Process
Once ‘buy in’ was established in clinical teams, small tests of
change using PDSA cycle tools were carried out, initially
within one ward, to design, test and modify the UUC care
plan (Box 1). This methodology was chosen because, as it
tests a planned change in a ‘live’ setting and considers its
strengths and weaknesses before adapting it for further testing,
it enhances the chances of successful application at the larger
scale (Langley et al, 2009).
Testing and implementation of the UUC care plan was
carried out using the same methodology ward by ward
within the pilot site over a 10-week period. Testing was
extensive with many changes and adaptations made ward by
ward. As the process spread from ward to ward, fewer issues
were being highlighted, despite local variation in clinical
specialties. Once all areas within the pilot hospital had tested
the tool and achieved a good level of compliance, agreement
was made on the final care plan.This was version 9 of the care
plan and included insertion and maintenance of UUCs on a
one page document (see key elements in Table 1).