RCA and FMEAIntroduction:Healthcare organizations accredited by the Joint Commission are required to conduct a root cause analysis (RCA) in response to any sentinel event, such as the one described in

RCA and FMEA

Introduction:

Healthcare organizations accredited by the Joint Commission are required to conduct a root cause analysis (RCA) in response to any sentinel event, such as the one described in the scenario attached below. Once the cause is identified and a plan of action established, it is useful to conduct a failure mode and effects analysis (FMEA) to reduce the likelihood that a process would fail. As a member of the healthcare team in the hospital described in this scenario, you have been selected as a member of the team investigating the incident.

Scenario:

You can find the scenario attached below in the attachment section.

Requirements:

Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. Use the Turnitin Originality Report available in Taskstream as a guide for this measure of originality.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

A.  Explain the general purpose of conducting a root cause analysis (RCA).

1.  Explain each of the six steps used to conduct an RCA, as defined by IHI.

2.  Apply the RCA process to the scenario to describe the causative and contributing factors that led to the sentinel event outcome. 

B.  Propose a process improvement plan that would decrease the likelihood of a reoccurrence of the scenario outcome.

1.  Discuss how each phase of Lewin’s change theory on the human side of change could be applied to the proposed improvement plan. 

C.  Explain the general purpose of the failure mode and effects analysis (FMEA) process.

1.  Describe the steps of the FMEA process as defined by IHI.

2.  Complete the attached FMEA table by appropriately applying the scales of severity, occurrence, and detection to the process improvement plan proposed in part B. 

Note: You are not expected to carry out the full FMEA. 

D.  Explain how you would test the interventions from the process improvement plan from part B to improve care. 

E.  Explain how a professional nurse can competently demonstrate leadership in each of the following areas:

•  promoting quality care

•  improving patient outcomes

•  influencing quality improvement activities

1.  Discuss how the involvement of the professional nurse in the RCA and FMEA processes demonstrates leadership qualities. 

F.  Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized. 

G.  Demonstrate professional communication in the content and presentation of your submission.  Please also check documents attached

t is anticipated that the initial discussion response should be in the range of 250-300 words. Response posts must demonstrate topic knowledge and scholarly engagement with peers. This is not the only

t is anticipated that the initial discussion response should be in the range of 250-300 words. Response posts must demonstrate topic knowledge and scholarly engagement with peers. This is not the only criteria utilized for evaluation; substantive content is imperative. All questions in the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments. All responses need to be supported by a minimum of one scholarly resource. Journals and websites must be cited appropriately. Citation and reference must adhere to APA format (6th Ed.).

Classroom Participation

Students are expected to initially address the discussion question by Wednesday of each week. Participation in the discussion forums is expected with a minimum total of three (3) substantive postings (this includes your initial posting and posting to two peers) on three (3) different days per week. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.

All discussion boards will be evaluated utilizing rubric criterion inclusive of content, analysis, collaboration, writing and APA. If you fail to post an initial discussion you will not receive these points, you may however post to your peers for partial credit following the guidelines above. Due to the nature of this type of assignment and the need for timely responses for initial posts and posting to peers, the Make-Up Coursework Policy (effective July 2017) does not apply to Discussion Board Participation.

Discussion Prompt [Due Wednesday]

Select ONE of the questions listed below and provide a substantive posting by Wednesday. Please include the question number you selected in the title of your post (e.g. Question 1 Contraceptives). Respond to a classmate who initially posted to the opposite question. 

1. What are the clinical criteria for selection of contraceptives, including emergency contraception? What resources would you utilize in your decision-making? Include the domains of the gynecologic and obstetric history in your response. Identify two evidence-based interventions which increase compliance and successful utilization of contraceptives?
2. What are the clinical, ethical, social, and economic consequences of unintended pregnancy? Why is it important for advance practice nurses to remain cognizant of this information? 

No Plagiarism please: Assignment—Case Study for Chronic ConditionFor this Assignment, you are answer the questions regarding this case study. Please make sure to support your answers using evidence

No Plagiarism please: 

Assignment—Case Study for Chronic Condition

For this Assignment, you are answer the questions regarding this case study. Please make sure to support your answers using evidence based practice.

Case Study: 

56 y/o Caucasian male presents to the primary care clinic with complains of dizziness and nausea x 4 days. The patient reports he has not been able to get out of bed since the symptoms started. The patient reports symptoms are worse when he tries to get out of bed to stand. He denies any headaches or blurry vision. He states he is urinating more over the last few days and he has noticed increase in thirst. He reports he just drank a large sweet tea before he came into the clinic.

The patient reports that he is out of his Lantus and metformin because he cannot afford the refill until he gets his disability check. He is disabled after his second CVA that left his with generalized weakness. His medical history includes DM, HTN, CAD.

Upon arrival at the clinic, the patient’s vital signs are as follows- Blood sugar 405, B/P 190/101, HR 102, R-20, T- 98.5.

Using Evidence Based practice, answer the following questions thoroughly. Be sure to use APA formatting.

Use headings while answering questions below:

1. What is the pertinent positive and negative findings in this patient assessment?
2. Create a list of differentials with rationales for this patient?
3. Discuss a medication regimen for this patient considering his financial status?
4. What is the priority concern for this patient?
5. How does this patient’s comorbid diagnosis impact his current symptoms?
6. Discuss how the patient’s’ health beliefs, culture and behaviors impact the potential outcomes for the patient.

Pharmacotherapy for Hematologic DisordersIn the 1970s, the average lifespan for patients diagnosed with sickle cell disease was 14 years. Today, the average lifespan has increased to 50 years and beyo

Pharmacotherapy for Hematologic Disorders

In the 1970s, the average lifespan for patients diagnosed with sickle cell disease was 14 years. Today, the average lifespan has increased to 50 years and beyond (TriHealth, 2012). The patient prognosis for many other hematologic disorders such as hemophilia and cancer continue to improve as well. This can be attributed to advancements in medical care—specifically drug therapy and treatment. When managing drug therapies for patients, it is essential to continuously examine current treatments and evaluate the impact of patient factors on drug effectiveness. To prepare for your role as an advanced practice nurse, you must become familiar with common drug treatments for various hematologic disorders seen in clinical settings.

To prepare:

· Select one of the following hematologic disorders: anemia, hemophilia, cancer, sickle cell anemia, thalassemia, thrombolytic disorders, or white blood cell disorders. Consider the types of drugs that would be prescribed to patients to treat symptoms associated with this disorder.

· Select one of the following factors: genetics, gender, ethnicity, age, or behavior. Reflect on how this factor might impact the effects of prescribed drugs, as well as any measures you might take to help reduce negative side effects.

With these thoughts in mind:

write Plz include sub heading when writing

· a description of the hematologic disorder you selected including types of drugs that would be prescribed to patients to treat associated symptoms. (I am looking for an explanation at the cellular or molecular level (whenever possible).

· Then, explain how the factor you selected might impact the effects of prescribed drugs, as well as any measures you might take to help reduce negative side effects.

) I am looking for an explanation at the cellular or molecular level (whenever possible).

Points to follow when writing a paper:

Ø Please all bullets points, bold, red and highlighted area must be attended to. 

Ø A clear purpose statement (The purpose of this paper is to…) is required in the introduction of all writings. 

Ø Please review all rubrics.

Ø Check APA format/setting.

Ø Your final paragraph should be a summary of the key points of your paper.

Ø Please personalized where necessary.

In the 1970s, the average lifespan for patients diagnosed with sickle cell disease was 14 years. Today, the average lifespan has increased to 50 years and beyond (TriHealth, 2012). The patient prognosis for many other hematologic disorders such as hemophilia and cancer continue to improve as well. This can be attributed to advancements in medical care—specifically drug therapy and treatment. When managing drug therapies for patients, it is essential to continuously examine current treatments and evaluate the impact of patient factors on drug effectiveness. To prepare for your role as an advanced practice nurse, you must become familiar with common drug treatments for various hematologic disorders seen in clinical settings.

To prepare:

· Select one of the following hematologic disorders: anemia, hemophilia, cancer, sickle cell anemia, thalassemia, thrombolytic disorders, or white blood cell disorders. Consider the types of drugs that would be prescribed to patients to treat symptoms associated with this disorder.

· Select one of the following factors: genetics, gender, ethnicity, age, or behavior. Reflect on how this factor might impact the effects of prescribed drugs, as well as any measures you might take to help reduce negative side effects.

With these thoughts in mind:

write Plz include sub heading when writing

· a description of the hematologic disorder you selected including types of drugs that would be prescribed to patients to treat associated symptoms. (I am looking for an explanation at the cellular or molecular level (whenever possible).

· Then, explain how the factor you selected might impact the effects of prescribed drugs, as well as any measures you might take to help reduce negative side effects.

) I am looking for an explanation at the cellular or molecular level (whenever possible).

Points to follow when writing a paper:

Ø Please all bullets points, bold, red and highlighted area must be attended to. 

Ø A clear purpose statement (The purpose of this paper is to…) is required in the introduction of all writings. 

Ø Please review all rubrics.

Ø Check APA format/setting.

Ø Your final paragraph should be a summary of the key points of your paper.

Ø Please personalized where necessary.

Code the first operative report, include any CPT surgery code(s), anesthesia code(s), and any modifiers applicable. (20 points)Code the E&M code for the second office visit.1. Description: Bilateral o

Code the first operative report, include any CPT surgery code(s), anesthesia code(s), and any modifiers applicable. (20 points)

Code the E&M code for the second office visit.

1. Description: Bilateral open Achilles lengthening with placement of short leg walking cast. 

PREOPERATIVE DIAGNOSIS: Idiopathic toe walker.POSTOPERATIVE DIAGNOSIS: Idiopathic toe walker.PROCEDURE: Bilateral open Achilles lengthening with placement of short leg walking cast.ANESTHESIA: Surgery performed under general anesthesia. A total of 10 mL of 0.5% Marcaine local anesthetic was used.COMPLICATIONS: No intraoperative complications.DRAINS: None.SPECIMENS: None.TOURNIQUET TIME: On the left side was 30 minutes, on the right was 21 minutes.HISTORY AND PHYSICAL: The patient is a 10-year-old boy who has been a toe walker since he started ambulating at about a year. The patient had some mild hamstring tightness with his popliteal angle of approximately 20 degrees bilaterally. He does not walk with a crouched gait but does toe walk. Given his tightness, surgery versus observation was recommended to the family. Family however wanted to correct his toe walking. Surgery was then discussed. Risks of surgery include risks of anesthesia, infection, bleeding, changes in sensation and motion of the extremities, failure to resolve toe walking, possible stiffness, cast, and cast problems. All questions were answered and parents agreed to above surgical plan.PROCEDURE IN DETAIL: The patient was taken to the operating room and placed supine on the operating table General anesthesia was then administered. The patient received Ancef preoperatively. The patient was then subsequently placed prone with all bony prominences padded. Two bilateral nonsterile tourniquets were placed on each thigh. Both extremities were then prepped and draped in a standard surgical fashion. We turned our attention first towards the left side. A planned incision of 1 cm medial to the Achilles tendon was marked on the skin. The extremity was wrapped in Esmarch prior to inflation of tourniquet to 250 mmHg. Incision was then made and carried down through subcutaneous fat down to the tendon sheath. Achilles tendon was identified and Z-lengthening was done with the medial distal half cut. Once Z-lengthening was completed proximally, the length of the Achilles tendon was then checked. This was trimmed to obtain an end-on-end repair with 0 Ethibond suture. This was also oversewn. Wound was then irrigated. Achilles tendon sheath was reapproximated using 2-0 Vicryl as well as the subcutaneous fat. The skin was closed using 4-0 Monocryl. Once the wound was cleaned and dried and dressed with Steri-Strips and Xeroform, the area was injected with 0.5% Marcaine. It was then dressed with 4 x 4 and Webril. Tourniquet was released at 30 minutes. The same procedure was repeated on the right side with tourniquet time of 21 minutes. While the patient was still prone, two short-leg walking casts were then placed. The patient tolerated the procedure well and was subsequently flipped supine on to hospital gurney and taken to PACU in stable condition.POSTOPERATIVE PLAN: The patient will be discharged on the day of surgery. He may weightbear as tolerated in his cast, which he will have for about 4 to 6 weeks. He is to follow up in approximately 10 days for recheck as well as prescription for intended AFOs, which he will need up to 6 months. The patient may or may not need physical therapy while his Achilles lengthenings are healing. The patient is not to participate in any PE for at least 6 months. The patient is given Tylenol No. 3 for pain.

2. 

HISTORY OF PRESENT ILLNESS: Mr. Smith is a 63-year-old gentleman new to our Clinic. He had been followed by Dr. Jones at Kernodle Clinic. Mr. Smith has a past medical history that includes hypertension for more than five years. It sounds like he has fairly severe white coat hypertension. Apparently, he has home readings consistently 30 points below what he gets in the office. He had been on Capoten in the past and gotten a cough with that. He had been on Norvasc in the past, but then stopped it for unclear reasons. More recently, he has been on Hyzaar. He also has hypercholesterolemia and has been on Lipitor. He has for the past year or so felt that his hands and feet were “burning up” at night. He reports that “he can almost see the heat waves from them.” He thinks this is a medication side effect. On his own, he stopped his Lipitor three weeks ago. He has not noticed any difference in his symptoms. He otherwise feels well and has no complaints.

PAST MEDICAL HISTORY: 1. Hypertension. 2. Hypercholesterolemia. 3. Status post plastic surgery after a motor vehicle collision when he was in his 20s. 4. History of depression around the time of the accident. He does report that intermittently he feels quite down, but he is able “to pick himself back up”. More recently, however, he has been in a more prolonged period. 5. He has significant moles and he is followed by an outside dermatologist. 6. He has had normal PSA and rectal exams. He had a colonoscopy about five years ago and again one year ago, both of which showed many polyps, pathology not known.

MEDICATIONS: Now only Hyzaar, a baby aspirin and a multivitamin

ALLERGIES: Capoten caused a cough.

SOCIAL HISTORY: He works in computer software. He does not smoke. He drinks wine and Martinis “probably more than I need to.” No drug use.

FAMILY HISTORY: The patient’s father died of a brain aneurysm in his 50s. Mom had colon cancer in her 80s and also hypertension. Five older sisters all with hypertension and hypercholesterolemia. No known coronary artery disease.

REVIEW OF SYSTEMS:

CONSTITUTIONAL: No fevers. Weight up 15 lbs since March. HEENT: Teeth doing okay. Does not feel congested in his sinuses. CARDIOVASCULAR: No chest pains, palpitations, PND, orthopnea or edema. RESPIRATORY: No shortness of breath. He does have a chronic intermittent cough that he has had for years. He had a chest x-ray a couple of years ago to evaluate this which was apparently normal. GI: No abdominal pain. No reflux-type symptoms. No change in bowel habits. GU: No hematuria or dysuria. MUSCULOSKELETAL: No chronic joint pains. PSYCHIATRIC: Not suicidal.

PHYSICAL EXAMINATION:

VITAL SIGNS: Weight 86.7 kg which is 191 lbs, blood pressure 174/114, pulse 103.

HEENT: Conjunctivae pink. Sclerae anicteric. Oropharynx clear.

NECK: No lymphadenopathy or thyromegaly or JVD.

LUNGS: Clear to auscultation and percussion.

HEART: Regular rate and rhythm without murmur, rub or gallop.

ABDOMEN: Normal bowel sounds. Soft, nontender. No hepatosplenomegaly.

EXTREMITIES: No cyanosis, clubbing or edema.

PSYCHIATRIC: Normal affect and behavior with seemingly good insight.

ASSESSMENT AND PLAN:

1. Hypertension, poor control even with supposed white coat hypertension. He again is worried about side effect of his medications. We talked about many options and decided to change him to HCTA 25 mg a day and Norvasc 10 mg a day.
2. Hypercholesterolemia. We will check lipid panel today. We will hold off on Lipitor for now, but will likely restart this once we confirm he is not having drug side effects. He is also interested in possibly trying fish oil.
3. Psychiatric. He was not interested in counseling at all. He was interested in medication. We will start Celexa 20 mg a day. He will titrate this up to 40 mg after three to four weeks. He will call us in a few weeks if he is having any problems.
4. Health maintenance. We will hold on PSA screening for a bit as he has been screened in the past. We will repeat colonoscopy in a few years and will try to get records of prior polyp pathology. He will try to focus on drinking a bit less alcohol and getting some regular exercise and eating better. Continue baby aspirin.
5. Return to clinic in two months.

John Student, MS3

Seen with Joe Doctor, MD