{"id":14903,"date":"2020-11-24T09:10:34","date_gmt":"2020-11-24T09:10:34","guid":{"rendered":"http:\/\/onlineclassesguru.com\/index.php\/2020\/11\/24\/nursing-root-cause-analysis\/"},"modified":"2020-11-24T09:10:34","modified_gmt":"2020-11-24T09:10:34","slug":"nursing-root-cause-analysis","status":"publish","type":"post","link":"https:\/\/onlineclassesguru.com\/index.php\/2020\/11\/24\/nursing-root-cause-analysis\/","title":{"rendered":"Nursing Root Cause Analysis"},"content":{"rendered":"<style type=\"text\/css\"><\/style><p>Nursing Root Cause Analysis<br \/>\nFollow Task instructions: please review enclosed scenario and have detailed explanations for topics (A- C4) . Joint Commission is a useful website. Reference and title page must be included, however an Abstract isn\u2019t necessary. Paper must be a minimum of 10 double spaced pages, not including reference. 4 pages total<br \/>\nFree Online OCR<br \/>\nHome<br \/>\nOCR API<br \/>\nContact us<br \/>\nFree Online OCR Convert JPEG, PNG, GIF, BMP, TIFF, PDF, DjVu to Text<br \/>\nSelect pages from 1 to 4<br \/>\nRecognition language(s) (you can select multiple)<br \/>\nRotate image 0\u00b0 CCW 90\u00b0 180\u00b0 CW 90\u00b0<br \/>\nPage layout analysis \u2013 split multi-column text into columns<br \/>\nPage<br \/>\nof 4<br \/>\nDownload<br \/>\nCopy to Clipboard<br \/>\nGoogle Translate<br \/>\nBing Translator<br \/>\nPaste Online<br \/>\nEdit Online<br \/>\n7 ask # .9-<br \/>\nCompetencies: 734.3.1: Principles of Leadership \u2013 The graduate applies<br \/>\nprinciples of leadership to promote high-quality healthcare in a variety of settings<br \/>\nthrough the application of sound leadership principles.<br \/>\n734.3.2: Interdisciplinary Collaboration \u2013 The graduate applies theoretical<br \/>\nprinciples necessary for effective participation in an interdisciplinary team.<br \/>\n734.3.3: Quality and Patient Safety \u2013 The graduate applies quality improvement<br \/>\nprocesses intended to achieve optimal healthcare outcomes, contributing to and<br \/>\nsupporting a culture of safety.<br \/>\n734.3.4: Healthcare Utilization and Finance \u2013 The graduate analyzes financial<br \/>\nimplications related to healthcare delivery, reimbursement, access, and national<br \/>\ninitiatives<br \/>\nIntroduction:<br \/>\nHealthcare organizations accredited by the Joint Commission are<br \/>\nrequired to conduct a root cause analysis (RCA) in response to any<br \/>\nsentinel event such as the one described below. Once the cause is<br \/>\nidentified and a plan of action established, it is useful to conduct a<br \/>\nfailure mode and effects analysis (FMEA) to reduce the likelihood that<br \/>\na process would fail. As a member of the healthcare team in the<br \/>\nhospital described in this scenario, you have been selected as a<br \/>\nmember of the team investigating the incident.<br \/>\nScenario:<br \/>\nScenario:<br \/>\nIt is 3:30 pm. on a Thursday and Mr. B, a 67-year-old patient, arrives at the six-<br \/>\nroom emergency department (ED) of a sixty-bed rural hospital. He has been brought<br \/>\nto the hospital by his son and neighbor. At this time, Mr. B is moaning and<br \/>\ncomplaining of severe pain to his (L) leg and hip area. He states he lost his balance<br \/>\nand fell after tripping over his dog.<br \/>\nMr. B was admitted to the triage room where his vital signs were B\/P 120\/80, HR-88<br \/>\n(regular), T-98.6, R-32, and his weight was recorded at 175 pounds. Mr. B. states<br \/>\nthat he has no known allergies and no previous falls. He states, \u201cMy hip area and leg<br \/>\nhurt really bad. I have never had anything like this before.\u201d Patient rates pain at ten<br \/>\nout of ten on the numerical verbal pain scale. He appears to be in moderate distress.<br \/>\nHis (L) leg appears shortened with swelling (edema in the calf), ecchymosis, and<br \/>\nlimited range of motion (ROM). Mr. B\u2019s leg is stabilized and then he is further<br \/>\nevaluated and discharged from triage to the emergency department (ED) patient<br \/>\nroom. He is admitted by Nurse J. The admitting nurse finds that Mr. B has a history<br \/>\nof impaired glucose tolerance and prostate cancer. At Mr. B\u2019s last visit with his<br \/>\nprimary care physician, laboratory data revealed elevated cholesterol and lipids. Mr.<br \/>\nB\u2019s current medications are atorvastatin and oxycodone for chronic back pain. After<br \/>\nthe nurse completes Mr. B\u2019s assessment, Nurse J informs the ED physician of<br \/>\nadmission findings and the ED physician proceeds to examine Mr. B.<br \/>\nStaffing on this day consists of two nurses (one RN and one LPN), one secretary, and<br \/>\nDownload<br \/>\nGoogle Translate<br \/>\nBing Translator<br \/>\nEdit Online<br \/>\nTUK#<br \/>\n2-<br \/>\nCompetencies: 734,3.7: Principles of Leadership \u2013 The graduate applies<br \/>\nprinciples of leadership to promote high-quality healthcare in a variety of settings<br \/>\nthrough the application of sound leadership principles,<br \/>\n734.3.2: Interdisciplinary Collaboration \u2013 The graduate applies theoretical<br \/>\nprinciples necessary for effective participation in an interdisciplinary team.<br \/>\n734.3,3: Quality and Patient Safety \u2013 The graduate applies quality improvement<br \/>\nprocesses intended to achieve optimal healthcare outcomes, contributing to and<br \/>\nsupporting a culture of safety.<br \/>\n734.3.4: Healthcare Utilization and Finance \u2013 The graduate analyzes financial<br \/>\nimplications related to healthcare delivery, reimbursement, access, and national<br \/>\ninitiatives<br \/>\nIntroduction:<br \/>\nHealthcare organizations accredited by the Joint Commission are<br \/>\nrequired to conduct a root cause analysis (RCA) in response to any<br \/>\nsentinel event such as the one described below, Once the cause is<br \/>\nidentified and a plan of action established, it is useful to conduct a<br \/>\nfailure mode and effects analysis (FMEA) to reduce the likelihood that<br \/>\na process would fail. As a member of the healthcare team in the<br \/>\nhospital described in this scenario, you have been selected as a<br \/>\nmember of the team investigating the incident.<br \/>\nScenario:<br \/>\nScenario:<br \/>\n-+<br \/>\nIt is 3:30 p.m. on a Thursday and Mr. B, a 67-year-old patient, arrives at the sixroom emergency department (ED) of a sixty-bed rural hospital. He has been brought<br \/>\nto the hospital by his son and neighbor. At this time, Mr. B is moaning and<br \/>\ncomplaining of severe pain to his (L) leg and hip area. He states he lost his balance<br \/>\nand fell after tripping over his dog.<br \/>\nMr. B was admitted to the triage room where his vital signs were BlP tz1l91, HR-88<br \/>\n(regular), T-98.6, R-32, and his weight was recorded at 175 pounds. Mr. B. states<br \/>\nthat he has no known allergies and no previous falls. He states, \u201cMy hip area and leg<br \/>\nhurt really bad, I have never had anything like this before.\u201d Patient rates pain at ten<br \/>\nout of ten on the numerical verbal pain scale. He appears to be in moderate distress.<br \/>\nHis (L) leg appears shortened with swelling (edema in the calf), ecchymosis, and<br \/>\nlimited range of motion (ROM). Mr. B\u2019s leg is stabilized and then he is further<br \/>\nevaluated and discharged from triage to the emergency department (ED) patient<br \/>\nroom. He is admitted by Nurse l. The admitting nurse finds that Mr, B has a history<br \/>\nof impaired glucose tolerance and prostate cancer. At Mr. B\u2019s last visit with his<br \/>\nprimary care physician, laboratory data revealed elevated cholesterol and lipids. Mr.<br \/>\nB\u2019s current medications are atorvastatin and oxycodone for chronic back pain. After<br \/>\nthe nurse completes Mr. B\u2019s assessment, Nurse J informs the ED physician of<br \/>\nadmission findings and the ED physician proceeds to examine Mr. B.<br \/>\nStaffing on this day consists of two nurses (one RN and one LPN), one secretary, and<br \/>\n,:,-<br \/>\nI<br \/>\nI<br \/>\n\u2018<br \/>\n,\u2019\/,<br \/>\ni<br \/>\none emergency department physician. Respiratory therapy is in-house and available<br \/>\nas needed. At the time of Mr. B\u2019s arrival, the ED staff is caring for two other patients.<br \/>\nOne patient is a 43-year-old female complaining of a throbbing headache. The<br \/>\npatlent rates current pain at four out of ten on numerical verbal pain scale. The<br \/>\npatient states that she has a history of migraines. She received treatment, remains<br \/>\nstable, and discharge is pending. The second patient is an eight-year-old boy being<br \/>\nevaluated for possible appendicitis. Laboratory results are pending for this patient.<br \/>\nBoth of these patients were examined, evaluated, and cared for by the ED physician<br \/>\nand are awaiting further treatment or orders.<br \/>\nAfter evaluation of Mr. B, Dr. T, the ED physician, writes the order for Nurse J to<br \/>\nadminister diazepam 5 mg IVP to Mr. B. The medication diazepam is administered<br \/>\nIVP at 4:05 p.m. After five minutes, the diazepam appears to have had no effect on<br \/>\nMr. B, and Dr. T instructs Nurse J to administer hydromorphone 2 mg IVP. The<br \/>\nmedication (hydromorphone) is administered IVP at 4:15 p,m. After five minutes, Dr.<br \/>\nT is still not satisfied with the level of sedation Mr. B has achieved and instructs<br \/>\nNurse J to administer another 2 mg of hydromorphone IVP and an additional 5 mg of<br \/>\ndiazepam IVP. The physician\u2019s goal is for the patient to achieve skeletal muscle<br \/>\nrelaxation from the diazepam, which will aid in the manual manipulation, relocation,<br \/>\nand alignment of Mr. B\u2019s hip. The hydromorphone IVP was administered to achieve<br \/>\npain control and sedation. After reviewing the patient\u2019s medical history, Dr. T notes<br \/>\nthat the patient\u2019s weight and current regular use of oxycodone appear to be making<br \/>\nit more difficult to sedate Mr. B.<br \/>\nFinally at4:25, the patient appears to be sedated and the successful reduction of his<br \/>\n(L) hip takes place. The patient appears to have tolerated the procedure and remains<br \/>\nsedated. He is not currently on any supplemental oxygen. The procedure concludes<br \/>\nat4:30 p.m. and Mr. B is resting without indications of discomfort and distress. At<br \/>\nthis time, the ED receives an emergency dispatch call alerting the emergency<br \/>\ndepartment that the emergency rescue unit paramedics are en route with a 75-yearold patient in acute respiratory distress. Nurse J places Mr. B on an automatic blood<br \/>\npressure machine programmed to monitor his B\/P every five minutes and a pulse<br \/>\noximeter. At this time Nurse J leaves his room. The nurse allows Mr. B\u2019s son to sit<br \/>\nwith him as he is being monitored via the blood pressure monitor. At 4:35, Mr. B\u2019s<br \/>\nB\/P is LLO\/62 and his 02 sat is92o\/o. He remains without supplemental oxygen and<br \/>\nhis ECG and respirations are not monitored,<br \/>\nNurse I and the LPN on duty have received the emergency transport patient. They<br \/>\nare also in the process of discharging the other two patients. Meanwhile, the ED<br \/>\nlobby has become congested with new incoming patients. At this time, Mr. B\u2019s 02<br \/>\nsaturation alarm is heard and shows \u201clow 02 saturation\u201d (currently showing a sat of<br \/>\n85o\/o). The LPN enters Mr. B\u2019s room briefly and resets the alarm and repeats the B\/P<br \/>\nreading.<br \/>\nNurse J is now fully engaged with the emergency care of the respiratory distress<br \/>\npatient, which includes assessments, evaluation, and the ordering respiratory<br \/>\ntreatments, CXR, labs, etc.<br \/>\nAt 4:43, Mr. B\u2019s son comes out of the room and informs the nurse that the \u201cmonitor<br \/>\nis alarming.\u201d When Nurse J enters the room, the blood pressure machine shows Mr.<br \/>\nB\u2019s B\/P reading is 58\/30 and the 02 sat is 79o\/o. The patient is not breathing and no<br \/>\npalpable pulse can be detected.<br \/>\nc:<br \/>\n\u2018.,1<br \/>\nff,<br \/>\nA STAT CODE is called and the son is escorted to the waiting room. The code team<br \/>\narrives and begins resuscitative efforts. When connected to the cardiac monitor, Mr.<br \/>\nB is found to be in ventricular fibrillation. CPR begins immediately by the RN, and Mr.<br \/>\nB is intubated, He is defibrillated and reversal agents, IV fluids, and vasopressors are<br \/>\nadministered. After 30 minutes of interventions, the ECG returns to a normal sinus<br \/>\nrhythm with a pulse and a B\/P of LLO\/7O. The patient is not breathing on his own<br \/>\nand is fully dependent on the ventilator. The patient\u2019s pupils are fixed and dilated. He<br \/>\nhas no spontaneous movements and does not respond to noxious stimuli. Air<br \/>\ntransport is called and, upon the family\u2019s wishes, the patient is transferred to a<br \/>\ntertiary facility for advanced care,<br \/>\nSeven days later, the receiving hospital informed the rural hospital that EEG\u2019s had<br \/>\ndetermined brain death in Mr. B. The family had requested life-support be removed,<br \/>\nand Mr. B subsequently died.<br \/>\nAdditional information: The hospital where Mr. B. was originally seen and treated had<br \/>\na moderate sedation\/analgesia (\u201cconscious sedation\u201d) policy that requires that the<br \/>\npatient remains on continuous B\/P, ECG, and pulse oximeter throughout the<br \/>\nprocedure and until the patient meets specific discharge criteria (i.e., fully awake,<br \/>\nVSS, no N\/V, and able to void), All practitioners who perform moderate sedation<br \/>\nmust first successfully complete the hospital\u2019s moderate sedation training module.<br \/>\nThe training module includes drug selection as well as acceptable dose ranges.<br \/>\nAdditional (backup) staff was available on the day of the incident. Nurse J had<br \/>\ncompleted the moderate sedation module. Nurse J had current ACLS certification and<br \/>\nwas an experienced critical care nurse. Nurse J\u2019s prior annual clinical evaluations by<br \/>\nthe manager demonstrated that the nurse was \u201cmeeting requirements.\u201d Nurse J did<br \/>\nnot have a history of negligent patient care. Sufficient equipment was available and<br \/>\nin working order in the ED on this day.<br \/>\nTask:<br \/>\na root cause analysis (RCA) that takes into consideration causative<br \/>\nfactors, errors, and\/or hazards that led to the sentinel event (this patient\u2019s<br \/>\noutcome).<br \/>\nA. Complete<br \/>\nB.<br \/>\nDiscuss a process improvement plan that would decrease the likelihood of a<br \/>\nreoccurrence of the outcome of the scenario.<br \/>\n1. Discuss a change theory that could be used to implement the process<br \/>\nimprovement plan developed in B.<br \/>\nfailure mode and effects analysis (FMEA) to project the likelihood that<br \/>\nthe process improvement plan you suggest would not fail.<br \/>\n1. Identify the members of the interdisciplinary team who will be included in<br \/>\nthe FMEA,<br \/>\n2. Discuss steps for preparing for the FMEA.<br \/>\n3. Apply the three steps of the FMEA (severity, occurrence, and detection) to<br \/>\nthe process improvement plan created in part B,<br \/>\n4. Explain how you would test the interventions from the process<br \/>\nimprovement plan from part B to improve care in a similar situation.<br \/>\nC. Use a<br \/>\nNote:You are not expected to carry out the full FMEA, but you should<br \/>\nexplain each step, and how you would apply it to your process<br \/>\nimprovement plan,<br \/>\nD.<br \/>\nDiscuss how the professional nurse may function as a leader in promoting<br \/>\nquality care and influencing quality improvement activities.<br \/>\nE. When you use sources to support ideas and elements in a paper or project,<br \/>\nprovide acknowledgement of source information for any content that is<br \/>\nquoted, paraphrased or summarized. Acknowledgement of source information<br \/>\nincludes in-text citation noting specifically where in the submission the source<br \/>\nis used and a corresponding reference, which includes:<br \/>\no Author<br \/>\no<br \/>\nr<br \/>\nr<br \/>\nDate<br \/>\nTitle<br \/>\nLocation of information (e.9., publisher, iournal, or website URL)<br \/>\nNote: The use of APA citation style is encouraged but is not required for this task.<br \/>\nEvaluators will offer feedback on the acknowledgement of source information but not<br \/>\nwith regard to conformity with APA or other citation style. For tips on using APA<br \/>\nstyle, please refer to the APA Resources web link found under General<br \/>\nInformation\/APA Guidelines in the left-hand panel in TaskStream,<br \/>\nNote; No more than a combined total of 3oo\/o of a submission can be directly quoted<br \/>\nor closely paraphrased from outside sources, even if cited correctly.<br \/>\np Evatuation<br \/>\nMethod<\/p>\n<p><center><a href=\"http:\/\/onlineclassesguru.com\/orders\/ordernow\"><img decoding=\"async\" src=\"https:\/\/encrypted-tbn0.gstatic.com\/images?q=tbn:ANd9GcTyj99p60XCLyLk1htB7-1neRt8-2QdnenNlQ&usqp=CAU\"target=\"_http:\/\/onlineclassesguru.com\/orders\/ordernow\"\/><\/center><p>","protected":false},"excerpt":{"rendered":"<p>Nursing Root Cause Analysis Follow Task instructions: please review enclosed scenario and have detailed explanations for topics (A- C4) . Joint Commission is a useful website. Reference and title page must be included, however an Abstract isn\u2019t necessary. Paper must be a minimum of 10 double spaced pages, not including reference. 4 pages total Free&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[],"tags":[],"class_list":["post-14903","post","type-post","status-publish","format-standard","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v17.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Nursing Root Cause Analysis - onlineclassesguru<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"http:\/\/onlineclassesguru.com\/index.php\/2020\/11\/24\/nursing-root-cause-analysis\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Nursing Root Cause Analysis - onlineclassesguru\" \/>\n<meta property=\"og:description\" content=\"Nursing Root Cause Analysis Follow Task instructions: please review enclosed scenario and have detailed explanations for topics (A- C4) . 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Joint Commission is a useful website. Reference and title page must be included, however an Abstract isn\u2019t necessary. 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