Breaking research down: your research plan to help you stay on topic
Part 2
Advanced Pharmacy Australia (AdPha) is proud to introduce the newest series published in Pharmacy GRIT, the Technicians and Assistants Research Series. This engaging series aims to make research approachable, guiding pharmacy technicians and assistants getting started on their research journeys.
The second instalment of the series is authored by Natasha Lemuelu (Qld) and Julia Tisdall (Qld) and guides you through the use of Plan-Do-Study-Act cycles to keep your research on track.
Endorsed and supported by the AdPha Specialty Practice Technicians and Assistants Leadership Committee, Pharmacy Technician and AdPha Board of Directors Technician Observer Tara Clayson-Fisher states “Julia’s experiences and enthusiasm speaks to the value of finding new ways to engage with and enjoy the work that you do”.
Natasha Lemuelu
CertIVHospPharm | Advanced Pharmacy Technician, Redcliffe Hospital | natasha.lemuelu@health.qld.gov.au
Julia Tisdall
CertIVHospPharm, DipMgt, Accredited Technician Checker | Pharmacy Administration Officer, Redcliffe Hospital | Julia.tisdall@health.qld.gov.au
[PharmacyGRIT article no: 20241404]
- What is a Plan-Do-Study-Act (PDSA) cycle?
- Why do you use a PDSA cycle?
- Example of a completed PDSA cycle
- Homework
- References
Welcome back to the Technicians and Assistants Research series. My name is Natasha Lemuelu, and I will be your lead author for Part 2. Before we start, I’d like to introduce myself by giving you some background about myself and my research journey.
For the last 16 years I have worked in hospital pharmacy departments in the public health system at four major hospitals, Sir Charles Gardiner Hospital (WA), Royal Brisbane Women’s Hospital (Qld), Logan Hospital (Qld), and I am currently working as an Advanced Pharmacy Technician at Redcliffe Hospital (Qld). I also have worked in Digital Health before joining the Redcliffe team. Throughout my career my roles have been in Cancer Care — including sterile production — ward technician within the surgical, medical, and mental health wards, worked in imprest and the dispensary, women’s and newborns satellite, and worked behind the scenes at digital health maintaining Queensland Health’s Pharmacy Software. I have had the privileged of working in many areas and I understand that every role is just as important as each other. As discussed in Part 1 of the Technicians and Assistants Research Series, technicians can do research and I have seen with my own eyes the day-to-day work of technicians and their input in making practice better and improving workflow; these contributions should be recognised.
Writing a publication or abstract is one method to gain recognition of your contributions to research. My research background before publishing this article was limited. I had completed projects, but my experience was limited in the way that I had never written an abstract or published an article before as I did not know where to start. I have now worked alongside Julia with this project and we both hope to inspire you to complete an abstract or publication soon if you are passionate and driven to do so. In Part 2, I will explain the Plan-Do-Study-Act (PSDA) cycle and using an example, explain how the PSDA cycle can be utilised for your research projects.
What is a Plan-Do-Study-Act (PDSA) cycle?
The Plan-Do-Study-Act (PDSA) cycle is a tool to learn about and refine an intervention and are often utilised in quality improvement projects. According to Action 6.02: Applying quality improvement systems of the Communicating for Safety Standard, the PDSA cycle is an “iterative feedback process that allows improvements to respond to changing circumstances or consequences, as well as ensuring continual and increasing engagement of clinicians”.1
The PDSA cycle is comprised for four steps (plan, do, study, act) and can be repeated to refine an intervention over time. Below are examples for each step of the PDSA cycle.
The plan step involves thinking about the concern you have (or your research problem). You should write down the issue/concern with background information. For example, how long has this issue been happening? Who is saying there is an issue? Is it just you or multiple people, for example, nurses, pharmacist etc. How are you measuring or looking into this concern? Are you looking at safety issues that have been recorded? What timeframe do you have to complete the project?
The do step is writing down what you are going to do for this project. Are you going to gather data and who will collect the data? What was the date the data was collected? The study part is analysing the data and finding out the results. Was it the outcome that you expected? Finally, the act step is to decide what are you doing to do with this data. Are you going to change a process or if the result showed there is no need to update the process, are you going to keep things as they are? Remember it's always good to share all results!
AdPha offers a wide range of research support through the Research Toolkit series, but we have also included a PDSA template here that may be useful to you. The basis of this template has come from a quality improvement template or PDSA cycle template from the Safety and Quality Unit, at the Surgical Treatment and Rehabilitation Service (STARS) Hospital, Queensland and has been reproduced here with permission from STARS. A downloadable version for your own use has also been provided.
Figure 1. Plan-Do-Study-Act (PDSA) template
[Reproduced with permission from STARS]
| Improvement activity governance | |
|---|---|
| Commencement date | |
| Area | |
| Lead person | |
| Team members (if any) | |
| Supporting committee | |
| Expected completion date | |
| PDSA cycle (repeat as needed) | |||
|---|---|---|---|
| Plan | What is the issue/concern? | ||
| How long has it been going on? | |||
| What is the source of the information? | |||
| What is the current measure of the issue/concern? | |||
| What is the successful measure of the issue/concern? | |||
| What is the timeline of the plan? |
Expected commence date: Expected completion date: |
||
| Do | What actions need to be taken? | Action to be taken | By whom |
| 1. | |||
| 2. | |||
| 3. | |||
| Date checked? | |||
| Study | What has been the result of the action taken? |
Resolved (successful measure has been met) Issue/concern continues |
|
| Act | What are the next steps? |
If the successful measure has NOT been met: Commence another PDSA cycle? Escalate to Manager/ Committee/ Meeting? Other? ______________________________ If the successful measure HAS been met: Complete the final improvement outcome statement at the end of the form |
|
|
Final improvement outcome statement |
|---|
 |
Why do you use a PDSA cycle?
PDSA cycles are useful research tools, and the template above can be used as a starting point for your project. They can help keep your project on track as it’s sometimes very easy to drift off topic.
Drawing on Julia’s previous experience during a medication wastage quality improvement project reveals the value of a PDSA cycle. While collecting data and recording it in Excel (Microsoft Corporation, Redmond, WA, USA), it was identified that there were many more categories/reasons than anticipated as to why medicine was being discarded. The richness of the data led to excitement and Julia started recording extra data in the spreadsheet that was not originally planned to be recorded. This made the dataset much larger than anticipated and so, harder to interpret. While the abundance of data was good, it was also not needed at the start of the project and made it a bit overwhelming. This is why having a clear plan, even if it's a word document in an SBAR format (Situation, Background, Action, Recommendation) or PDSA cycle is essential to help you stay on track and will help you not get overwhelmed. I would also suggest completing the PDSA form with the team you are working with so you are all on the same page and can agree on who is the lead of the project etc. I then recommend storing the document in a shared file location such as SharePoint (Microsoft Corporation, Redmond, WA, USA).
PDSA cycle can be used to assign roles and divide responsibilities to members of the research team and formalise peoples’ contributions to the project. This can also help determine authorship for any subsequent publications. There are several ways to determine authorship; but relative contribution is often used. For example, generally 1st author has contributed the most work, developed the idea of the project, or controls the project, 2nd author contributes more than 3rd author, and so on. The final listed author is generally someone who oversees the project or the most senior researcher. Frameworks such as CRediT (Contributor Roles Taxonomy)2 and ICMJE Roles and Responsibilities3 are also essential for determining authorship.
Example of a completed PDSA cycle
The PDSA cycle example below is a pretend project to show you how a PDSA form can be filled out. It can be used as a guide to show how much information you need to place in the plan.
| Improvement activity governance | |
|---|---|
| Commencement date | 01/01/2023 |
| Area | Pharmacy |
| Lead person | Natasha Lemuelu |
| Team members (if any) | Julia Tisdall |
| Supporting committee | Medication Safety |
| Expected completion date | 31/01/2023 |
| PDSA cycle (repeat as needed) | |||
|---|---|---|---|
| Plan | What is the issue/concern? | Getting medicine to the ward on time | |
| How long has it been going on? | 6 months | ||
| What is the source of the information? | Complaints from the ward | ||
| What is the current measure of the issue/concern? | Complaints; recorded clinical incidents; missed doses | ||
| What is the successful measure of the issue/concern? | Reduced missed doses | ||
| What is the timeline of the plan? |
Expected commence date: 01/01/2023 Expected completion date: 31/01/2023 |
||
| Do | What actions need to be taken? | Action to be taken | By whom |
| 1. Conduct audit on missed doses to identify a pattern | Natasha Lemuelu | ||
| 2. | |||
| 3. | |||
| Date checked? | 15/01/2023 | ||
| Study | What has been the result of the action taken? | Able to find cause of the issue which was a lack of staff education on after-hours processes |
|
| Act | What are the next steps? |
If the successful measure has NOT been met: Educate new and current staff on after-hours processes |
|
By completing a PDSA template you should feel like you have a clear plan and feel like you are in control of the project. This will build your confidence and help you be more assertive and clearer when presenting the results to wider stakeholders.
Homework
Your homework until Part 3 is to fill out the example template for the study and seek feedback from your supervisor, colleagues, or broader research network. Using this template should help provide clear guidance and steps for the project so it is not too overwhelming and helps you stay on track.
Thanks for reading, the next part of the Technicians and Assistants Research series will give advice for writing an abstract with the results of your study. This will (hopefully!) encourage you in writing an abstract for Medicines Management 2024.
Acknowledgements
The authors would like to thank the following for their contributions to this work: The AdPha Specialty Practice Technicians and Assistants Leadership Committee, Chen Foo (Assistant Director of Pharmacy, Logan Hospital), Ann Whitaker (Director of Pharmacy, Redcliffe Hospital), Liz Hayward (Assistant Director of Pharmacy, Redcliffe Hospital), Edwin Cheung (Assistant Director of Pharmacy, Redcliffe Hospital), Lee Howard (Pharmacy Administration Team Leader, Redcliffe Hospital), Mariel Bulan (Clinical Assistant Team Leader, Logan Hospital), Melissa Hall (Clinical Assistant, Logan Hospital), Joanne Burrows (Configuration Officer, Clinical Information Systems Support Unit [CISSU]), The Safety and Quality Unit, at the Surgical Treatment and Rehabilitation Service (STARS) Hospital, and Benjamin Hughes (Senior Pharmacist, STARS).
References
- Australian Commission on Safety and Quality in Health Care (ACSQHC). Action 6.02: applying quality improvement systems. Sydney; ACSQHC; 2024. Available from https://www.safetyandquality.gov.au/standards/nsqhs-standards/communicating-safety-standard/clinical-governance-and-quality-improvement-support-effective-communication/action-602. Accessed 29 April 2024.
- National Information Standards Organization (NISO), Contributor Roles Taxonomy. CRediT. NISO; 2024. Available from https://credit.niso.org/. Accessed 30 April 2024.
- International Committee of Medical Journal Editors (ICMJE). Roles and responsibilities of authors, contributors, reviewers, editors, publishers, and owners. ICMJE; 2024. Available from https://www.icmje.org/recommendations/browse/roles-and-responsibilities/. Accessed 30 April 2024.