COMPETENCIES WGU C489 Task 2 ________________________________________ 734.3.1 : Principles of Leadership
COMPETENCIES WGU C489 Activity 2 ________________________________________ 734.three.1 : Rules of Management The graduate applies rules of management to advertise high-quality healthcare in quite a lot of settings by means of the appliance of sound management rules. 734.three.2 : Interdisciplinary Collaboration The graduate applies theoretical rules obligatory for efficient participation in an interdisciplinary workforce. 734.three.three : High quality and Affected person Security The graduate applies high quality enchancment processes supposed to attain optimum healthcare outcomes, contributing to and supporting a tradition of security. INTRODUCTION ________________________________________ 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 situation connected beneath. 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 cut back the chance that a course of would fail. As a member of the healthcare workforce within the hospital described on this situation, you might have been chosen as a member of the workforce investigating the incident. SCENARIO ________________________________________ 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. Right now, 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 recognized allergy symptoms and no earlier falls. He states, “My hip space and leg damage actually dangerous. 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 reasonable 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 main care doctor, laboratory information revealed elevated ldl cholesterol and lipids. Mr. B’s present drugs are atorvastatin and oxycodone for power 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 this present day 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 employees 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 treatment 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 treatment 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 a further 5 mg of diazepam IVP. The doctor’s objective is for the affected person to attain skeletal muscle rest from the diazepam, which can support within the guide manipulation, relocation, and alignment of Mr. B’s hip. The hydromorphone IVP was administered to attain 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 look 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 isn't at present on any supplemental oxygen. The process concludes at four:30 p.m.,and Mr. B is resting with out indications of discomfort and misery. Right now, 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 stress machine programmed to watch his B/P each 5 minutes and a pulse oximeter. Right now, Nurse J leaves Mr. B’s room. The nurse permits Mr. B’s son to sit down with him as he's being monitored through the blood stress 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 strategy of discharging the opposite two sufferers. In the meantime, the ED foyer has develop into congested with new incoming sufferers. Right now, Mr. B’s O2 saturation alarm is heard and exhibits “low O2 saturation” (at present displaying 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 therapies, 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 stress machine exhibits Mr. B’s B/P studying is 58/30 and the O2 saturation is 79%. The affected person will not be respiration and no palpable pulse may be detected. A STAT CODE known as and the son is escorted to the ready room. The code workforce 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 respiration 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 known as, 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 info: The hospital the place Mr. B. was initially seen and handled had a reasonable sedation/analgesia (“acutely 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 capable of void). All practitioners who carry out reasonable sedation should first efficiently full the hospital’s reasonable sedation coaching module. The coaching module consists of drug choice in addition to acceptable dose ranges. Further (backup) employees was out there on the day of the incident. Nurse J had accomplished the reasonable sedation module. Nurse J had present ACLS certification and was an skilled crucial 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. Enough tools was out there and in working order within the ED on this present day. REQUIREMENTS ________________________________________ Your submission should be your authentic work. Not more than a mixed complete of 30% of the submission and not more than a 10% match to anyone particular person supply may be straight quoted or intently paraphrased from sources, even when cited accurately. An originality report is offered while you submit your job that can be utilized as a information. You should use the rubric to direct the creation of your submission as a result of it gives detailed standards that will probably be used to judge your work. Every requirement beneath could also be evaluated by a couple of rubric side. The rubric side titles could include hyperlinks to related parts of the course. A. Clarify the overall goal 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 situation to explain the causative and contributing elements that led to the sentinel occasion final result. B. Suggest a course of enchancment plan that will lower the chance of a reoccurrence of the situation final result. 1. Talk about how every part of Lewin’s change concept on the human aspect of change could possibly be utilized to the proposed enchancment plan. C. Clarify the overall goal 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, prevalence, and detection to the method enchancment plan proposed partially B. Be aware: You aren't anticipated to hold out the complete FMEA. D. Clarify how you'd 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 show 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 include solely letters, numbers, areas, and these symbols: ! - _ . * ' ( ) File measurement 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 ________________________________________ A:ROOT CAUSE ANALYSIS NOT EVIDENT A proof of the overall goal of conducting an RCA will not be offered. APPROACHING COMPETENCE The reason doesn't precisely describe the overall goal for conducting an RCA. COMPETENT The reason precisely describes the overall goal for conducting an RCA. A1:RCA STEPS NOT EVIDENT A proof of 6 RCA steps will not be offered. 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 situation will not be offered. APPROACHING COMPETENCE The appliance of the RCA course of to the situation doesn't precisely describe causative or contributing elements that led to the sentinel occasion final result, or the appliance doesn't precisely differentiate between causative and contributing elements. COMPETENT The appliance of the RCA course of to the situation precisely describes the causative and contributing elements that led to the sentinel occasion final result. B:IMPROVEMENT PLAN NOT EVIDENT A proposed course of enchancment plan will not be offered. APPROACHING COMPETENCE The proposal doesn't define a logical course of enchancment plan, or the proposal doesn't logically focus on how the proposed plan will lower the chance of a reoccurrence of the situation final result. COMPETENT The proposal outlines a logical course of enchancment plan and logically discusses how the proposed plan will lower the chance of a reoccurrence of the situation final result. B1:CHANGE THEORY NOT EVIDENT A dialogue of the appliance of Lewin’s change concept will not be offered. APPROACHING COMPETENCE The dialogue doesn't logically describe how Lewin’s change concept could possibly be utilized to the proposed enchancment plan, or the dialogue doesn't describe every part of the idea. COMPETENT The dialogue logically describes how every part of Lewin’s change concept could possibly be utilized to the proposed enchancment plan. C:GENERAL PURPOSE OF FMEA NOT EVIDENT A proof of the overall goal of the FMEA course of will not be offered. APPROACHING COMPETENCE The reason doesn't precisely describe a normal goal of the FMEA course of, or the reason doesn't logically focus on why the FMEA course of could be used. COMPETENT The reason precisely describes a normal goal 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 offered. 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 offered. APPROACHING COMPETENCE The FMEA desk is incomplete, doesn't establish applicable failure modes associated to the advance plan proposed in immediate B, or doesn't precisely apply the scales of severity, prevalence, and detection in evaluating the recognized failure modes. COMPETENT The finished FMEA desk appropriately identifies failure modes associated to the advance plan proposed partially B and demonstrates correct software of the scales of severity, prevalence, and detection in evaluating the recognized failure modes. D:INTERVENTION TESTING NOT EVIDENT A proof of intervention testing will not be offered. APPROACHING COMPETENCE The reason doesn't describe steps of an applicable testing process or observe that will 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 A proof of how an expert nurse demonstrates management will not be offered. 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 offered. 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 embody each in-text citations and a reference listing for sources which can be quoted, paraphrased, or summarized. APPROACHING COMPETENCE The submission consists of in-text citations for sources which can be quoted, paraphrased, or summarized and a reference listing; nevertheless, the citations or reference listing is incomplete or inaccurate. COMPETENT The submission consists of in-text citations for sources which can be correctly quoted, paraphrased, or summarized and a reference listing that precisely identifies the writer, date, title, and supply location as out there. G:PROFESSIONAL COMMUNICATION NOT EVIDENT Content material is unstructured, is disjointed, or accommodates 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 troublesome to observe, or accommodates 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 accurately, and successfully conveys the supposed that means. Mechanics, utilization, and grammar promote correct interpretation and understanding. WEB LINKS ________________________________________ IHI FMEA Software SUPPORTING DOCUMENTS ________________________________________ FMEA Desk.docx