Table 2

Changes tested

Project/aimChanges tested (PDSA cycles)
Early discharges -
Discharge 70% of patients before 13:00 by 30 June 2018
  1. Commence physician ward rounds by 8:30 AM.

  2. Start wards rounds with patients who are planned for discharge.

  3. Place physician discharge orders into the electronic medical record (EMR) during rounds.

  4. Start a discharge checklist at the time of admission.

  5. When possible, plan discharges 24 hours. ahead (includes completing the discharge summary and medication prescriptions on the previous day).

  6. Daily display and communication of 24-hour plan discharge

  7. 2 min postround huddles on planned discharges

  8. Discharge prescription sent to pharmacy a day before

Skin injuries—eliminate preventable skin injuries, including phlebitis, by 30 June 2018
  1. Use of turning clock for pressure injury prevention.

  2. Use a monitoring tool to evaluate all intravenous insertions, maintenance, and removals.

  3. SSKIN bundle compliance (surface, skin inspection, keep moving, incontinence, nutrition)

  4. Assess percutaneous coronary intervention sites every shift for 48 hours.

Consumables cost—
reduce consumables cost by 20% by 30 June 2018
  1. Head nurse/charge nNurse counter check all orders made by stores personnel.

  2. Identify the fast-moving items, which can be ordered in bulk.

  3. Use central line kits more efficiently.

Nursing care hours—
increase the percentage of time nurses spend in direct patient care by 30% by 30 June 2018
  1. Redistribute inventory checking to non-RN staff and patient attendants.

  2. Move Coagucheck QC and difficult intubation kit checks from day and evening to night shift.

  3. Place the automatic stop order (ASO) notification sheets in a designated place in the physicians’ office, rather than have each nurse notify each physician about specific ASOs.

  4. Conduct hourly patient rounding on morning and evening shifts

  5. Hand over the patients for radiology and nuclear medicine procedures to the staff in the nuclear medicine and radiology departments rather than waiting in the department for the procedure to finish.

  6. Have pharmacy directly call physicians for questions, cutting out the nursing ‘middle-man’.

Laboratory tests—
reduce the no of laboratory tests by 20% by 30 June 2018
  1. Orient all new HDU B physicians on how to place lab orders correctly in the EMR, including signing all lab tests orders at the same time to prevent the generation of multiple accession numbers.

  2. Use visual reminder tools to reinforce the importance of limiting testing.

  3. Whenever appropriate, order lab tests only once per 2 weeks for long-term patients.

  4. Ask physicians to order single tests instead of panels of tests whenever appropriate.

  5. Use point-of-care testing for activated partial thromboplastin time/international normalised ratio tests.

  6. Follow evidence-based practices for collection of samples, including the order of collection.

  7. Send blood samples to the lab only after plasma separation.

  8. Perform competency validation for all new staff and on a regular basis for existing staff.

  9. Discourage collection of blood samples from existing cannulas.

  • HDU B, high-dependency unit B; PDSA, Plan-Do-Study-Act.