Explain the Plan-Do-Study-Act (PDSA) cycle and provide an example of how a NICU nurse might use it to improve patient safety.

• A. Problem-Do-Solve-Act; example: replacing e-prescribing.
• B. Plan-Do-Study-Act is a cyclical quality improvement process: Plan a change, Do it on a small scale, Study the results, Act to refine or implement broadly. Example: implement a double-check system for line medication administration, evaluate error rates after one month, adjust process as needed.
• C. Plan-Do-Then-Adapt; example: monitor infection rates.
• D. Prepare-Do-Reflect-Act; example: staff training.

Answer: (B)

Plan-Do-Study-Act is a cyclical quality improvement approach that helps teams test changes, learn from the results, and refine or expand successful ideas. The Plan step is about choosing a safety improvement and designing how to test it. The Do step puts that plan into action on a small scale, so you can observe its effects without risking widespread disruption. The Study step involves measuring and analyzing the outcomes to see if the change produced the intended benefit, capturing both data and learning from the experience. The Act step uses what you learned to decide whether to adopt the change more broadly, modify it and run another small test, or abandon it.

In a NICU safety scenario, a nurse might notice that medication lines are at risk for misadministration. The Plan would outline a double-check system where a second licensed staff member verifies the line medication before it’s given. The Do would implement this check for a limited period in one unit or during specific shifts. The Study would involve collecting data on error rates and near-misses, comparing them to baseline, and gathering staff feedback over about a month. The Act would determine whether to expand the double-check process hospital-wide, adjust the verification steps based on what was learned, or try a different safety safeguard if results aren’t favorable.

Why this fits best: it operationalizes a small, testable change, uses data to judge impact, and supports iterative refinement toward safer practice, which is exactly what PDSA is designed to accomplish. Other options use different names or omit the essential “Study” and data-driven refinement steps, or propose vague outcomes without the structured cycle needed for reliable improvement.