The following example shows how a health care organization developed and tested an asthma flow sheet on a small scale, using five PDSA cycles, before implementing its use with all physicians and nurses in the clinic.

Cycle 1:
Gather sample flow sheets. Develop our own asthma flow sheet (including patient demographics and six key measures. Test Version 1 of the flow sheet with two patients of one provider, and revise as necessary.

Cycle 2:
Test Version 2 of the flow sheet with two providers for a few days, and revise as necessary.

Cycle 3:
Conduct a two-week trial of Version 3. Obtain feedback from providers and nurses, and make revisions accordingly. Then meet with all health providers for consensus on assigning asthma severity scores and to improve ease of use of the flow sheet.

Cycle 4:
Test Version 4 with all providers. Obtain feedback from pediatricians and nurses.

Cycle 5:
Implement use of Version 4 of the flow sheet by all physicians and nurses. Do peer review of documentation, and then begin using the flow sheet.