Examples of Plans and Charts – Flu Vaccination

Sample PDSA forms

Example 1

The following example illustrates how the Plan-Do-Study-Act (PDSA) form can be filled per the specific goal to increase flu vaccination rates:

Quality improvement (QI) questionInput by QI team member
What is your goal (or planned change)?Increase flu vaccination rates in patients with diabetes by 20% from the previous year.
What is the timeline for implementing the PDSA?January to March
Who is going to implement the change (eg, physician A, nurse B, medical assistant C) and what exactly will each individual do?Dr. Jones and her nurse Ms. Smith will implement the project. Ms. Smith will identify patients with diabetes by reviewing their chart, and will then ask the patient if they had a flu shot this season. If the answer is no, Ms. Smith will note that Dr. Jones has recommended that they get the vaccine today and that Ms. Smith will be giving it after preparing the patient for the physician visit. If the patient expresses concern, Ms. Smith will alert Dr. Jones who will ask the patient their reasons and discuss the importance of the flu vaccine, especially in patients with diabetes. Ms. Smith will provide patient educational materials for those who refuse the vaccine.
Which patients will be involved (eg, all patients seen by Dr. A over the course of the PDSA)?All patients with diabetes with scheduled visits during the months of January to March.
How will you measure the change?Ms. Smith will have a report run weekly for flu vaccination rates among patients with diabetes.
How will you report information about the PDSA to the team (eg, weekly morning meeting; posting a Run Chart in the staff room)? To the whole practice (eg, hosting a lunch to present the plan to the practice staff)?Dr. Jones and Ms. Smith will review the data each week, construct a Run Chart, and consider the reasons for the results. They will communicate their results at the weekly staff meetings.

Example 2

The following example illustrates how a PDSA form can be filled per a specific goal to increase flu vaccination documentation:

QI stepPlan
Goal (or planned change)
  • Increase flu vaccination documentation to 90% in medical records of seen patients
  • First 3 weeks of the month, with weekly read-outs
  • Medical assistants (MAs) who typically record information in the medical record (in a large practice, this may begin in the first cycle with 2 or 3 MAs working with one clinician)
  • Champion will manage program, do training, and collect data
  • MA training over lunch with distribution of form highlighting process
  • Weekly and overall data collection addressed by MA
  • Presentation of Run Chart data on a weekly basis
Patients considered
  • All patients seen during the time period considered (ie, first 3 weeks of the month)
  • Champion reviews chart to assess whether entry for flu vaccine was received or declined
Presentation of final results
  • Meeting of participating MAs to review and discuss results
    • Invite feedback on the process and reasons for results
    • Recognize participation efforts with lunch or coffee break—and give special acknowledgment to individuals who are motivated in these activities, as they can be considered as future flu vaccination Champions

Tracking Change: The Run Chart

The following is an example of a Run Chart from a DRIVE participant, with flu vaccination rates charted by month. As this was a small clinic, their efforts to increase the use of a strong recommendation by all clinic staff was derived from Electronic Health Records (EHR) data from the larger system’s IT department.

Download DRIVE Run Chart

Download Run Chart Template

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