Running head: PLAN DO STUDY ACT (PDSA) SUMMARY REPORT 1

Plan Do Study Act (PDSA) summary report

Charito Ward

Bon Secours Memorial College of Nursing

Synthesis of Nursing Practice

NUR 4242

Ms. Wendi Liverman

March 30, 2017

I pledge.

Plan Do Study Act (PDSA) summary report

Introduction

Working for the department of Veterans Affairs (VA) opens the eyes of any new

employee of things that should be implemented that have not been. Some of the policies are

outdated and important issues are often overlooked. The issues that the VA can create an

opportunity for improvement for any new employee who wants to see improvement or change in

the right direction. One of the observations I had noticed in the Operating Room (OR) and Pre-

Operative (Pre-op) area was the lack of having a jewelry and/or piercing waiver in place or as

protocol.
 A year prior to working at the VA I was an employee at the Bon Secours Maryview

Medical Center in the OR. A change that occurred in 2015 had a jewelry waiver on the actual

surgical consent. The jewelry waiver portion of the consent had options such as: cannot remove

jewelry, refuse to remove jewelry and Not Applicable (N/A); the Pre-op nurse would circle

which one applied to the patient and the patient would sign it if it was anything other than N/A.

Although in a civilian facility implementing change is much easier, it can still be done in

a military or federal facility. There are more hurdles to apply changes, which may be why some

of the protocols in place are outdated. Some employees may feel that the work it takes to have a

change is not worth the time and headache. In order to start considering a jewelry/piercing

waiver I had to go to the chief of surgery to get the go ahead, then to the head of VISN for

approval to create a template on paper. I then had to provide my template to the Board of Ethics

for approval to have the waiver in place for use.

Explanation of project

At the VA piercings have become more relevant than years prior; patients are now

younger than before and piercings have become more socially accepted. Before the idea of

having a jewelry waiver in place I had observed the issue of patients who refused to remove their

wedding bands, necklaces, lip piercings, nipple piercings etc. The pre-op nurses would complain

to the physicians about how the patients refused to remove their piercings or jewelry, sometimes

the doctors were able to talk them out of it, other times the patients still refused. One of the

issues was that the patients were not told in their pre-surgery appointments that jewelry and

piercings should be removed. Another issue was patients didnt consider piercings as jewelry,

and the last issue was that patients did not know why jewelry and piercings should be removed

previously they didnt know the rationale for it.

PLAN DO STUDY ACT (PDSA) SUMMARY REPORT 3

Implementation

I ran two Plan Do Study Act (PDSA) cycles, hindsight I could have probably done this in

one PDSA cycle. The first PDSA cycle I ran was prior to implementing the jewelry waiver. I

went through the necessary steps needed in order to implement a jewelry waiver. The steps were

to get approval from the Chief of Surgery and the head of VISN, approval from the board of

ethics and an easy to follow waiver template to have in place. The first PDSA cycle was

complete and nothing was missing.

The second PDSA cycle was implementing the jewelry waiver into practice. Once the

template was made and reviewed with the Registered Nurses (RN) in Pre-op so they could ask

questions if they did not understand, the waiver was set to be used when needed. In the waiver

were the risks of leaving the jewelry on or piercings in place such as: harboring infection, risk to

airway, cutting off circulation and possibility cancelling surgery. The alternatives to having the

jewelry in were removing completely and removing and replacing with metal alternatives. The

patient would read the consent and sign it along with the physician that would be preforming the

surgery. What occurred was shocking, the patients who read over the jewelry/piercing waiver

decided they wanted to remove their piercings or jewelry, two staff members who were familiar

and comfortable with piercings were asked to remove piercings the patients had difficulty

removing on their own. The jewelry was then bagged and given to the family member they were

waiting in the pre-op area with. Sometimes the patient would ask the staff to replace the

piercings, and it was done for them after they finished in phase 1 in recovery.

One person after reading the waiver refused to have her piercing removed, but due to the

location of the piercing and type of surgical procedure being done the case was cancelled, the

physician felt that the piercing imposed too much of a risk to do the surgery with the piercing in
PLAN DO STUDY ACT (PDSA) SUMMARY REPORT 4

place. Surveys from the Pre-op staff felt unanimously that the jewelry waiver was a good

addition to have, it informed the patients of the risks and allowed for them to make the choice to

keep the jewelry in or not. The patients survey results were 98% positive stating they felt that the

waiver had good information to allow them to understand why it is important to remove jewelry.

The one occurrence that I did not plan for was the fact that the waiver itself caused patients to be

adamant about having their jewelry removed instead of signing the waiver, so in actuality, the

waiver was not necessarily used.

I plan to do one more cycle once the waiver goes live in the computer charting system at

the VA. Currently it has passed all approval to be done electronically. Now we are just waiting

for the template to go through onto the notes portion of the chart. I will do another survey after

the electronic waiver is implemented to see if the electronic note is more or just as effective as

the paper template we are currently using. I will also ask the Pre-op nurses how they feel about

the electronic copy of the waiver compared to the paper copy.

Conclusion

By doing this project I have learned how much work it takes to implement a change in

the VA system, I have also found out that several people had thought about implementing a

waiver but I was the only one who actually put the work into it to create a change. By having the

jewelry/piercing waiver it adequately informs the patient of the risks and alternatives, while

protecting the physician and the facility of an impending lawsuit. As of right now I do not see

any changes that need to be made for the paper to electric template for the jewelry/piercing

waiver only time and staff opinion will tell if things need to be added, removed or tweaked in

order to keep it effective. The waiver was accepted for use by the facility and staff, as a matter of

fact they are looking at making the template a form to be used nation-wide for VA use.
PLAN DO STUDY ACT (PDSA) SUMMARY REPORT 5

Overall I am very happy with the outcome of my project, it was a lot of hard work,

research and dedication and some heartache but in the end is has been very rewarding. I have

learned that change is accepted in a system that seems resistant to change as long as it makes

sense. The Pre-op nurses, OR nurses and physicians are happy with the jewelry/ piercing waiver

for the information and ease of use for them, patients are happy to be properly informed as to

why they need to remove their jewelry and piercings.

PLAN DO STUDY ACT (PDSA) SUMMARY REPORT 6

References

Delassie, J., Varada, S., Au, S., Pope, A., Manders, E., & Ramierez-Fort, M. K. (2014, January

10). Peri-Operative management of the patient with body piercings [Supplemental

Material for Magazine]. SciMedCentral. Retrieved from

https://www.jscimedcentral.com/Dermatology/dermatology-2-1009.pdf

Smith, F. D. (2016, June 2016). Caring for surgical patients with piercings [Supplemental

magazine material]. AORN Journal, 103(6), 583-596.

http://dx.doi.org/http://dx.doi.org/10.1016/j.aorn.2016.04.005