# Implementation of clinical practice guidelines using the Plan–Do–Study–Act framework: The methodology and experiences of the Academy of Nutrition and Dietetics Health Informatics Infrastructure Registry Study on gestational diabetes mellitus

## TL;DR

This study shows how using the Plan–Do–Study–Act framework helps dietitians apply clinical guidelines for gestational diabetes in real-world practice.

## Contribution

The study demonstrates how PDSA cycles can effectively translate clinical guidelines into practice for dietitians managing gestational diabetes.

## Key findings

- Six themes were identified, showing the value of assessing current practices and the flexibility of PDSA.
- The registry audit showed improved process measures and high normalization scores among dietitians and sites.
- PDSA facilitated practice changes and aligned with implementation theories like Normalization Process Theory.

## Abstract

Registered dietitian nutritionists (RDNs) use clinical practice guidelines (CPGs) to inform evidence‐based practice. Despite the availability of CPGs, guidelines are not always translated into practice. This challenge is central to implementation science (IS), which seeks to understand how evidence can be adopted and sustained.

The Gestational Diabetes Mellitus (GDM) Registry Study was a multiphase, multisite hybrid implementation study that explored guideline implementation using quality improvement (QI) methods grounded in the Model of Improvement and guided by Plan–Do–Study–Act (PDSA) cycles. Following a baseline period, RDNs completed training, conducted a gap analysis, and identified 2 CPG implementation aims. Sites completed iterative PDSA cycles. Deidentified nutrition care data were entered into the GDM Study Registry and manually audited to evaluate process outcomes. RDNs participated in a closing interview. Qualitative data were analyzed using a constructivist approach and reflexive thematic analysis, supported by artificial intelligence (AI)–assisted qualitative software.

Six themes were identified, highlighting the value of assessing current practices and the flexibility of PDSA as an implementation strategy. Themes were mapped against the Normalization Process Theory and Consolidated Framework for Implementation Research and showed alignment between PDSA and implementation principles. The registry audit demonstrated improved process measures. The median normalization score across RDNs (9.00) and sites (9.42) was high, suggesting normalization.

PDSA facilitated the work of normalization and enabled practice changes. This study contributes to IS by demonstrating how QI strategies, such as PDSA can help RDNs translate evidence into everyday nutrition care.