The nurses in a medical unit have seen an increase in the number of pressure injuries developing in their clients. The nurses decide to initiate a performance improvement (PI) project using the PDSA model. Which of the following is an example of “Plan” from that model?

Performance Improvement (PI) models like the PDSA (Plan-Do-Study-Act) cycle to guide problem-solving and promote better outcomes. The PDSA model is a cyclical, four-step framework used to test and implement changes in clinical practice.

Rationale for correct answer:

D. Meeting with all disciplines to develop a multidisciplinary approach for reducing pressure injuries: This reflects the “Plan” phase of the PDSA cycle. The team is identifying the problem, engaging key stakeholders, and developing a collaborative strategy to address pressure injuries.

Rationale for incorrect answers:

A. Orienting clients to the unit’s practice of hourly rounding on clients: This is an action that occurs after a plan has been made. It falls under the “Do” phase, where interventions are implemented. It reflects putting a plan into practice, not the planning process itself.

B. Reviewing the incidence of pressure injuries on clients cared for using the protocol: This is an example of the “Study” phase, where data is analyzed to determine whether the intervention had the desired effect. It involves reviewing outcomes, not planning them.

C. Based on findings from clients who developed injuries, implementing an evidence-based skin care protocol on all units: This reflects part of the “Act” phase, where broader implementation of a successful intervention is carried out. It's a step beyond planning and testing; it represents full-scale application of what has been learned.

Take home points:

• The "Plan" stage of the PDSA cycle focuses on identifying a problem, collecting baseline data, and designing an initial intervention.
• Understanding each phase of the PDSA cycle (Plan, Do, Study, Act) ensures that quality improvement efforts are well-organized, data-driven.

In nursing and healthcare quality improvement, outcome measurements are indicators used to evaluate the actual results or impact of an intervention or care process on client health and safety.

Rationale for correct answer:

C. A nursing unit adopts a set of strategies for reducing pressure injuries, and the UPC members use direct observation of the skin to measure incidence of pressure injuries. Measuring the incidence of pressure injuries is a true outcome measurement. It evaluates whether the implemented strategies had the desired clinical effect on patient outcomes.

D. A nursing unit implements a new fall prevention protocol and checks the monthly performance data for incidence of falls on the unit. The incidence of falls reflects the clinical outcome of the fall prevention strategy. This is a classic example of an outcome measurement because it focuses on the end result that matters to patient safety.

Rationale for incorrect answers:

A.A nurse teaches a client how to administer an injection and then watches the client do a return demonstration. This is a process evaluation, not an outcome measurement. The nurse is assessing whether the client can perform the procedure correctly, but it does not measure the end result.

B. A nurse implements a new pain-management protocol and checks clients’ charts to confirm whether interventions are being provided. This is process-focused-it checks compliance with the intervention, not whether the intervention improved the clients' pain levels (which would be an outcome).

E. A nursing unit implements a client rounding program, and the charge nurse watches the assistive personnel to see whether hourly rounding is being done on clients. This is another process measure-the nurse is checking whether the intervention was carried out, not whether it had the desired impact, such as fewer call lights or improved patient satisfaction.

Take home points:

• Outcome measurements evaluate the effectiveness of nursing interventions by focusing on changes in client health status.
• Distinguishing between process and outcome measures ensures that healthcare teams not only implement changes correctly.