DNP880 Module 3 assignment: implementation plan built around PDSA cycles, a full sample

Four Cycles in Sixteen Weeks: A PDSA Implementation Plan for Food Insecurity Screening and Same-Visit Referral in Diabetes Care

Student Name

Doctor of Nursing Practice Program, Aspen University

DNP880: DNP Project

Instructor Name

Month Day, Year

Four Cycles in Sixteen Weeks: A PDSA Implementation Plan for Food Insecurity Screening and Same-Visit Referral in Diabetes Care

An implementation plan translates a proposal into a sequence of actions with owners, resources, and a way to learn along the way. This plan describes how routine food insecurity screening and same-visit community health worker referral will be introduced for adults with type 2 diabetes in two clinics of a composite community health center over 16 weeks, using plan-do-study-act cycles as the pilot step of the Iowa Model.

Why PDSA

Plan-do-study-act cycles test changes on a small scale, with a prediction stated in advance and data studied before deciding to adopt, adapt, or abandon the change (Langley et al., 2009). A systematic review of published PDSA applications reported that under a fifth of the projects described a sequence of linked, iterative cycles, and that data collected at short intervals rarely informed the next test (Taylor et al., 2014). This plan therefore specifies four cycles in advance, each with a question, a prediction, a scale, and the data that will be reviewed, while allowing later cycles to change in response to what earlier ones reveal. The Iowa Model's pilot step calls for exactly this kind of structured trial before deciding whether a change is appropriate for adoption (Iowa Model Collaborative, 2017).

Preparation: Weeks 1 to 3

Before the first cycle, the team, the DNP student, a nurse manager, two medical assistants, a community health worker, a physician champion, and a food bank liaison, will build the workflow. The two screening items will be added to the rooming template alongside the existing depression screen, with a pop-up for positive responses that places a same-day task for the community health worker. The food bank will provide a one-page electronic referral that feeds its intake system. Training will include a 30-minute session for medical assistants on asking the questions privately and without judgment, practiced in role-play, and a 20-minute huddle for clinicians on the purpose and the referral pathway. Baseline data on screening documentation in the prior three months will be extracted.

Roles and Responsibilities

Each team member has a defined job. The DNP student leads the project, writes each cycle's plan and prediction, extracts and charts the data, and chairs the weekly review. The nurse manager protects medical assistant time for training, adjusts schedules when a cycle shows rooming pressure, and approves changes to clinic workflow. The medical assistants ask the screening questions, document the answers, and trigger the referral task. The community health worker meets patients who screen positive, completes the electronic referral with them, and makes the two-week follow-up call. The physician champion answers clinician questions, models the conversation during visits, and brings concerns from the medical staff meeting. The food bank liaison confirms receipt of each referral and reports, with patient permission, whether food was picked up or delivered.

A simple responsibility grid will be posted in each clinic's workroom so that everyone can see who owns each step. When a step fails, the team will ask which role owned it and what made it hard, rather than who made a mistake.

Cycle 1: Can the Questions Fit Into Rooming? (Weeks 4 and 5)

Plan: one medical assistant at one clinic will ask the two questions for every adult with diabetes on two morning sessions. Prediction: at least 90 percent of eligible patients will be screened, and rooming time will increase by less than one minute. Do: the medical assistant screens and records time with a stopwatch for 20 patients. Study: screening rate, rooming time, and the assistant's comments. Act: adopt, adjust the script, or change the placement of the questions.

Cycle 2: Does the Handoff Work? (Weeks 6 and 7)

Plan: extend screening to all medical assistants at the first clinic for one week, with positive screens handed to the community health worker during the visit. Prediction: at least 80 percent of patients who screen positive will meet the community health worker before leaving. Study: handoff rate, reasons for missed handoffs, such as the worker being with another patient, and patient comments. Act: adjust staffing or allow a phone handoff within 48 hours if in-person handoff fails.

Cycle 3: Do Patients Reach the Food Bank? (Weeks 8 to 11)

Plan: at the first clinic, the community health worker calls each referred patient within two weeks to ask whether they received food and what got in the way if not. Prediction: at least 60 percent of referred patients will have received food within two weeks. Study: completion rate and barriers, such as transportation or distribution hours. Act: if transportation is the main barrier, test produce box pickup at the clinic in the next cycle.

Cycle 4: Spread to the Second Clinic (Weeks 12 to 16)

Plan: implement the refined workflow at the second clinic. Prediction: screening rates will reach 85 percent within two weeks, faster than at the first clinic, because the process is now tested. Study: screening, handoff, and completion rates compared between clinics. Act: document the final workflow for adoption and sustainment. Each cycle is designed to answer one question; the next cycle begins only after the answer is known.

Resources and Budget

The project requires few new resources. Staff time for training totals about 14 hours across the team, paid within normal schedules. The community health worker's added time is estimated at six hours weekly during implementation. The food bank provides food and delivery at no cost to the health center through its existing grant. Electronic template changes will be made by the center's informatics analyst in about four hours. Printed materials in English and Spanish cost about $150. The DNP student's time is provided through the academic placement.

Anticipated Barriers

The most likely barriers are rooming time pressure on busy days, community health worker availability, patient discomfort with the questions, and transportation to food distribution. Each cycle is designed to surface one of these early, when changes are easiest. A standing weekly 20-minute team meeting will review cycle data and decide next steps.

Communication and Sustainment

Clinic staff will receive a one-paragraph update after each cycle stating what was tested, what the data showed, and what will change next. The quality committee will receive a monthly summary with the run chart of screening rates. At the end of week 16, the team will hand ownership of the workflow to the nurse manager, with the screening rate added to the clinic's monthly quality dashboard, the referral form kept in the record template, and a brief orientation module added for new medical assistants. Sustainment is planned now because the Iowa Model treats integration and sustainment as a distinct step, not an afterthought.

Conclusion

This plan implements food insecurity screening and referral through four planned PDSA cycles, each testing one link, fit in rooming, handoff, completion, and spread, with explicit predictions and data. Preparation, resources, and barriers are specified, and the structure follows the Iowa Model's pilot step while addressing documented weaknesses in how PDSA is often applied.

References

Iowa Model Collaborative. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223

Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290-298. https://doi.org/10.1136/bmjqs-2013-001862