|  Test changes to surgical care processes on a small scale to ensure not only that they are successful, but also that they can be understood clearly by all and implemented safely. You may find that some clinicians do not readily accept changes to clinical processes, so results from their colleagues' tests can help demonstrate possible successes and gain support for the proposed change.
The key to making effective changes is rigorous testing before broader implementation. Members of teams in all kinds of organizations can study the examples of testing changes here as they design their own tests.
Click here for more information and general tips on Forming the Team, Setting Aims, Establishing Measures, or Selecting Changes |
| | Example: Administer the first dose of prophylactic antibiotic by the anesthesiologist. Plan
The team predicted that the anesthesiologist would be best able to ensure that the first dose was administered within 1 hour of incision time. The antibiotic would need to be available when the patient arrived to the peri-operative area in order for this plan to work. The anesthesiologist would document the administration time and incision time. Do
The day before the test, the team discussed the plan with one anesthesiologist, who agreed to the small test. The day of the test, a patient was selected from the operating schedule and it was agreed that the anesthesiologist would administer and document the first antibiotic dose. Study -
The antibiotic was available when the patient arrived in the perioperative area. -
The anesthesiologist administered the first dose of the antibiotic and documented the time of the anesthesia record. -
The anesthesiologist did not document the incision time as he was working with the patient's airway and the anesthesia settings at the time and did not witness the actual incision. -
The team decided that it was difficult for the anesthesiologist to document incision time due to the other patient activities occurring at that time. -
The team predicted that the circulating nurse could document the incision time more easily than the anesthesiologist. -
The team agreed to test the having the anesthesiologist document administration time and the circulating nurse document the incision time on the next patient.
| | | | Use Antibiotics Appropriately
Change 1: Administer the first dose of prophylactic antibiotic by the anesthesiologist.
Maintain Normal Blood Glucose
Change 2: Develop intra-operative protocol for glucose management | Cycle 1: | Draft protocol tested with one anesthesiologist and on one cardiac surgery patient. | | Cycle 2: | Modified protocol based on learnings from first tests and tested revised protocol with one anesthesiologist and on ten cardiac surgery patients. | | Cycle 3: | Expanded test to include two anesthesiologists and all cardiac surgery patients they treated. | | Cycle 4: | Modified protocol further based on learnings from tests. | | Cycle 5: | Implemented protocol for all cardiac surgical patients. | Optimize Oxygen Tension
Change 3: Administer FiO2 > 80% to 100% of adult patients intra-operatively and for 2 hours post-operatively.
| Cycle 1: | Revised ordering of supplies for operating room and post anesthesia care unit to include non-breather masks only. | | Cycle 2: | Modified anesthesia record to document intra-operative FiO2 and tested with one anesthesiologist on one day. | | Cycle 3: | Expanded test with same anesthesiologist to one week. | | Cycle 4: | Tested revised form with all anesthesiologists for one week. | | Cycle 5: | Implemented use of revised form for all patients. | | |
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