Table 1

Comprehensive list of Plan-Do-Study-Act cycles undertaken during the QI initiative

PDSA cyclePlanDoStudyAct
1AAssessed baseline understanding of clinicians to provide evidence-based AECOPD careConducted baseline knowledge assessments of cliniciansFound that clinicians had low baseline knowledge of evidence-based management practices for AECOPDDesigned a local COPD management protocol based on international guidelines, continuing medical education sessions to teach the protocol, and an EHR-based template to guide clinicians through the protocol
1BAssessed baseline capacity of outpatient team to provide counselling services to all patients with COPDReviewed EHR to estimate volume of patients on a monthly basis and determine if there is sufficient counsellor capacity to allow for approximately 10 min of counselling per patientDetermined there was insufficient counsellor capacity given the expected number of patients on a monthly basis and the time required to provide high-quality counselling for patients with COPDHired additional chronic disease counsellors to increase counselling capacity, and developed counselling modules for facility visits
1CAssessed status of hospital formulary to provide optimal evidence-based AECOPD careReviewed the hospital formulary with the pharmacist in charge and the medical directorDetermined that the formulary had some, but not all, necessary medications for evidence-based COPD managementAdded salmeterol (long-acting beta agonist) to the formulary and developed regular procurement plan
2AAssessed feasibility of the EHR-based template to help clinicians follow the COPD protocolCollected feedback from clinicians after 1 month of utilisationFound that clinicians felt that the template was cumbersome to use, and that there were extraneous details included that were not relevant to patient careModified the template according to clinician feedback
2BAssessed utilisation of newly added salmeterol medicationReviewed EHR and prescription recordsFound low utilisation of salmeterolConducted continuing medical education session for clinicians about availability and appropriate utilisation of salmeterol and other COPD-related medications
3Assessed adherence to local COPD protocolReviewed EHR and prescribing patternsFound low adoption of the local COPD protocolPrinted paper copies of the COPD protocol flow diagram for display in clinician working areas, and provided targeted weekly feedback to individual clinicians about their personal protocol utilisation rates to improve performance
4Assessed ongoing adherence to COPD hospital protocolReviewed EHR and prescribing patternsObserved an initial improvement in adherence to the protocol, followed by a decline during a time where there was high staff turnoverConducted COPD continuing medical education sessions, and staff orientation sessions to the EHR template, with additional attention for new staff, and continued targeted weekly feedback for individual clinicians
  • AECOPD, acute exacerbations of COPD; COPD, chronic obstructive pulmonary disease; EHR, electronic health record; PDSA, Plan-Do-Study-Act; QI, quality improvement.