PDSA Planning Form

Team: Healthy Smiles
This test will be used to: (check one) ___ develop _X__ pilot ___ implement a change
Objective of this test:
Use the CRA and SMG forms perform Risk Assessment and provide Self Management Goals.
PLAN
  1. Briefly describe the change you plan to test.
Perform Risk Assessment and provide Self Management Goals with one patient between the age of 6 and 20 seen in Dental.
  1. PREDICTION: What do you think will happen?
The CRA form will be easy to use to determine the risk of the patient. The SMG form will be easy to use and will facilitate review of SMG with the patient.
  1. What data will you need to test your prediction(s)? How will you collect it?
Needed: 1 patient in the age group, CRA form, and SMG form
The forms will be scanned and the results of the PDSA will be discussed at the team meeting.
  1. Preparation for testing:
Task to be completed for test / Person responsible / When? / Where & How?
Print color copies of the CRA and SMG forms in English and Spanish / Dr. Johnson / 3/11 / Meadows Clinic w/1 patient
DO
  1. What problems or unexpected events did you encounter?
The CRA form looked too clinical. The patient and the assistant were reluctant to be involved in filling it with the dentist so the dentist filled it by herself.
  1. List feedback and observations from the participants.
The CRA form was perceived by the dentist and assistant as being too complicated and doesn’t facilitate communication with the patient.
The dentist and assistant prefer having one form for CRA/SMG instead of 2 separate forms.
The dental staff didn’t like not having the patient engaged in the CRA process and seeing how the dentist determined the risk level.
The dental staff liked the SMG form provided.
STUDY
  1. What do the data show?
There is a need for a simplified CRA/SMG process that is in line with current HC CRA/SMG procedure forms.

  1. Was your prediction confirmed? What did you learn?
The CRA form was perceived as being too complicated but the team liked the SMG form.
ACT
  1. Following this test, will you: (check one) __ Adopt _X_ Adapt __ Abandon this change?
  2. What is your plan for the next cycle?
Develop and test a user friendly CRA/SMG form for use by HC staff