be the case:
“My daily work is too busy, a QI project is going to take up a lot of my time”
“I will need to audit a lot of set of notes to get a baseline”
“I don’t really understand what a PDSA cycle is”
“I am not sure what constitutes a problem and how I would go about measuring it”
We are always looking for innovative ways to encourage people to make their change ideas a reality and this year we came up with the idea of QI Live! – a live QI project involving one PDSA cycle, in one hour, captured live on video. We are hoping to show our audience how simple it really is to go through one PDSA cycle using the Model for Improvement, and by doing so, hopefully, will motivate some of you to go out and just do it!
Below is a summary of the small QI project and you can see the video here.
What are we trying to accomplish?
Two of our junior doctors, Dr. Jack Goddall and Dr. Victoria Hodge, had identified an issue with their knowledge on using an EpiPen whilst doing a simulation session.
An EpiPen contains life-saving adrenaline, which is usually carried by allergy sufferers in case they have an allergic reaction. The drug needs to be administered quickly and correctly in order to restore the patient’s blood pressure during the reaction.
As healthcare professionals, it is not inconceivable that in this emergency situation, that you will be entrusted to deliver the life-saving drug. Failure to do so correctly and in a timely fashion may result in death from a preventable cause.
Their aim was to identify how many junior doctors at FY1 level were able to deliver adrenaline via an EpiPen correctly to a child in a simulated scenario; and then generate an improvement.
How will we know that a change is an improvement?
The team set out to measure the number of junior doctors participating in the project that are able to deliver adrenaline via an EpiPen correctly as a baseline and look to improve this with interactive education.
What change can we make that will result in an improvement?
The team hypothesised that they could generate an improvement if their colleagues were provided with an interactive teaching session from an allergy nurse specialists and they would test this as an initial, short PDSA cycle.
Three simulation stations were set up and the junior doctors were given a scenario whereby it was made clear that the child was suffering from an allergic reaction and their only task was to administer the EpiPen as soon as possible.
The doctors were to be marked using an eight-point marking system, developed by our allergy nurse specialist and a total of 28 doctors were assessed.
Only 4% (1/28) of the doctors were able to do this correctly – she happened to own an EpiPen herself! – which gave us a baseline.
An interactive teaching session was delivered by the allergy nurse as the first change to test as a PDSA. Re-measuring by running the scenario and the marking system as before showed that 73% (19/26) were now able to administer the adrenaline correctly.
A significant improvement which was followed by a discussion on possible future PDSA cycles to the goal of 100%.
Improving quality need not be hard or complicated. The Model for Improvement is easy to use and is designed to accelerate improvement by testing changes on a small scale and scaling them up with each subsequent PDSA cycles.
It has been used by hundreds of healthcare organisations in the world to guide their improvement. We hope you will start working on your project soon – you never know, it might be the next big thing!
As ever, if you have any comments or questions or if you would like some help with your own improvement project, please get in contact.
Keefai – @kfy98