I let the quilt hang on my design wall until I'm comfortable with what I want to do. Usually though I will end up adding some more quilting along the way as I actually quilt it. I use parchment paper (like you use in baking) if I want to draw a pattern and quilt through it. The parchment paper tears away easily but isn't as fragile as tissue paper so you can wrestle the quilt around the machine more.