Root Cause Analysis

1. 1-2 page narrative cover letter (This is where you introduce your topic and include referenced information from the 5 articles you chose to do annotated bibliographies on.  Refereneced information from all 5 articles must be inlcuded.
2. Completed Root Cause Analysis Action Plan Framework Template
3. An APA Reference list.

• 1-2 Page Narrative Cover Letter:

Typed narrative cover sheet (1-2 pages in length) providing the context for the event and suggestions for changes in policy/procedure, which would assist in prevention of future occurrences of the same type. Remember the discussion post you did in Week 2 describing the error you would evaluate? Consider revising that post in light of everything you have learned this term and using it as your cover letter.

• Completed Root Cause Analysis Action Plan Framework Template:

Do this part first! Download the “Root Cause Analysis Action Plan Framework Template” (attached to the top of this page), and answer each of the questions. Make sure you follow the instructions on the form.
Answer all of the questions in the template.
If you identify a finding that is a Root Cause, you mark is as needing an Action Plan (yes or no).  If it is marked Yes, you address the Plan in the Action Plan section of the Template.
Also regarding the Action Plan item, list the Responsible Party (RN, CNA, MD, LPN, etc) and the Method: Method: Is the Action Plan item related to: Policy, Education, Audit, Observation or Implementation.

• Reference List:

Compile all parts of the annotated bibliography you created into one single reference list.

Cut and paste all 3 parts of the assignment into 1 WORD document

Instructions

Barriers to Effective Communication

We face barriers to effective communication in healthcare. As our world becomes smaller, we are in contact with patients or colleagues from culturally diverse backgrounds. Skills must be developed to improve effective communication.

Search the SUO Library for following articles:

• The Role of Nursing in Bridging the Gap between Managers and Physicians in Hospitalsgarding diversity.
• Improving Communication in the Health Care Setting

Based on your research, answer the questions (five sentences / question) in a Microsoft Word document. Think of communication with a healthcare colleague when answering.

• What barriers to effective communication occur with a professional colleague who is culturally diverse? How can these barriers affect patient outcomes?
• What assumptions can you make about a professional colleague whose customs are different than yours? How can these assumptions impact communication?
• How can you overcome language barriers to increase team unity and motivation? Why is it important to take responsibility and improve your cultural competence?

Think of communication with patients.

• What specific language barriers can result when you communicate with a patient who speaks limited English?
• How do you adjust to conflicting values or traditions from patients in a specific religion or culture? For example, patients who are Jehovah’s Witness religion may refuse blood products or other religions may not eat pork. 
• How do you adjust dietary restrictions communicating in a collaborative manner with the dietary department?
• What are the benefits of a healthcare organization to provide cultural awareness training for employees? 
• Does your current or past organization provide cultural awareness training? If not, what will you recommend to your management team?
• Select one culture different from yours and describe how this culture deals with death and mourning.

Submission Details:

• Support your responses with examples and APA cited sources.

Practicum Journal Entry

 

•             Include references immediately following the content.

 

•             Use APA style for your journal entry and references.

 

 

 

As a future advanced practice nurse, it is important that you are able to connect your classroom experience to your Practicum Experience. By applying the concepts that you study in the classroom to clinical settings, you enhance your professional competency

 

To prepare for this course’s Practicum Experience, address the following in your Practicum Journal: 1 to 2 page Jounal:

 

•Select and describe a nursing theory to guide your practice.

 

•Develop goals and objectives for your Practicum Experience in this course. When developing your goals and objectives, be sure to keep the seven domains of practice in mind.

 

•Create a timeline of practicum activities based on your practicum requirements.

 

 

 

References

 

Readings

 

•Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2013). Primary care: A collaborative practice (4th ed.). St. Louis, MO: Mosby

 

. ◦Part 1, “Introduction” (pp. 1–48)

 

◦Consensus Model for APRN Regulation

 

http://www.nursecredentialing.org/APRN-ConsensusModelReport.aspx

 

 

 

◦National Organization for Nurse Practitioner Faculties Competencies

 

http://nonpf.com/displaycommon.cfm?an=1&subarticlenbr=14

 

 

 

•Visit the NONPF website for the Core Competencies: http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/competencies/npcorecompetenciesfinal2012.pdf

 

•For Family/Across the Lifespan competencies: http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/competencies/populationfocusnpcomps2013.pdf?hhSearchTerms=PopulationFocusNPComps2013+and+pdf

 

 

 

•  Adverse Event or Near Miss Analysis
• Details
• Attempt 1Available
• Attempt 2NotAvailable
• Attempt 3NotAvailable
• Toggle Drawer  Overview

  Write a 5–7-page a comprehensive analysis on an adverse event or  near miss from your professional nursing experience. Integrate research  and data on the event and use as a basis to propose a quality  improvement (QI) initiative in your current organization.
  Health care organizations strive for a culture of safety. Yet  despite technological advances, quality care initiatives, oversight,  ongoing education and training, laws, legislation and regulations,  medical errors continue to occur. 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.
  Show More

• Toggle Drawer  Context
  The purpose of the report is to assess whether specific quality  indicators point to improved patient safety, quality of care, cost and  efficiency goals, and other desired metrics. Nurses and other health  professionals with specializations and/or interest in the condition,  disease, or the selected issue are your target audience.
• Toggle Drawer  Questions to Consider
  As you prepare to complete this assessment, you may want to think  about other related issues to deepen your understanding or broaden your  viewpoint. You are encouraged to consider the questions below and  discuss them with a fellow learner, a work associate, an interested  friend, or a member of your professional community. Note that these  questions are for your own development and exploration and do not need  to be completed or submitted as part of your assessment.
  Show More
• Toggle Drawer  Resources
  Required Resources
  MSN Program Journey
  The following is a useful map that will guide you as you continue  your MSN program. This map gives you an overview of all the steps  required to prepare for your practicum and to complete your degree. It  also outlines the support that will be available to you along the way.
• MSN Program Journey | Transcript.
• Show More
•  Assessment Instructions
  Preparation
  Prepare a comprehensive analysis on an adverse event or near-miss  from your professional nursing experience that you or a peer  experienced. Integrate research and data on the event and use as a basis  to propose a Quality Improvement (QI) initiative in your current  organization.
  Note: Remember, you can submit all, or a portion  of, your draft to Smarthinking for feedback, before you submit the final  version of your analysis for this assessment. However, be mindful of  the turnaround time for receiving feedback, if you plan on using this  free service.
  The numbered points below correspond to grading criteria in the  scoring guide. The bullets below 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 that relate to each grading criterion.

1. 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 that led to the event.
   • Discuss the extent to which the incident was preventable.
   • Research the impact of the same type of adverse event or near miss in other facilities.
2. Analyze the implications of the adverse event or near miss for all stakeholders.
   • Evaluate both short-term and long-term effects on the  stakeholders (patient, family, interprofessional team, facility,  community). Analyze how it was managed and who was involved.
   • Analyze the responsibilities and actions of the  interprofessional team. Explain what measures should have been taken and  identify the responsible parties or roles.
   • Describe any change to process or protocol implemented after the incident.
3. Evaluate quality improvement technologies related to the event that are required to reduce risk and increase patient safety.
   • Analyze the quality improvement technologies that were put in  place to increase patient safety and prevent a repeat of similar events.
   • Determine whether the technologies are being utilized appropriately.
   • Explore how other institutions integrated solutions to prevent these types of events.
4. Incorporate relevant metrics of the adverse event or near miss incident to support need for improvement.
   • Identify the salient data that is associated with the adverse  event or near miss that is generated from the facility’s dashboard. (By  dashboard, we mean the data that is 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.
5. Outline a quality improvement initiative to prevent a future adverse event or near miss.
   • Explain how the process or protocol is now managed and monitored in your facility.
   • Evaluate how other institutions addressed similar incidents or events.
   • Analyze QI initiatives developed to prevent similar incidents,  and explain why they are successful. Provide evidence of their success.
   • Propose solutions for your selected institution that can be implemented to prevent future adverse events or near-miss incidents.
6. Communicate analysis and proposed initiative in a professional  and effective manner, writing content clearly and logically with correct  use of grammar, punctuation, and spelling.
7. Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.
8. Submission Requirements

• Length of submission: A minimum of five but no more than seven double-spaced, typed pages.
• Number of references: Cite a minimum of three sources (no older  than seven years, unless seminal work) of scholarly or professional  evidence that support your evaluation, recommendations, and plans.
• APA formatting: Resources and citations are formatted according to current APA style and formatting.
• Assessment 1 Ex

Question

Question 1. Xi, a fifty-four-year-old female, has a history of migraine that does not respond well to OTC migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Which of the following actions would you take for appropriate decision making?

Prescribe Maxalt, but to monitor the use, only give her four tablets with no refills.

Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with the first dose.

Explain that rizatriptan is not used for postmenopausal migraines and recommend Fiorinal (aspirin and butalbital).

Prescribe sumatriptan (Imitrex) with the explanation that it is the most effective triptan.

Question 2. Chronic pain is a complex problem. Some specific strategies to deal with it include ________.

telling the patient to “let pain be your guide” to using treatment therapies

prescribing pain medication on a pro re nata (PRN) basis to keep down the amount used

scheduling return visits on a regular basis rather than waiting for poor pain control to drive the need for an appointment

All the given options

Question 3. Phil is starting treatment with febuxostat (Uloric). Education of patients starting febuxostat includes which one of the following instructions?

Gout may worsen with therapy.

Febuxostat may cause severe diarrhea.

The patients should consume a high-calcium diet.

The patients will need frequent CBC monitoring.

Question 4. The Pain Management Contract is most appropriate for:

Patients with a history of chemical dependency or possible inappropriate use of pain medications

All patients with chronic pain who will require long-term use of opiates

Patients who have a complex drug regimen

Patients who see multiple providers for pain control

Question 5. Patients whose total dose of prednisone exceed 1 gram will most likely need a second prescription for _________.

metformin, a biguanide to prevent diabetes

omeprazole, a proton pump inhibitor to prevent peptic ulcer disease

naproxen, an NSAID to treat joint pain

furosemide, a diuretic to treat fluid retention

Question 6. Sallie has been taking 10 mg of prednisone per day for the past six months. She should be assessed for ________.

gout

iron deficiency anemia

osteoporosis

renal dysfunction

Question 7. All NSAIDs have an FDA black box warning regarding __________.

potential for causing life-threatening GI bleeds

increased risk of developing systemic arthritis with prolonged use

risk of life-threatening rashes, including Stevens-Johnson

potential for transient changes in serum glucose

Question 8. Which of the following statements is true about age and pain?

Use of drugs that depend heavily on the renal system for excretion may require dosage adjustments in very young children.

Among the NSAIDs, indomethacin is the preferred drug because of lower adverse effects profiles than other NSAIDs.

Older adults who have dementia probably do not experience much pain due to loss of pain receptors in the brain.

Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs.

Question 9. Kirk sprained his ankle and is asking for pain medication for his mild-to-moderate pain. The appropriate first-line medication would be __________.

ibuprofen (Advil)

acetaminophen with hydrocodone (Vicodin)

oxycodone (OxyContin)

oral morphine (Roxanol)

Question 10. Patients who are on or who will be starting chronic corticosteroid therapy need monitoring of __________.

serum glucose

stool culture

folate levels

vitamin B12

Question 11. Jamie has fractured his ankle and has received a prescription for acetaminophen and hydrocodone (Vicodin). Education when prescribing Vicodin includes which one of the following instructions?

It is OK to double the dose of Vicodin if the pain is severe.

Vicodin is not habit forming.

He should not take any other acetaminophen-containing medications.

Vicodin may cause diarrhea; therefore, he should increase his fluid intake.

Question 12. Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity. An early sign of aspirin toxicity is _____.

black, tarry stools

vomiting

tremors

tinnitus

Question 13. Henry is eighty-two years old and takes two aspirin every morning to treat the arthritis pain in his back. He states that the aspirin helps him to “get going” each day. Lately, he has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for Henry?

Add an H2 blocker such as ranitidine to his therapy.

Discontinue the aspirin and switch him to Vicodin for the pain.

Decrease the aspirin dose to one tablet daily.

Have Henry take an antacid fifteen minutes before taking the aspirin each day.

Question 14. Patients with RA who are on chronic low-dose prednisone will need co-treatment with which medications to prevent further adverse effects?

A bisphosphonate

Calcium supplementation

Vitamin D

All of the above

Question 15. One of the main drug classes used to treat acute pain is NSAIDs. They are used due to which of the following reasons?

They have less risk for liver damage than acetaminophen.

Inflammation is a common cause of acute pain.

They have minimal GI irritation.

Regulation of blood flow to the kidney is not affected by these drugs.

Question 16. Chemical dependency assessment is integral to the initial assessment of chronic pain. Which of the following raises a “red flag” about potential chemical dependency?

Use of more than one drug to treat the pain

Multiple times when prescriptions are lost with requests to refill

Preferences for treatments that include alternative medicines

Presence of a family member who has abused drugs

Question 17. Jayla is a nine-year-old who has been diagnosed with migraines for almost two years. She is missing up to a week of school each month. Her headache diary confirms she averages four or five migraines per month. Which of the following would be appropriate?

Prescribe amitriptyline (Elavil) daily, start at a low dose and increase the dose slowly every two weeks until effective in eliminating migraines.

Encourage her mother to give her Excedrin Migraine (aspirin, acetaminophen, and caffeine) at the first sign of a headache to abort the headache.

Prescribe propranolol (Inderal) to be taken daily for at least three months.

Explain that it is rare for a nine-year-old to get migraines and that she needs an MRI to rule out a brain tumor.

Question 18. Narcotics are exogenous opiates. They act by ______.

inhibiting pain transmission in the spinal cord

attaching to receptors in the afferent neuron to inhibit the release of substance P

blocking neurotransmitters in the midbrain

increasing beta-lipoprotein excretion from the pituitary

Question 19. Pathological similarities and differences between acute pain and chronic pain include which of the following options?

Both have decreased levels of endorphins.

Chronic pain has a predominance of C-neuron stimulation.

Acute pain is most commonly associated with irritation of peripheral nerves.

Acute pain is diffuse and hard to localize.

Question 20. Different areas of the brain are involved in specific aspects of pain. The reticular and limbic systems in the brain influence ______.

the sensory aspects of pain

the discriminative aspects of pain

the motivational aspects of pain

the cognitive aspects of pain