Plan-Do-Study-Act Cycles Research Articles

A Trainee-Led Quality Improvement Project Using Change Management Theory to Improve Bedside Rounding.

The coronavirus disease 2019 pandemic disrupted the practice of family-centered rounds. After the height of the pandemic, a trainee-led team identified a low percentage of bedside rounds on general pediatrics resident teams and combined a quality improvement framework and change management theory to increase bedside rounds. Initial efforts focused on a single general pediatrics team with the aim to increase bedside rounds from 18% to 50% within 6 months and sustain improvement for 12 months. A second aim was to increase bedside rounds from 7% to 50% for all general pediatrics resident teams within 6 months of spread. The Model for Improvement informed the identification of 3 primary drivers of bedside rounds: knowledge, culture, and logistics. Twelve plan-do-study-act (PDSA) cycles were implemented. Measures included the percentage of bedside rounds (primary outcome), caregiver attendance (secondary outcome), and nurse attendance and rounding time (balancing measures). For the initial team, 13 522 patient days were analyzed for the primary outcome with the average percentage of weekly bedside rounds increasing from 18% to 89% with 12 months of sustained improvement. The spread of the intervention to all teams revealed an increase in bedside rounding from 7% to 54%. The most significant improvements occurred after PDSA cycle 2, a communication bundle, and PDSA cycle 5, when the project was spread to all teams. This trainee-led initiative reveals the strength of the incorporation of change management theory within a quality improvement framework, resulting in rapid and sustainable increase in bedside rounds.

Immediate Skin to Skin Contact and Zero Separation of Mother Infant Dyads Among Healthy Term Infants Delivered Vaginally: A Quality Improvement Initiative in a Tertiary Care Institute in South India

Background The neonatal resuscitation program (NRP) recommends immediate skin-to-skin contact (SSC) of the neonate with the mother’s abdomen. Early establishment of SSC has increased the duration of breastfeeding and decreased neonatal morbidity significantly. Objective To achieve immediate SSC and zero separation of infant–mother dyads for a minimum of 30 min in vaginally born healthy term babies from 0% to 50% over 3 months by implementing a quality improvement (QI) initiative. Methods A QI initiative was undertaken at the maternity-newborn care unit of a tertiary-care hospital between March 2022 and December 2022. A team including neonatologists, obstetricians, pediatric postgraduates, and nurses (both neonatal and obstetric) in the concerned areas was identified. Using 5-why technique and fishbone analysis, the root cause analysis was done. Two plan-do-study-act (PDSA) cycles were undertaken. First, sensitization of healthcare personnel was done, and a written policy was made. Efforts were made to sustain the QI. Continuous surveillance, internal audits, and regular interprofessional team meetings were carried out. Results Prior to this QI, baseline data showed that no babies received SSC for 30 min. During the first PDSA cycle, 16.6% (4/24) of babies received SSC and zero separation for 30 min. During the II PDSA cycle, among 46 eligible neonates, 50% (23/46) received SSC >30 min. During the sustenance phase, among 262 eligible neonates, 75.2 % (197/262) received >30 min of SSC immediately after delivery. Conclusion Immediate SSC and zero separation for 30 min could be achieved by implementing simple measures through this QI initiative. The major hurdles, including the knowledge gap, fear, and safety of neonates, were tackled through simple strategies like education sessions, ergonomic modification, and sensitization of the healthcare team.

Improving Utilization of a Nursing-Initiated Supportive Medication Order Panel in the Inpatient Setting.

Many medications are low-risk but must undergo the same ordering process as high-risk medications in the inpatient setting. Nurses identify the need for supportive medications and notify providers. An order panel and policy were developed to allow nurses to order low-risk, supportive medications. The aim of this study was to increase order panel utilization from a 6% to a goal of 15%. This was a quality improvement study at a 1000-bed academic medical center. Five plan-do-study-act (PDSA) cycles were implemented. The primary end point was order panel utilization, and secondary end points were individual nursing unit utilization and the number of orders for each medication on the panel. After each PDSA cycle, order panel utilization improved to 7.8%, 13.2%, 7.5%, 10.2%, and 10.6%, respectively. The units using the order panel most often were general medicine (n = 95, 28%), medical intensive care (n = 71, 21%), and inpatient oncology (n = 40, 12%). The medication most frequently ordered was lanolin alcohols-mineral oil with petrolatum (Eucerin) cream (n = 220, 28%). Order panel utilization improved from a baseline of 6% to an average of 9.9%. Increasing awareness of the order panel and adding medications will contribute to improvement in order panel utilization in the long-term.

Identifying value in healthcare transformation initiatives: an evaluation of an approach to benefits realisation

Benefits realisation management (BRM) aims to facilitate the process of identifying, measuring and tracking desired benefits derived from a project. Improvement methodology frameworks often describe BRM as integral to identifying...

Sustaining extended Kangaroo mother care in stable low birthweight babies in NICU: a quality improvement collaborative of six centres of Karnataka

BackgroundKangaroo mother care (KMC) is a proven intervention for intact survival in preterms. Despite evidence, its adoption has been low. We used a point of care quality improvement (QI) approach...

A Quality Improvement Initiative to Increase Documentation of Preferences for Life-Sustaining Treatment in Hospitalized Adults

Portable Orders for Life-Sustaining Treatment (POLST) forms allow patients to codify their preferences for life-sustaining treatments across inpatient and outpatient settings. In 2019 only 29.5% of our hospitalized internal medicine patients with an inpatient do-not-resuscitate (DNR) order and no DNR POLST at admission discharged with a DNR POLST. This presented an opportunity to improve POLST completion and avoid undesired or inappropriate care after discharge. Using electronic health record (EHR) data, the authors identified hospitalized adults (age ≥ 50 years) admitted to an internal medicine service with a DNR order and discharged alive. Patient records were cross-referenced with the state's POLST registry for an active POLST form. Among patients with a missing or full-code POLST form at admission, the authors calculated the proportion with a DNR POLST form completed by discharge. These data were tracked over time with control charts to detect performance shifts following three Plan-Do-Study-Act (PDSA) cycles over 34 months, which included a single educational training on electronic POLST navigation, an EHR discharge navigator notification, and quarterly e-mailed individualized performance reports. The study population (N = 387) was 55.0% male and predominately non-Hispanic white (80.9%). Patients discharging to a skilled nursing facility or hospice were three times more likely to discharge with a DNR POLST compared to patients discharging home. Overall, the proportion of DNR POLST forms completed by discharge increased from 0.36 to 0.60 after three PDSA cycles (p < 0.001). This quality improvement initiative demonstrated improved POLST form completion rates in a target population of adults at elevated risk for readmission and death.

Medication supply at hospital discharge via community pharmacy: a quality improvement study.

Patient delays at the point of their discharge account for more than half a million additional bed days every year in Scotland, United Kingdom. Bottlenecks in discharge medication dispensing contribute to such delays. To test whether the discharge process could be made more time-efficient by utilising community pharmacy supply of medicines on the day of discharge, rather than hospital pharmacy supply. Glasgow Royal Infirmary, Scotland. Local community pharmacy staff received training and communication about each patient discharge. Pharmacies could access an immediate discharge letter (IDL) on a shared electronic record. The existing pandemic law allowed medication dispensing from this IDL, without a prescription. The programme was implemented from June to November 2020, across three Plan-Do-Study-Act (PDSA) cycles. Comparisons were made between the new community pharmacy model and standard hospital model. Across three PDSA cycles, in total 335 patients had community pharmacy supply compared to 376 patients eligible for hospital pharmacy supply. The median time taken from creation of the IDL to final completion was significantly lower in the new community pharmacy model compared to the hospital pharmacy model; 154min (interquartile range (IQR) 82-272min) vs 296min (IQR 197-1281min) p value < 0.000 CONCLUSION: A community pharmacy supply model compared to a standard hospital pharmacy model resulted in a median time saving of 142min per patient. Such a time saving has the potential to deliver a transformational change in patient flow and free up hospital pharmacy staff to deliver other clinical interventions.

Using a quality improvement tool, Plan-Do-Study-Act cycle, to boost TB notification in India post-Covid-19 pandemic

Quality improvement tools such as the Plan-Do-Study-Act (PDSA) cycle hold tremendous potential to improve the quality of healthcare in India. The electronic-PDSA tool was previously developed by CETI (Collaboration to Eliminate TB among Indians) and successfully piloted in small groups. In this study the e-PDSA was scaled up across the nation over a brief 10 week period to boost TB notification by training District Tuberculosis Officers (DTOs) virtually post-Covid-19 pandemic. Quality improvement counselors, who were interns from Masters in Public Health Institutions, were liaisons to “hand-hold” and assist the DTOs through the PDSA cycle. The course was voluntary and offered to all DTOs through Central TB Division and State TB Officers from May 2022 to July 2022. Of the 779 Districts in India and nearly equal number of DTOs, 546 (70%) DTOs enrolled in the course and of these 437 (80%) conducted a PDSA while 342 (43%) districts/DTOs did not enroll or did not complete a PDSA. With a baseline notification in February-March-April 2022 and intervention in May-June-July 2022; 55% of the districts in the PDSA group showed improvement in TB Notification compared to 45% in the non-PDSA group. When data was analyzed by population (not district) there was a trend in increase in notification post-pandemic in both PDSA and non-PDSA groups, and the PDSA group had a slightly higher 5.6 per 100,000 population improvement compared to 5.0 per 100,000 in the non-PDSA group. The cost of intervention was $40,000 or $92 per DTO for three months. The course was highly acceptable with DTOs rating 4.3 out of 5 in recommending the course to other DTOs. Our data shows that a large scale-up of the PDSA cycle is feasible, economical and effective with little additional resources. The focus was on increasing the efficiency of the existing processes well within the authority of the DTO. Repeat cycle of PDSA with notification and other measures such as presumptive sputum examination could significantly impact the program and help to achieve TB Free India.

A Quality Improvement Initiative to Increase the Milk Donation to the Human Milk Bank Post-Coronavirus Disease-19 Pandemic.

Background and Objective: Donor human milk (DHM) from the human milk bank (HMB) is the next best alterative in circumstances when mother's own milk is not available. There was a steep decline in the volume of DHM collected during the coronavirus disease-19 (COVID-19) pandemic due to various factors, while DHM demand increased. Hence, a quality improvement (QI) study was conducted to increase the volume of milk donation to HMB from postpandemic baseline of 300-400 to 1,000 mL/day over 8 weeks. Materials and Methods: Fish bone analysis was used to identify the potential barriers, and four Plan-Do-Study-Act (PDSA) cycles were conducted from January 2021 to March 2021 to address the key barriers. In the first PDSA cycle, training of health care providers was done. Sessions for educating mothers in the second PDSA cycle and individualized one-to-one counseling of mothers by a mother support group were done in the third PDSA cycle. The availability of breast pump was increased in the fourth PDSA cycle. Sustainability of the interventions was studied for 6 months and data were analyzed. Results: The average DHM collected per day at the end of each PDSA cycle was 900, 1,500, 1,000, and 1,100 mL. Although the sustenance phase was affected by the second COVID-19 wave, prompt identification of the issues and timely interventions prevented the donated volume from dropping to preintervention levels. Conclusion: QI initiatives customized for local settings can result in significant improvement in voluntary milk donation in HMB, which can result in more availability of DHM to premature babies.

Leveraging quality improvement to promote health equity: standardization of prenatal aspirin recommendations

ObjectiveAspirin (ASA) is recommended for patients at elevated risk of preeclampsia. Limited data exists on adherence to guidelines for ASA prescription. This project evaluates the implementation of a standardized approach to ASA prescription in an academic OB/Gyn practice.MethodsWe implemented a quality improvement project to evaluate compliance with the United States Preventative Services Task Force (USPSTF) recommendations for ASA to prevent preeclampsia. Pre-intervention, we analyzed prescription adherence at 201 New Obstetric (NOB) visits. A multi-step intervention was then implemented at 199 NOB visits. Nurses utilized a checklist created from USPSTF guidelines to identify high-risk patients, defined as having ≥1 high-risk factor or ≥2 moderate-risk factors. ASA orders were placed by physicians. A Plan-Do-Study-Act (PDSA) cycle was performed, and changes implemented. Primary outcome was percent of patients screened at RN intake visit (goal = 90%). Secondary outcomes were percent of patients who screened positive that received the ASA recommendation (goal = 80%) and percent screened and recommended by race.ResultsPre-intervention, 47% of patients met criteria for ASA and 28% received a documented recommendation. Post-intervention, 99% were screened. Half (48%) met criteria for an ASA recommendation and 79% received a recommendation (p = < 0.001). Rates of appropriate recommendation did not differ by Black (80%) vs. non-Black (79%) status (p = 0.25). Subsequent PDSA cycles for 12 months neared 100% RN screening rates. Physicians correctly recommended ASA 80–100% of the time.ConclusionIt is feasible, sustainable and equitable to standardize screening and implementation of ASA to patients at high risk for preeclampsia. Providers can easily reproduce our processes to improve delivery of equitable and reliable preventative obstetric care.

Improving management of hyponatraemia by increasing urine testing in the emergency department

Hyponatraemia on hospital admission is associated with increased length of stay, healthcare expenditures and mortality. Urine studies collected before fluid or diuretic administration are essential to diagnose the underlying cause...

Catalyzing Change for Equitable Participation

This manuscript discusses the Plan, Do, Study, Act (PDSA) cycles designed to help math teacher-researchers (TRs) create more equitable discourse patterns in their classrooms. Before the first cycle, TRs were asked to complete gender and race implicit assessment tests (IATs). Then, TRs planned and recorded a video of themselves facilitating a math discussion. Next, math teacher educators (MTEs) used the Equity QUantified In Participation (EQUIP) classroom observation instrument to code and analyze the discussion. Subsequently, TRs had an opportunity to reflect on the EQUIP and IAT results and set goals for making their teaching practices more equitable. MTEs provided guidance and resources to help the TRs develop a plan to achieve their equitable teaching goals. The implications for PK-12 practicing teachers from two PDSA cycles with three TRs are shared here. We hope this work will inspire and guide other TRs to implement similar PDSA cycles.

Access to Firearms: Initiation of Firearm Screening Amongst Psychiatric Patients in a Pediatric Emergency Department.

Increase provider screening rates for firearm access among patients presenting to the pediatric emergency department (PED) for a psychiatric chief complaint. In this resident-driven quality improvement (QI) project, a retrospective chart review examined firearm access screening rates among patients presenting to the PED with the chief complaint of "psychiatric evaluation." After establishing our baseline screening rate, the first phase of our Plan, Do, Study, Act (PDSA) cycle included implementing Be SMART education for pediatric residents. We made Be SMART handouts available in the PED, created electronic medical record (EMR) templates to facilitate documentation, and emailed routine reminders to residents during their PED block. In the second PDSA cycle, the pediatric emergency medicine (PEM) fellows expanded our efforts to increase project awareness from a supervisory role. The baseline screening rate was 14.7% (50/340). After PDSA 1, a center line shift occurred, and screening rates increased to 34.3% (297/867). After PDSA 2, screening rates increased to 35.7% (226/632). In the intervention phase, providers who received training screened 39.5% (238/603) of encounters versus providers who did not receive training screened 30.8% (276/896) of encounters. Of all encounters screened, 39.2% (205/523) screened positive for in-home firearms. We improved firearm access screening rates in the PED using provider education, EMR prompts, and PEM fellow participation. Opportunities remain to promote firearm access screening and secure storage counseling in the PED.

Quality Improvement Project to Improve Hand Hygiene Compliance in a Level III Neonatal Intensive Care Unit.

This quality improvement project aimed to improve hand hygiene (HH) compliance in a Level III Neonatal Intensive Care Unit. The project was conducted over three Plan-Do-Study-Act (PDSA) cycles, with each cycle lasting two months. The interventions included healthcare worker (HCW) education on HH, repetition of education, and immediate feedback to HCWs. Compliance data were collected through covert observations of HCWs in the NICU. The overall compliance rate increased from 31.56% at baseline to 46.64% after the third PDSA cycle. The HH compliance was noted to be relatively low after touching patient care surroundings, at entry and exit from the NICU main unit, before wearing gloves and after removing gloves, at baseline and throughout the three PDSA cycles. HCW education alone did not result in significant improvements, highlighting the need for additional interventions. The study underscores the importance of involving NICU leadership and providing immediate feedback to promote HH compliance. Further efforts should focus on addressing the false sense of security associated with glove usage among HCWs, individual rewards and involving the healthcare staff in the shared goal of increasing HH compliance. Consideration of workload metrics and their impact on compliance could steer future interventions.

958 A Study on Electronic Treatment Escalation Plan (TEP) Forms Completion and Compliance

Abstract Aim Establishing a Treatment Escalation Plan (TEP) allows doctors to discuss and record patient preferences in advance, in addition to cardiopulmonary resuscitation (DNA-CPR), but also for various aspects of emergency care and treatment.This study examines the overall rates of TEP form completion, as well as completion within 48 hours of the patient's hospitalization, as observed in routine practise at a DGH. Method This study was conducted utilising PDSA (Plan-Do-Study-Act) cycles and a cross-sectional methodology, auditing all adult in-patients admitted to the hospital for Orthopaedic surgery.The first cycle occurred in March 2022, followed by interventions in the form of an institutional algorithm, and the second cycle followed in November 2022. Results In the first cycle, 69.5% of patients had a completed TEP form, with 47.8% filling one within 48 hours of admission.It took an average of 4.4 days to complete, with 3.2 overrides. Following intervention and discussion in departmental meetings, 88.2% of tasks were completed, with 35.2% ended within 48 hours. Average days rose to 3.7 days, and overrides fell to 1.3 times. A questionnaire developed for the juniors to ask them about their reasons for noncompliance, and it was realised that the majority of them were concerned about the legal ramifications, correspondence with the patient and family, and a small percentage were due to a lack of time. Conclusions When juniors are fully informed of the technique to complete TEP forms, completion rates increase significantly. The process would be maintained under control by regular audits and training for rotating juniors.

1016 A Quality Improvement Project Addressing the Healthcare Dimension of Effectiveness in a Large Cardiothoracic Surgery Department by Ensuring the Contents of the Current Emergency Surgical Chest Drain Boxes Are Correctly Stocked Through Additional Rigorous Checks by June 2022, by Using the Model for Improvement Approach

Abstract Background Emergency chest drain insertion on cardiothoracic wards is frequent occurrence due to complications such as pneumothorax. The emergency insertion requires the immediate availability of a significant amount of sterile equipment. A box containing all the equipment on the ward was checked and restocked by the ward nursing staff, however, data suggested missing equipment was prevalent. This has implications for clinical effectiveness, timely intervention, and ultimately patient safety. Aim This project establishes the frequency of missing items and aims to reduce this frequency through more rigorous checks of the emergency chest drain box contents. Method Retrospective analysis of the box contents was performed over 3 months to establish baseline data. Thoracic surgery doctors completed a questionnaire, before and after the changes, about their experiences with the emergency chest drain boxes and missing items. A revised stock checklist was produced in collaboration with the project champion, the audit lead for thoracic surgery, and the procedural document team. The checklist introduction used transformational leadership. Subsequent completeness data was collected, in addition to a follow-up questionnaire. Results There was an 81% reduction in the 3-month average number of reported missing items following implementation; and a 92% increase in perceived confidence that the box will be correctly stocked. Conclusions An 81% reduction using two Plan Do Study Act (PDSA) cycles represents an improvement in effectiveness. There are plans to implement a single-use, pre-packed emergency chest drains insertion pack. The ongoing third PDSA cycle introduces the single-use pack, ongoing improvement will be demonstrated with repeat audits.

1038 Introducing a Patient-Initiated Follow Up (PIFU) Pathway to a District General Hospital’s Urology Department: A Two-Cycle Quality Improvement Project Following the First 100 Patients

Abstract Aim Outpatient appointments have almost doubled from 54 to 94 million in the last 10-years: 68% follow-up visits, costing £8 billion yearly. Patient-Initiated Follow Up (PIFU) enables patients to initiate follow up ‘as needed’ rather than attend routine follow-up. This project aims to introduce and improve a PIFU-pathway to reduce the 7% yearly increase in local follow-ups and improve patient satisfaction. Method Using Plan-Do-Study-Act (PDSA) quality improvement methodology, a PIFU-pathway for new patients under a single consultant was established in a district general hospital’s urology department. Patients in clinic were given a letter with contact number should they request review. Those within 4-to-12 months of PIFU were quantitatively evaluated through retrospective health record analysis. A further PDSA cycle sought to improve the service by acting on patient opinions collected via telephone. Results 100 patients were evaluated with an average 6-months on PIFU. Mean age 58 years, 41% were female. PIFU indications: lower urinary tract symptoms (57%), stones (12%), UTI (9%), other (22%). Only 2% utilised PIFU, 98% sought no further appointments, 97% reported preference of PIFU over routine follow-up and improved satisfaction. 43% were unaware how to utilise PIFU; 91% either forgot about PIFU or lost PIFU contact information. Subsequent interventions include development of introductory and reminder texts, an email address, and specific webpage. Conclusions The project suggests PIFU can reduce the number of unnecessary outpatient appointments in secondary care, whilst improving patient satisfaction and without compromising care across numerous chronic urological conditions. Clinicians can subsequently target active problems or waiting list control.

A Continuous Quality Improvement Framework for Sustainable Action and Advancement of Diversity, Equity, Inclusion, and Belonging in Physical Therapy.

To address racial and ethnic disparities, physical therapy organizations, educational institutions, and clinical practices seek to advance diversity, equity, inclusion (DEI), and social justice in health care. Although our professional organizations have crafted proclamations, resource lists, developed new accreditation standards, and strategic plans, we lack a unifying framework and action tools for substantial and sustained progress. In addition, the DEI acronym is missing the essential element of belonging (B), that is, sharing a sense of purpose and feeling safe to contribute opinions as a valued member of an organization. Therefore, the purpose of this position paper is to propose the utilization of a continuous quality-improvement (CQI) framework using Plan-Do-Study-Act (PDSA) cycles to advance DEI-B in physical therapy education and practice. The CQI framework and PDSA cycles are data-driven, iterative approaches for identifying areas for improvement, implementing interventions, collecting data, analyzing outcomes, and taking evidence-based next action steps. Application of this framework can enhance sustainability of DEI-B goals and foster progress toward the proposed accreditation criteria of the Commission on Accreditation in Physical Therapy Education in this critical area. Tenants for PDSA team success are presented, and PDSA cycles are described. Addressing racism and advancing DEI-B efforts in the physical therapy profession requires bold, sustained, and intentional action that incorporates standards, strategies, and methods for measuring change. Examples of PDSA DEI-B initiatives, interventions, and outcomes are provided to illustrate how this approach can be implemented within a physical therapy education program. Using this CQI framework provides our profession with a DEI-B roadmap for advancing incremental and sustained progress.

WTP6.7 Implementation of a Trust-wide electronic operation note proforma – a quality improvement project

Abstract Aims The operation note is an important document that records intra-operative details and provides post-operative instructions. It ensures continuity of care and may be used for medicolegal purposes. In our Trust, there is a move towards electronic operation notes in line with the digitisation of patient records. Here we report initial data from our multi-staged implementation of a Trust-wide electronic operation note proforma. Method The Plan/Do/Study/Act (PDSA) method was used. Regular key stakeholder meetings were held involving the Information Technology (IT) department and various surgical teams. The Royal College of Surgeons’ Good Surgical Practice (GSP) provided minimum standards for operation notes. Forms4Health was used as the platform for electronic operation notes. In PDSA cycle 1, a retrospective audit was performed involving 50 randomly selected handwritten or typed operation notes. The operation notes were audited by two independent reviewers against GSP standards. Handwritten operation notes were also assessed for legibility. Results A total of 29 handwritten and 21 typed operation notes were analysed. Among the handwritten operation notes, 15 (52%) were legible. Handwritten notes demonstrated 68% compliance with GSP standards, as compared to 79% for typed notes (p &amp;lt;0.05). Typed notes were superior at recording time of surgery (p &amp;lt;0.01), whether it was elective or emergency (p &amp;lt;0.01), complications encountered (p &amp;lt;0.05) and thromboprophylaxis instructions (p &amp;lt;0.01). Conclusions Our data indicate a significant improvement in GSP compliance via electronic notes. As next steps, we will integrate the proforma into existing Trust IT platforms and include additional features to increase user efficiency and re-audit service improvement.

A Quality Improvement Study to Improve Oxygen Prescription in the PICU of a Tertiary Care Centre in Delhi, India.

Introduction Oxygen has been gravely misused since its inception as a therapeutic agent. There is a deficit of audits and baseline data for the Indianpopulation, especially in the pediatric age group, which doesn't allow for standardization of protocols and guidelines. Objective Our study aimed at increasing valid prescription rates to 90% by implementation of quality improvement interventions, and assessing knowledge and perception of healthcare workers towards oxygen therapy. Methodology It followed a before-and-after prospective observational study model where baseline audit data was compared with data observed after the implementation of quality improvement strategies. The data was collected through an audit of the medical records of all pediatric patients receiving oxygen therapy in the PICU. Knowledge and perception of healthcare workers about oxygen therapy were assessed via a self-designed questionnaire. The study was undertaken in three phases, including Quality Improvement (QI) team formation and data collection, root cause analysis, and implementation of Plan-Do-Study-Act (PDSA) cycles. Observations and results In the baseline audit, 1.4% of the prescriptions were complete and valid. Subsequently, over the course of four PDSA cycles, valid prescription rates increased; 62.07% in the first, 79.51% in the second, 81.81% in the third, and 91.42% in the fourth cycle respectively. After applying the chi-square test to compare PDSA4 and baseline data, the p-values for written prescriptions and target saturation were found to be statistically significant. In the healthcare worker survey, we found that 100% of them were aware of indications of oxygen prescription, FiO2, and side effects of excessive usage of oxygen therapy, 95% were aware of conditions affecting pulse-oximetry in the pediatric age group, and 75% knew about target saturation and its significance and the procedure to change alarm settings on the monitor. Conclusion Currently, there exists a lack of effective oxygen prescription audits, especially in India, which can be attributed to a lack of awareness and partly, a lack of initiative. Quality improvement initiatives are effective in improving the valid oxygen prescription rate. However, sustained goals can be achieved through regular audits only.