COMPETENCIES WGU C489 Process 2
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734.three.1 : Ideas of Management
The graduate applies ideas of management to advertise high-quality healthcare in quite a lot of settings via the appliance of sound management ideas.
734.three.2 : Interdisciplinary Collaboration
The graduate applies theoretical ideas vital for efficient participation in an interdisciplinary staff.
734.three.three : High quality and Affected person Security
The graduate applies high quality enchancment processes meant to realize optimum healthcare outcomes, contributing to and supporting a tradition of security.
INTRODUCTION
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Healthcare organizations accredited by the Joint Fee are required to conduct a root trigger evaluation (RCA) in response to any sentinel occasion, such because the one described within the state of affairs connected under. As soon as the trigger is recognized and a plan of motion established, it’s helpful to conduct a failure mode and results evaluation (FMEA) to scale back the probability course of would fail. As a member of the healthcare staff within the hospital described on this state of affairs, you may have been chosen as a member of the staff investigating the incident.
SCENARIO
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It’s three:30 p.m. on a Thursday and Mr. B, a 67-year-old affected person, arrives on the six-room emergency division (ED) of a sixty-bed rural hospital. He has been dropped at the hospital by his son and neighbor. At the moment, Mr. B is moaning and complaining of extreme ache to his (L) leg and hip space. He states he misplaced his stability and fell after tripping over his canine.
Mr. B was admitted to the triage room the place his important indicators have been B/P 120/80, HR-88 (common), T-98.6, and R-32, and his weight was recorded at 175 kilos. Mr. B. states that he has no identified allergic reactions and no earlier falls. He states, “My hip space and leg damage actually unhealthy. I’ve by no means had something like this earlier than.” Affected person charges ache at 10 out of 10 on the numerical verbal ache scale. He seems to be in average misery. His (L) leg seems shortened with swelling (edema within the calf), ecchymosis, and restricted vary of movement (ROM). Mr. B’s leg is stabilized after which is additional evaluated and discharged from triage to the emergency division (ED) affected person room. He’s admitted by Nurse J. Nurse J finds that Mr. B has a historical past of impaired glucose tolerance and prostate most cancers. At Mr. B’s final go to together with his major care doctor, laboratory knowledge revealed elevated ldl cholesterol and lipids. Mr. B’s present medicines are atorvastatin and oxycodone for persistent again ache. After Mr. B’s evaluation is accomplished, Nurse J informs Dr. T, the ED doctor, of admission findings, and Dr. T proceeds to look at Mr. B.
Staffing on at the present time consists of two nurses (one RN and one LPN), one secretary, and one emergency division doctor. Respiratory remedy is in-house and out there as wanted. On the time of Mr. B’s arrival, the ED workers is caring for 2 different sufferers. One affected person is a 43-year-old feminine complaining of a throbbing headache. The affected person charges present ache at four out of 10 on numerical verbal ache scale. The affected person states that she has a historical past of migraines. She acquired therapy, stays steady, and discharge is pending. The second affected person is an eight-year-old boy being evaluated for doable appendicitis. Laboratory outcomes are pending for this affected person. Each of those sufferers have been examined, evaluated, and cared for by Dr. T and are awaiting additional therapy or orders.
After analysis of Mr. B, Dr. T writes the order for Nurse J to manage diazepam 5 mg IVP to Mr. B. The medicine diazepam is run IVP at four:05 p.m. After 5 minutes, the diazepam seems to have had no impact on Mr. B, and Dr. T instructs Nurse J to manage hydromorphone 2 mg IVP. The medicine hydromorphone is run IVP at four:15 p.m. After 5 minutes, Dr. T continues to be not happy with the extent of sedation Mr. B has achieved and instructs Nurse J to manage one other 2 mg of hydromorphone IVP and an extra 5 mg of diazepam IVP. The doctor’s purpose is for the affected person to realize skeletal muscle leisure from the diazepam, which can assist within the handbook manipulation, relocation, and alignment of Mr. B’s hip. The hydromorphone IVP was administered to realize ache management and sedation. After reviewing the affected person’s medical historical past, Dr. T notes that the affected person’s weight and present common use of oxycodone seem like making it tougher to sedate Mr. B.
Lastly, at four:25 p.m., the affected person seems to be sedated, and the profitable discount of his (L) hip takes place. The affected person seems to have tolerated the process and stays sedated. He’s not presently on any supplemental oxygen. The process concludes at four:30 p.m.,and Mr. B is resting with out indications of discomfort and misery. At the moment, the ED receives an emergency dispatch name alerting the emergency division that the emergency rescue unit paramedics are enroute with a 75-year-old affected person in acute respiratory misery. Nurse J locations Mr. B on an computerized blood strain machine programmed to observe his B/P each 5 minutes and a pulse oximeter. At the moment, Nurse J leaves Mr. B’s room. The nurse permits Mr. B’s son to take a seat with him as he’s being monitored through the blood strain monitor. At four:35 p.m., Mr. B’s B/P is 110/62 and his O2 saturation is 92%. He stays with out supplemental oxygen and his ECG and respirations should not monitored.
Nurse J and the LPN on obligation have acquired the emergency transport affected person. They’re additionally within the means of discharging the opposite two sufferers. In the meantime, the ED foyer has turn into congested with new incoming sufferers. At the moment, Mr. B’s O2 saturation alarm is heard and exhibits “low O2 saturation” (presently exhibiting a saturation of 85%). The LPN enters Mr. B’s room briefly, resets the alarm, and repeats the B/P studying.
Nurse J is now absolutely engaged with the emergency care of the respiratory misery affected person, which incorporates assessments, analysis, and the ordering of respiratory remedies, CXR, labs, and so forth.
At four:43 p.m., Mr. B’s son comes out of the room and informs the nurse that the “monitor is alarming.” When Nurse J enters the room, the blood strain machine exhibits Mr. B’s B/P studying is 58/30 and the O2 saturation is 79%. The affected person will not be respiratory and no palpable pulse could be detected.
A STAT CODE is named and the son is escorted to the ready room. The code staff arrives and begins resuscitative efforts. When linked to the cardiac monitor, Mr. B is discovered to be in ventricular fibrillation. CPR begins instantly by the RN, and Mr. B is intubated. He’s defibrillated and reversal brokers, IV fluids, and vasopressors are administered. After 30 minutes of interventions, the ECG returns to a traditional sinus rhythm with a pulse and a B/P of 110/70. The affected person will not be respiratory on his personal and is absolutely depending on the ventilator. The affected person’s pupils are mounted and dilated. He has no spontaneous actions and doesn’t reply to noxious stimuli. Air transport is named, and upon the household’s needs, the affected person is transferred to a tertiary facility for superior care.
Seven days later, the receiving hospital knowledgeable the agricultural hospital that EEG’s had decided mind dying in Mr. B. The household had requested life-support be eliminated, and Mr. B subsequently died.
Further data: The hospital the place Mr. B. was initially seen and handled had a average sedation/analgesia (“aware sedation”) coverage that requires that the affected person stays on steady B/P, ECG, and pulse oximeter all through the process and till the affected person meets particular discharge standards (i.e., absolutely awake, VSS, no N/V, and in a position to void). All practitioners who carry out average sedation should first efficiently full the hospital’s average sedation coaching module. The coaching module contains drug choice in addition to acceptable dose ranges. Further (backup) workers was out there on the day of the incident. Nurse J had accomplished the average sedation module. Nurse J had present ACLS certification and was an skilled important care nurse. Nurse J’s prior annual scientific evaluations by the supervisor demonstrated that the nurse was “assembly necessities.” Nurse J didn’t have a historical past of negligent affected person care. Ample tools was out there and in working order within the ED on at the present time.
REQUIREMENTS
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Your submission have to be your unique work. Not more than a mixed complete of 30% of the submission and not more than a 10% match to anyone particular person supply could be straight quoted or carefully paraphrased from sources, even when cited appropriately. An originality report is supplied if you submit your job that can be utilized as a information.
It’s essential to use the rubric to direct the creation of your submission as a result of it offers detailed standards that might be used to guage your work. Every requirement under could also be evaluated by multiple rubric side. The rubric side titles could comprise hyperlinks to related parts of the course.
A. Clarify the final objective of conducting a root trigger evaluation (RCA).
1. Clarify every of the six steps used to conduct an RCA, as outlined by IHI.
2. Apply the RCA course of to the state of affairs to explain the causative and contributing elements that led to the sentinel occasion consequence.
B. Suggest a course of enchancment plan that may lower the probability of a reoccurrence of the state of affairs consequence.
1. Talk about how every section of Lewin’s change idea on the human aspect of change might be utilized to the proposed enchancment plan.
C. Clarify the final objective of the failure mode and results evaluation (FMEA) course of.
1. Describe the steps of the FMEA course of as outlined by IHI.
2. Full the connected FMEA desk by appropriately making use of the scales of severity, incidence, and detection to the method enchancment plan proposed partially B.
Notice: You aren’t anticipated to hold out the total FMEA.
D. Clarify how you’ll take a look at the interventions from the method enchancment plan from half B to enhance care.
E. Clarify how an expert nurse can competently exhibit management in every of the next areas:
• selling high quality care
• enhancing affected person outcomes
• influencing high quality enchancment actions
1. Talk about how the involvement of the skilled nurse within the RCA and FMEA processes demonstrates management qualities.
F. Acknowledge sources, utilizing in-text citations and references, for content material that’s quoted, paraphrased, or summarized.
G. Reveal skilled communication within the content material and presentation of your submission.
File Restrictions
File title could comprise solely letters, numbers, areas, and these symbols: ! – _ . * ‘ ( )
File dimension restrict: 200 MB
File sorts allowed: doc, docx, rtf, xls, xlsx, ppt, pptx, odt, pdf, txt, qt, mov, mpg, avi, mp3, wav, mp4, wma, flv, asf, mpeg, wmv, m4v, svg, tif, tiff, jpeg, jpg, gif, png, zip, rar, tar, 7z
RUBRIC
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A:ROOT CAUSE ANALYSIS
NOT EVIDENT
An evidence of the final objective of conducting an RCA will not be supplied. APPROACHING COMPETENCE
The reason doesn’t precisely describe the final objective for conducting an RCA. COMPETENT
The reason precisely describes the final objective for conducting an RCA.
A1:RCA STEPS
NOT EVIDENT
An evidence of 6 RCA steps will not be supplied. APPROACHING COMPETENCE
The reason doesn’t precisely establish or doesn’t logically describe a number of of the 6 steps used to conduct an RCA, as outlined by IHI. COMPETENT
The reason precisely identifies and logically describes every of the 6 steps used to conduct an RCA, as outlined by IHI.
A2:CAUSATIVE AND CONTRIBUTING FACTORS
NOT EVIDENT
An software of the RCA course of to the state of affairs will not be supplied. APPROACHING COMPETENCE
The applying of the RCA course of to the state of affairs doesn’t precisely describe causative or contributing elements that led to the sentinel occasion consequence, or the appliance doesn’t precisely differentiate between causative and contributing elements. COMPETENT
The applying of the RCA course of to the state of affairs precisely describes the causative and contributing elements that led to the sentinel occasion consequence.
B:IMPROVEMENT PLAN
NOT EVIDENT
A proposed course of enchancment plan will not be supplied. APPROACHING COMPETENCE
The proposal doesn’t define a logical course of enchancment plan, or the proposal doesn’t logically talk about how the proposed plan will lower the probability of a reoccurrence of the state of affairs consequence. COMPETENT
The proposal outlines a logical course of enchancment plan and logically discusses how the proposed plan will lower the probability of a reoccurrence of the state of affairs consequence.
B1:CHANGE THEORY
NOT EVIDENT
A dialogue of the appliance of Lewin’s change idea will not be supplied. APPROACHING COMPETENCE
The dialogue doesn’t logically describe how Lewin’s change idea might be utilized to the proposed enchancment plan, or the dialogue doesn’t describe every section of the speculation. COMPETENT
The dialogue logically describes how every section of Lewin’s change idea might be utilized to the proposed enchancment plan.
C:GENERAL PURPOSE OF FMEA
NOT EVIDENT
An evidence of the final objective of the FMEA course of will not be supplied. APPROACHING COMPETENCE
The reason doesn’t precisely describe a basic objective of the FMEA course of, or the reason doesn’t logically talk about why the FMEA course of could be used. COMPETENT
The reason precisely describes a basic objective of the FMEA course of and logically discusses why the FMEA course of could be used.
C1:STEPS OF FMEA PROCESS
NOT EVIDENT
An outline of the steps will not be supplied. APPROACHING COMPETENCE
The outline of the steps of the FMEA course of doesn’t precisely outline every of the steps. COMPETENT
The outline precisely defines every of the steps of the FMEA course of.
C2:FMEA TABLE
NOT EVIDENT
A accomplished FMEA desk will not be supplied. APPROACHING COMPETENCE
The FMEA desk is incomplete, doesn’t establish applicable failure modes associated to the development plan proposed in immediate B, or doesn’t precisely apply the scales of severity, incidence, and detection in evaluating the recognized failure modes. COMPETENT
The finished FMEA desk appropriately identifies failure modes associated to the development plan proposed partially B and demonstrates correct software of the scales of severity, incidence, and detection in evaluating the recognized failure modes.
D:INTERVENTION TESTING
NOT EVIDENT
An evidence of intervention testing will not be supplied. APPROACHING COMPETENCE
The reason doesn’t describe steps of an applicable testing process or observe that may be utilized by the candidate to check interventions from the method enchancment plan partially B, or the reason doesn’t logically describe how the intervention testing procedures or practices would enhance care. COMPETENT
The reason describes steps of the testing procedures or practices that the candidate would use which can be applicable for testing the interventions from the method enchancment plan partially B. The reason logically describes how the intervention testing procedures or practices would enhance care.
E:DEMONSTRATE LEADERSHIP
NOT EVIDENT
An evidence of how an expert nurse demonstrates management will not be supplied. APPROACHING COMPETENCE
The reason doesn’t logically describe how an expert nurse competently demonstrates management in a number of of the given areas. COMPETENT
The reason logically describes how an expert nurse competently demonstrates management in every of the given areas.
E1:INVOLVING PROFESSIONAL NURSE IN RCA AND FMEA PROCESSES
NOT EVIDENT
A dialogue of involvement within the RCA and FMEA processes will not be supplied. APPROACHING COMPETENCE
The dialogue doesn’t logically describe how the involvement of the skilled nurse in both the RCA course of or the FMEA course of demonstrates management qualities. COMPETENT
The dialogue logically describes how the involvement of the skilled nurse in each the RCA and FMEA processes demonstrates management qualities.
F:SOURCES
NOT EVIDENT
The submission doesn’t embrace each in-text citations and a reference listing for sources which can be quoted, paraphrased, or summarized. APPROACHING COMPETENCE
The submission contains in-text citations for sources which can be quoted, paraphrased, or summarized and a reference listing; nonetheless, the citations or reference listing is incomplete or inaccurate. COMPETENT
The submission contains in-text citations for sources which can be correctly quoted, paraphrased, or summarized and a reference listing that precisely identifies the creator, date, title, and supply location as out there.
G:PROFESSIONAL COMMUNICATION
NOT EVIDENT
Content material is unstructured, is disjointed, or incorporates pervasive errors in mechanics, utilization, or grammar. Vocabulary or tone is unprofessional or distracts from the subject. APPROACHING COMPETENCE
Content material is poorly organized, is tough to comply with, or incorporates errors in mechanics, utilization, or grammar that trigger confusion. Terminology is misused or ineffective. COMPETENT
Content material displays consideration to element, is organized, and focuses on the primary concepts as prescribed within the job or chosen by the candidate. Terminology is pertinent, is used appropriately, and successfully conveys the meant that means. Mechanics, utilization, and grammar promote correct interpretation and understanding.
WEB LINKS
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IHI FMEA Software
SUPPORTING DOCUMENTS
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FMEA Desk.docx
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