Write a comprehensive analysis (5-7 pages) of an adverse event or near miss from your nursing experience. Integrate research and data on the event to propose a quality improvement (QI) initiative to your current organization.Health care organizations strive to create a culture of safety. Despite technological advances, quality care initiatives, oversight, ongoing education and training, legislation, and regulations, medical errors continue to be made. Some are small and easily remedied with the patient unaware of the infraction. Others can be catastrophic and irreversible, altering the lives of patients and their caregivers and unleashing massive reforms and costly litigation. Many errors are attributable to ineffective interprofessional communication.This assessment’s goal is to address a specific event in a health care setting that impacts patient safety and related organizational vulnerabilities with a quality improvement initiative to prevent future incidents.Demonstration of ProficiencyBy successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:Competency 1: Plan quality improvement initiatives in response to adverse events and near-miss analyses.Evaluate quality improvement technologies related to the event that are required to reduce risk and increase patient safety.Analyze the missed steps or protocol deviations related to an adverse event or near miss.Analyze the implications of the adverse event or near miss for all stakeholders.Outline a quality improvement initiative to prevent a similar adverse event or near miss.Competency 3: Evaluate quality improvement initiatives using sensitive and sound outcome measures.Incorporate relevant metrics of the adverse event or near miss incident to support need for improvement.Competency 5: Apply effective communication strategies to promote quality improvement of interprofessional care.Communicate analysis and proposed initiative in a professional, effective manner, writing clearly and logically, with correct use of grammar, punctuation, and spelling.Integrate relevant sources to support arguments, correctly formatting citations and references using APA style.InstructionsFor this assessment, you will prepare a comprehensive analysis on an adverse event or near miss that you or a peer experienced during your professional nursing career. You will integrate research and data on the event and use this information as the basis for a quality improvement (QI) initiative proposal in your current organization.The following points correspond to the grading criteria in the scoring guide. The subbullets under each grading criterion further delineate tasks to fulfill the assessment requirements. Be sure that your adverse event or near-miss analysis addresses all of the content below. You may also want to read the scoring guide to better understand the performance levels relating to each grading criterion.Analyze the missed steps or protocol deviations related to an adverse event or near miss.Describe how the event resulted from a patient’s medical management rather than from the underlying condition.Identify and evaluate the missed steps or protocol deviations leading to the event.Explain the extent to which the incident was preventable.Research the impact of the same type of adverse event or near miss in other facilities.Analyze the implications of the adverse event or near miss for all stakeholders.Evaluate the short- and long-term effects on the stakeholders (patient, family, interprofessional team, facility, community). Analyze each stakeholder’s contribution to the event.Analyze the interprofessional team’s responsibilities and actions. Explain what measures each interprofessional team member should have taken to create a culture of safety.Describe any change to process or protocol implemented after the incident.Evaluate quality improvement technologies related to the event that are required to reduce risk and increase patient safety.Analyze the quality improvement technologies put in place to increase patient safety and prevent recurrence of the near miss or adverse event.Determine the appropriateness of the technology application for a specific patient or situation.Research scholarly, evidence-based literature to learn how institutions can integrate solutions to prevent similar events.Incorporate relevant metrics of the adverse event or near-miss incident to support need for improvement.Identify the salient data associated with the adverse event or near miss that is generated from the facility’s dashboard.Note: Dashboard means data generated from the information technology platform that provides integrated operational, financial, clinical, and patient safety data for health care management.Analyze what the relevant metrics show.Explain research or data related to the adverse event or near miss that is available outside of your institution. Compare internal data to external data. Use resources such as the Centers for Disease Control and Prevention (CDC), Agency for Healthcare Research and Quality (AHRQ), Institute for Healthcare Improvement (IHI), and the World Health Organization (WHO).Outline a quality improvement initiative to prevent the recurrence of an adverse event or near miss.Explain, from an evidence-based viewpoint, how your facility now manages or should manage the process or protocol.Evaluate how other institutions addressed similar incidents or events.Analyze QI initiatives developed to prevent similar incidents. Explain why they are successful. Provide evidence of their success.Propose solutions for your selected institution that can be implemented to prevent similar future adverse events or near-miss incidents.Communicate analysis and proposed initiative in a professional, effective manner, writing content clearly and logically, with correct use of grammar, punctuation, and spelling.Integrate relevant sources to support arguments, correctly formatting citations and references using APA style.Example Assessment: You may use theAdverse Event or Near-Miss Analysis Exemplar [PDF]for an idea of what an assessment receiving a proficient or higher evaluation would look like.Additional RequirementsSubmission length: 5–7 typed, double-spaced pages.Font: Times New Roman, 12 points.Number of references: Cite a minimum of 5 current scholarly and/or authoritative sources to support your evaluation, recommendations, and plans. Current literature is defined as no older than 5 years unless it is a seminal work.APA formatting: Citations and references must adhere to APA style and formatting guidelines. Consult these resources for an APA refresher:APA Style & Format.APA Module.American Psychological Association. (n.d.).APA style. Retrieved from https://www.apastyle.org/Grading Rubric:1. Analyze the missed steps or protocol deviations related to an adverse event or near miss.Passing Grade:  Analyzes the missed steps or protocol deviations related to an adverse event or near miss. Identifies knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty where further information could improve the analysis.2.  Analyze the implications of the adverse event or near miss for all stakeholders.Passing Grade:  Analyzes the implications of the adverse event or near miss for all stakeholders. Identifies assumptions on which the analysis is based.3.  Evaluate quality improvement technologies related to the event that are required to reduce risk and increase patient safety.Passing Grade:  Evaluates quality improvement technologies related to the event that are required to reduce risk and increase patient safety. Identifies criteria by which to evaluate the technologies.4.   Incorporate relevant metrics of the adverse event or near-miss incident to support need for improvement.Passing Grade:  Incorporates relevant metrics of the adverse event or near-miss incident to support need for improvement. Evaluates the quality of the data.5.  Outline an evidence-based quality improvement initiative to prevent an adverse event or near miss.Passing Grade:  Outlines an evidence-based quality improvement initiative to prevent an adverse event or near miss. Impartially considers conflicting data and other perspectives.6.   Communicate analysis and proposed initiative in a professional, effective manner, writing clearly and logically, with correct use of grammar, punctuation, and spelling.Passing Grade:  Communicates analysis and proposed initiative in a professional, effective, and error-free manner, writing clearly and logically.7.   Integrate relevant sources to support arguments, correctly formatting citations and references using APA style.Passing Grade:  Integrates relevant sources to support arguments, formatting citations and references, using APA style without errors.

Research legislation that has occurred within the last 5 years at the state or federal level as a result of nurse advocacy. Describe the legislation and what was accomplished. What additional steps need to be taken to continue advocacy for this issue?

As our population continues to rise along with life expectancy, large cadres of nursing practice and research scholars are needed to address the pressing healthcare issues in our society.  Utilization of nursing inquiry and the ability to translate evidence into practice for the betterment of patient care and overall outcomes is key.  Additionally, they are well prepared to address system challenges and concerns and implement changes for improvement here as well. The work of the cadre will enhance the translation of evidence into practice, with the utilization of learned quality improvement methodologies aimed to both improve and transform the delivery of healthcare (Trautman et al., 2018).In an effort to lead clinical innovation the cadre needs to become strong leaders and influencers.  They are positioned to negotiate and work highly groups to effect change with the implementation of any or all aspects of nursing inquiry (Fuller & Hansen, 2019).  Forming professional relationships through networking is also beneficial.  These relationships afford the person leading change a consortium of resources to support and assist with change.Simply implementing a change in any type of environment is rarely successful and/or sustainable.  Providing the audience with the evidence and outcomes when implementing a desired change in practice is important.  We as healthcare workers should be providing care with a patient centered approach and possess a common desire to attain high quality and safety outcomes.  As leaders of change, we must possess strong self-awareness along with the characteristic of approachability and adaptability.  As we implement changes, we along with our teams, can identify limitations and make adjustments according for optimal results.I need a comment for this post at least 2 paragraphs and use 2 sources no later than 5 years.

Gina is the charge nurse of the 3:00 PM to 11:00 PM shift on the acute care unit where you have worked for 18 months since your graduation. Your supervisor has asked you if you would like to learn the duties of the relief charge nurse. You were thrilled that she approached you for this position. Because it was a relief position, it was permissible for your supervisor to appoint you and not necessary for you to formally apply for the position. One day each week, for the last 2 weeks, you have been working with Gina about the responsibilities of the position. There are several things Gina does that bother you, and you are not sure what you should do. For example, if used supplies were inadvertently not charged to patients at the time of service, Gina admitted she would just charge them to whoever patients she thought were likely to have used them. When you questioned Gina about this, she said, “Well, at the end of the day, the unit needs to make sure that all supplies have been charged for, or the CFO will be after all of us. It is one of the charge nurses’ responsibilities, and I don’t have time to chase everyone down to find the correct patient to charge and besides everyone has insurance and so it does not come out of the patient’s pocket. Most importantly, we must make sure the hospital gets reimbursed or we won’t have our jobs.” In addition, when Gina does the staffing correlation for the upcoming shift, you notice that she fudges a bit and makes sure the night shift is given credit for needing more staff than they need. When questioned, she said, “Oh, we have to take care of each other, better too much staff than not enough.” You think Gina’s actions are unethical, but you do not know what to do about it. It does not directly harm a patient, but you feel uncomfortable about what she is doing and feel it is not the ethical thing to do.ASSIGNMENT:   You have many options here including doing nothing. Using the MORAL ethical problem-solving model, solve this case and compare your solution with others in your class.Making Sound Staffing DecisionsYou are the staffing coordinator for a small community hospital. It is now 12:30 PM, and your staffing plan for the 3:00 PM to 11:00 PM shift must be completed no later than 1:00 PM. (The union contract stipulates that any “call offs” that must be done for low census must be done at least 2 hours before the shift begins; otherwise, employees will receive a minimum of 4 hours of pay.) You do, however, have the prerogative to call off staff for only half a shift (4 hours). If they are needed for the last half of the shift (7:00 PM to 11:00 PM), you must notify them by 5:00 PM tonight. A local outside registry is available for supplemental staff; however, their cost is two and a half times that of your regular staff, so you must use this resource sparingly. Mandatory overtime is also used but only as a last resort. The current hospital census is 52 patients, although the emergency department (ED) is very busy and has four possible patient admissions. There are also two patients with confirmed discharge orders and three additional potential discharges on the 3:00 PM to 11:00 PM shift. All units have just submitted their patient classification system (PCS) calculations for that shift. You have five units to staff: the intensive care unit (ICU), pediatrics, obstetrics (includes labor, delivery, and postpartum), medical, and surgical departments. The ICU must be staffed with a minimum of a 1:2 nurse–patient ratio. The pediatric unit is generally staffed at a 1:4 nurse–patient ratio and the medical and surgical departments at a 1:6 ratio. In obstetrics, a 1:2 ratio is used for labor and delivery, and a 1:6 ratio is used in postpartum. On reviewing the staffing, you note the following:Intensive Care Unit Census = 6. Unit capacity = 8. The PCS shows a current patient acuity level requiring 3.2 staff. One of the potential admissions in the ED is a patient who will need cardiac monitoring. One patient, however, will likely be transferred to the medical unit on 3:00 PM to 11:00 PM shift. Four registered nurses (RNs) are assigned for that shift.Pediatrics Census = 8. Unit capacity = 10. The PCS shows a current acuity level requiring 2.4 staff. There are two RNs and one certified nursing assistant assigned for the 3:00 PM to 11:00 PM shift. There are no anticipated discharges or transfers.Obstetrics Census = 6. Unit capacity = 8. Three women are in active labor, and three women are in the postpartum unit with their babies. Two RNs are assigned to the obstetrics department for the 3:00 PM to 11:00 PM shift. There are no in-house staff on that shift who have been cross trained for this unit.Medical Floor Census = 19. Unit capacity = 24. The PCS shows a current acuity level requiring 4.4 staff. There are two RNs, one licensed vocational nurse, and two certified nursing assistants assigned for the 3:00 PM to 11:00 PM shift. Three of the potential ED admissions will come to this floor. Two of the potential patient discharges are on this unit.Surgical Floor Census = 13. Unit capacity = 18. The PCS shows a current acuity level requiring 3.6 staff. Because of sick calls, you have only one RN and two certified nursing assistants assigned for the 3:00 PM to 11:00 PM shift. Both confirmed patient discharges as well as one of the potential discharges are from this unit.ASSIGNMENT:   Answer the following questions:1.  Which units are overstaffed, and which are understaffed?2.  Of those units that are overstaffed, what will you do with the unneeded staff?3.  How will you staff units that are understaffed? Will outside registry or mandatory overtime methods be used?4.  How did staffing mix and PCS acuity levels factor into your decisions, if at all?5.  What safeguards can you build into the staffing plan for unanticipated admissions or changes in patient acuity during the shift?

DescriptionAlma Faulkenberger is an 85-year-old female outpatient sitting in the waiting room awaiting an invasive pelvic procedure. The health care professional who will assist in her procedure enters the room and calls “Alma.” There is no reply so the professional retreats to the work area. Fifteen minutes later the professional returns and calls “Alma Frankenberg.” Still no reply, so he leaves again. Another 15 minutes pass and the professional approaches Alma and shouts in her ear, “Are you Alma Frankenberg?” She replies, “No I am not, and I am not deaf either, and when you get my name correct I will answer you.”Using the topic 1 materials, develop a plan to help Alma be compliant with the procedure and post-treatment medication. Also, describe the approach you would take to patient education in this case.