Fluent Essays

First, When you quote something from any of the 4 articles you have to write the exact sentence + the page number and but them in a quotation mark. like this ...... ( ..... 17). Then, you have to explain that in your own words just for few sentence. RTT1 Task 2 (0315) value: 0.00 value: 1.00 value: 2.00 value: 3.00 value: 4.00 Score/Level Articulation of Response (clarity, organization, mechanics) The candidate provides unsatisfactory articulation of response. The candidate provides weak articulation of response. The candidate provides limited articulation of response. The candidate provides adequate articulation of response. The candidate provides substantial articulation of response.   A. Root Cause Analysis The candidate does not complete an appropriate root cause analysis (RCA) that takes into consideration causative factors, errors, and/or hazards that led to the sentinel event (this patient’s outcome). The candidate completes an appropriate root cause analysis (RCA), with no detail, that takes into consideration causative factors, errors, and/or hazards that led to the sentinel event (this patient’s outcome). The candidate completes an appropriate root cause analysis (RCA), with limited detail, that takes into consideration causative factors, errors, and/or hazards that led to the sentinel event (this patient’s outcome). The candidate completes an appropriate root cause analysis (RCA), with adequate detail, that takes into consideration causative factors, errors, and/or hazards that led to the sentinel event (this patient’s outcome). The candidate completes an appropriate root cause analysis (RCA), with substantial detail, that takes into consideration causative factors, errors, and/or hazards that led to the sentinel event (this patient’s outcome).   B. Improvement Plan The candidate does not discuss a process improvement plan that would decrease the likelihood of a reoccurrence of the outcome of the scenario The candidate provides a logical discussion, with no detail, of a process improvement plan that would decrease the likelihood of a reoccurrence of the outcome of the scenario The candidate provides a logical discussion, with limited detail, of a process improvement plan that would decrease the likelihood of a reoccurrence of the outcome of the scenario The candidate provides a logical discussion, with adequate detail, of a process improvement plan that would decrease the likelihood of a reoccurrence of the outcome of the scenario. The candidate provides a logical discussion, with substantial detail, of a process improvement plan that would decrease the likelihood of a reoccurrence of the outcome of the scenario   B1. Change Theory The candidate does not provide a logical discussion of a change theory that could be used to implement the process improvement plan developed in B. The candidate provides a logical discussion, with no detail, of a change theory that could be used to implement the process improvement plan developed in B. The candidate provides a logical discussion, with limited detail, of a change theory that could be used to implement the process improvement plan developed in B. The candidate provides a logical discussion, with adequate detail, of a change theory that could be used to implement the process improvement plan developed in B. The candidate provides a logical discussion, with substantial detail, of a change theory that could be used to implement the process improvement plan developed in B.   C. FMEA The candidate does not use a failure mode and effects analysis to project the likelihood that the process improvement plan suggested would not fail. The candidate uses a failure mode and effects analysis, with no support, to project the likelihood that the process improvement plan suggested would not fail. The candidate uses a failure mode and effects analysis, with limited support, to project the likelihood that the process improvement plan suggested would not fail. The candidate uses a failure mode and effects analysis, with adequate support, to project the likelihood that the process improvement plan suggested would not fail. The candidate uses a failure mode and effects analysis, with substantial support, to project the likelihood that the process improvement plan suggested would not fail.   C1. Members of the Interdisciplinary Team The candidate does not accurately identify the members of the interdisciplinary team who will be included in the FMEA. N/A N/A N/A The candidate accurately identifies the members of the interdisciplinary team who will be included in the FMEA.   C2. Pre-Steps The candidate does not provide a logical discussion of the steps for preparing for the FMEA. The candidate provides a logical discussion, with no detail, of the steps for preparing for the FMEA. The candidate provides a logical discussion, with limited detail, of the steps for preparing for the FMEA. The candidate provides a logical discussion, with adequate detail, of the steps for preparing for the FMEA. The candidate provides a logical discussion, with substantial detail, of the steps for preparing for the FMEA.   C3. Three Steps The candidate does not appropriately apply the 3 steps of the FMEA (severity, occurrence, and detection) to the process improvement plan created in part B. The candidate appropriately applies, with no detail, the 3 steps of the FMEA (severity, occurrence, and detection) to the process improvement plan created in part B. The candidate appropriately applies, with limited detail, the 3 steps of the FMEA (severity, occurrence, and detection) to the process improvement plan created in part B. The candidate appropriately applies, with adequate detail, the 3 steps of the FMEA (severity, occurrence, and detection) to the process improvement plan created in part B. The candidate appropriately applies, with substantial detail, the 3 steps of the FMEA (severity, occurrence, and detection) to the process improvement plan created in part B.   C4. Interventions The candidate does not provide a logical explanation of how the candidate would test the interventions from the process improvement plan from part B to improve care in a similar situation. The candidate provides a logical explanation, with no support, of how the candidate would test the interventions from the process improvement plan from part B to improve care in a similar situation. The candidate provides a logical explanation, with limited support, of how the candidate would test the interventions from the process improvement plan from part B to improve care in a similar situation. The candidate provides a logical explanation, with adequate support, how the candidate would test the interventions from the process improvement plan from part B to improve care in a similar situation. The candidate provides a logical explanation, with substantial support, of how the candidate would test the interventions from the process improvement plan from part B to improve care in a similar situation.   D. Key Role of Nurses The candidate does not provide a logical discussion of how the professional nurse may function as a leader in promoting quality care and influencing quality improvement activities. The candidate provides a logical discussion, with no detail, of how the professional nurse may function as a leader in promoting quality care and influencing quality improvement activities. The candidate provides a logical discussion, with limited detail, of how the professional nurse may function as a leader in promoting quality care and influencing quality improvement activities. The candidate provides a logical discussion, with adequate detail, of how the professional nurse may function as a leader in promoting quality care and influencing quality improvement activities. The candidate provides a logical discussion, with substantial detail, of how the professional nurse may function as a leader in promoting quality care and influencing quality improvement activities.   E. Sources There is evidence of quoted, paraphrased or summarized content without acknowledgement of source information. This level is also appropriate if task instructions require the candidate to quote, paraphrase or summarize content from a source to complete the assessment, and this has not yet been done. The candidate provides required acknowledgement of source information for quoted, paraphrased and summarized content. However, in-text citations and/or source information is incomplete or inaccurate with respect to author, date, title and the location of the information (e.g., publisher, journal or website URL). N/A N/A The candidate provides source information for all quoted, paraphrased and summarized content. Source information appears to include accurate and complete acknowledgement of source information regarding the author, date, title and location of the information (e.g., publisher, journal or website URL) as well as appropriate in-text citation. This level is also appropriate if there is no evidence of quoted, paraphrased or summarized content, and it is not required by the instructions.   TITLE OF PAPER 1 Organizational Systems and Quality Leadership Task 2 Your Name (without letters or titles) TITLE OF PAPER 2 Organizational Systems and Quality Leadership Task 2 A. Root Cause Analysis The task directions for this prompt are to complete a root cause analysis that takes into consideration causative factors, errors, and/or hazards that led to the sentinel event (this patient’s outcome). Review the IHI content on root cause analysis before beginning this task so that you are sure you understand the process. Then, simply follow the steps in the process. While cause and effect and Ishikawa diagrams are visual representations of the relationships between the causative factors, their use is not mandatory in this assignment. It is better, generally, to describe in essay form what factors are involved, and how they are related. You will also want to clearly identify any errors (causative factors) and/or hazards (contributing factors) in the scenario. List these, together with an explanation of why you identified them as errors or hazards. I strongly encourage you to be very specific in which factors you are identifying as errors, and which as hazards. You might consider separating each into its own paragraph in your response. B. Improvement Plan The task directions for this ask you to discuss a process improvement plan that would decrease the likelihood of a reoccurrence of the outcome of the scenario. Think about this paper as describing an ongoing cycle of activities surrounding the sentinel event. In the RCA you identify the causes of the problem, in this section you are offering a plan to correct those causes, and in the third section you will evaluate your plan to determine whether it will do what you intend it to do. TITLE OF PAPER 3 In this prompt you are describing the changes in the process of care for conscious sedation that you recommend to address the causative factors you identified in your RCA. What specific changes do you recommend to prevent a recurrence? B1. Change Theory In this prompt you are to discuss a change theory that could be used to implement the process improvement plan developed in B. You will want to review the material in IHI on change theory (QI 105) so that you understand what it is, and how it is used. Pay careful attention that you are both describing the change theory, and applying it to your plan of correction. You will want to identify the theory you are using, describe each of the steps or stage of that theory, then describe how each of the stages will be applied to your improvement plan. Students have a tendency to describe one or the other, but to then forget to combine the two into a coherent approach to implementing their plan of correction. After you’ve written this section, be sure to go back and make sure that you have tied the concepts together. C. FMEA The task directions for this prompt are to use a failure mode and effects analysis (FMEA) to project the likelihood that the process improvement plan you suggest would not fail. This prompt contains four sub-prompts (C1, C2, C3, and C4). These prompts are part of your response to C. Do not get confused or feel that you are repeating yourself. You are simply being guided through the process of answering this general prompt. In this prompt, describe what the FMEA is, then provide substantial support to imagine how your plan would be successful and how you would use the FMEA to determine that it would be successful (or would not fail.) You do not need to actually implement the FMEA, you only need to describe how you implement it. TITLE OF PAPER 4 C1. Members of the Interdisciplinary Team The task directions for this prompt merely ask you to identify the members of the interdisciplinary FMEA team. A mere listing is probably insufficient; you will want to provide some justification for your choices. C2. Pre-Steps The task directions are to discuss the steps in preparing for the FMEA. Be sure you address your improvement plan in your discussion. This prompt challenges students because the steps are not spelled out. Consider that virtually all procedures involve a series of steps that can be divided into three phases: steps in preparing for the process, the process, and the post-steps. A careful reading of the steps of the FMEA, as outlined in the FMEA tool available from the IHI website, will reveal the three phases of the process. That is, the steps that occur before the actual FMEA begins, the analysis process itself, and the steps that follow the analysis. To properly answer the prompt, I would suggest clearly identifying the steps, then describing them. That is, “Step one is yadda, yadda, yadda.” This way the evaluator can easily identify the steps you are discussing. C3. Three Steps The task directions for this prompt are to apply the three steps of the FMEA (Severity, occurrence, and detection) to the process improvement plan you created in prompt B. Again, insure that you are clearly identifying each of the three topics and that you are applying them to the scenario. I strongly suggest that you discuss each in its own paragraph and not intermingle them. Intermingling them leads to a confused discussion and may make it difficult for the evaluator to clearly identify the three elements. Be sure to describe how each is used in the TITLE OF PAPER 5 FMEA process. A thorough discussion will include a description of the three steps, a description of how they might be applied to your improvement plan, and a discussion of the purpose and application of RPN values. Remember that you do not have to carry out the FMEA. This means that you do not need to develop tables, assign numbers, and so forth. You merely need to describe the processes involved. C4. Interventions The task directions for this prompt are to explain how you would test the interventions from the process improvement plan from part B to improve care in a similar situation. You want to be very specific in describing how you might test your improvement plan. D. Key Role of Nurses The task instructions for this prompt are to discuss how the professional nurse may function as a leader in promoting quality care and influencing quality improvement activities. This prompt may be a more generic discussion of how nurses function as leaders in improving quality of care. Think about some of the things that you have learned in this course about the role that nurses play in influencing quality in healthcare. Review the IHI material and your Cherry and Jacob text for additional ideas. Discuss WHY the nurse plays a key role. You might consider some of the provisions from the ANA Code of Ethics (or those of other professional nursing organizations). The Reference Page The Reference Page always starts on a new page, never at the tail end of the final paragraph. Use the hard page command to force a new page – [Ctrl]-[Enter]. The Reference TITLE OF PAPER 6 Page uses hanging indents: this document is set up with a hanging indent on the Reference Page if you choose to use it as a template. Sources are listed alphabetically by first author’s last name or by organization if no author can be found. The title of the article is in sentence case, not title case, and is italicized. The Online Writing Lab at Purdue is an excellent source for guidance on citations and referencing. Simply use an internet search engine to find “OWL at Purdue APA format”. Do not allow any blue underlined hyperlink to remain when typing in a Web link. As soon as it automatically appears, immediately backspace once to remove it. Referencing Your Citations This is a good rule of thumb - If the thought didnt originate within your cranium, it originated within someone elses cranium, and therefore must be cited (this includes anything paraphrased or quoted). If it is cited, it must be listed on the Reference page. If it is not cited, it should NOT appear on the Reference page. Hint: anything you looked up or read on the internet did not originate within your cranium ☺ and that includes state regulations, the ANA Code of Ethics, IHI modules, course textbooks and online courses, etc. Sources. If you use sources, include all in-text citations and references in APA format. When using sources to support ideas and elements in a paper or project, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the paper or project. Note: No more than a combined total of 30\% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the APA Guidelines section. Remember: Personal correspondence and interviews should NOT be TITLE OF PAPER 7 listed on the reference page, because they are not discoverable for anyone else; but they may be cited within the document. TITLE OF PAPER 8 References Authors, R. & Alphabetic, O. (2010). Authors must be in alphabetic order. Search Owl at Purdue for APA Style Helps. http://owl.english.purdue.edu/. (try not to allow blue hyperlinks). Any hyperlinks on the reference page must work – the evaluators WILL check these. Do not hyperlink to a page within an area accessible only through personal login, because the evaluator does not have your login and password. Hope-this-helps, I. (2013). Use this document to create your own template: Fill in your own information. Mentoring Advice Times: 7, 1-3. Last, N. & First, I. (1998). Title in italics without caps. Town, ST: Lippincott. SUBDOMAIN 734.3 ­ ORGANIZATIONAL SYSTEMS & QUALITY LEADERSHIP Competencies: 734.3.1: Principles of Leadership ­ The graduate applies principles of leadership to promote high­quality healthcare in a variety of settings through the application of sound leadership principles. 734.3.2: Interdisciplinary Collaboration ­ The graduate applies theoretical principles necessary for effective participation in an interdisciplinary team. 734.3.3: Quality and Patient Safety ­ The graduate applies quality improvement processes intended to achieve optimal healthcare outcomes, contributing to and supporting a culture of safety. 734.3.4: Healthcare Utilization and Finance ­ The graduate analyzes financial implications related to healthcare delivery, reimbursement, access, and national initiatives 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 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: It is 3:30 p.m. on a Thursday and Mr. B, a 67­year­old patient, arrives at the six­room emergency department (ED) of a sixty­bed rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog. Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR­88 (regular), T­98.6, R­32, and his weight was recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, “My hip area and leg hurt really bad. I have never had anything like this before.” Patient rates pain at ten out of ten on the numerical verbal pain scale. He appears to be in moderate distress. His (L) leg appears shortened with swelling (edema in the calf), ecchymosis, and limited range of motion (ROM). Mr. B’s leg is stabilized and then he is further evaluated and discharged from triage to the emergency department (ED) patient room. He is admitted by Nurse J. The admitting nurse finds that Mr. B has a history of impaired glucose tolerance and prostate cancer. At Mr. B’s last visit with his primary care physician, laboratory data revealed elevated cholesterol and lipids. Mr. B’s current medications are atorvastatin and oxycodone for chronic back pain. After the nurse completes Mr. B’s assessment, Nurse J informs the ED physician of admission findings and the ED physician proceeds to examine Mr. B. Staffing on this day consists of two nurses (one RN and one LPN), one secretary, and one emergency department physician. Respiratory therapy is in­house and available as needed. At the time of Mr. B’s arrival, the ED staff is caring for two other patients. One patient is a 43­year­old female complaining of a throbbing headache. The patient rates current pain at four out of ten on numerical verbal pain scale. The patient states that she has a history of migraines. She received treatment, remains stable, and discharge is pending. The second patient is an eight­year­old boy being evaluated for possible appendicitis. Laboratory results are pending for this patient. Both of these patients were examined, evaluated, and cared for by the ED physician and are awaiting further treatment or orders. After evaluation of Mr. B, Dr. T, the ED physician, writes the order for Nurse J to administer diazepam 5 mg IVP to Mr. B. The medication diazepam is administered IVP at 4:05 p.m. After five minutes, the diazepam appears to have had no effect on Mr. B, and Dr. T instructs Nurse J to administer hydromorphone 2 mg IVP. The medication (hydromorphone) is administered IVP at 4:15 p.m. After five minutes, Dr. T is still not satisfied with the level of sedation Mr. B has achieved and instructs Nurse J to administer another 2 mg of hydromorphone IVP and an additional 5 mg of diazepam IVP. The physician’s goal is for the patient to achieve skeletal muscle relaxation from the diazepam, which will aid in the manual manipulation, relocation, and alignment of Mr. B’s hip. The hydromorphone IVP was administered to achieve pain control and sedation. After reviewing the patient’s medical history, Dr. T notes that the patient’s weight and current regular use of oxycodone appear to be making it more difficult to sedate Mr. B. Finally at 4:25, the patient appears to be sedated and the successful reduction of his (L) hip takes place. The patient appears to have tolerated the procedure and remains sedated. He is not currently on any supplemental oxygen. The procedure concludes at 4:30 p.m. and Mr. B is resting without indications of discomfort and distress. At this time, the ED receives an emergency dispatch call alerting the emergency department that the emergency rescue unit paramedics are en route with a 75­year­old patient in acute respiratory distress. Nurse J places Mr. B on an automatic blood pressure machine programmed to monitor his B/P every five minutes and a pulse oximeter. At this time Nurse J leaves his room. The nurse allows Mr. B’s son to sit with him as he is being monitored via the blood pressure monitor. At 4:35, Mr. B’s B/P is 110/62 and his O2 sat is 92\%. He remains without supplemental oxygen and his ECG and respirations are not monitored. Nurse J and the LPN on duty have received the emergency transport patient. They are also in the process of discharging the other two patients. Meanwhile, the ED lobby has become congested with new incoming patients. At this time, Mr. B’s O2 saturation alarm is heard and shows “low O2 saturation” (currently showing a sat of 85\%). The LPN enters Mr. B’s room briefly and resets the alarm and repeats the B/P reading. Nurse J is now fully engaged with the emergency care of the respiratory distress patient, which includes assessments, evaluation, and the ordering respiratory treatments, CXR, labs, etc. At 4:43, 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 pressure machine shows Mr. B’s B/P reading is 58/30 and the O2 sat is 79\%. The patient is not breathing and no palpable pulse can be detected. A STAT CODE is called and the son is escorted to the waiting room. The code team arrives and begins resuscitative efforts. When connected to the cardiac monitor, Mr. B is found to be in ventricular fibrillation. CPR begins immediately by the RN, and Mr. B is intubated. He is defibrillated and reversal agents, IV fluids, and vasopressors are administered. After 30 minutes of interventions, the ECG returns to a normal sinus rhythm with a pulse and a B/P of 110/70. The patient is not breathing on his own and is fully dependent on the ventilator. The patient’s pupils are fixed and dilated. He has no spontaneous movements and does not respond to noxious stimuli. Air transport is called and, upon the family’s wishes, the patient is transferred to a tertiary facility for advanced care. Seven days later, the receiving hospital informed the rural hospital that EEG’s had determined brain death in Mr. B. The family had requested life­support be removed, and Mr. B subsequently died. Additional information: The hospital where Mr. B. was originally seen and treated had a moderate sedation/analgesia (“conscious sedation”) policy that requires that the patient remains on continuous B/P, ECG, and pulse oximeter throughout the procedure and until the patient meets specific discharge criteria (i.e., fully awake, VSS, no N/V, and able to void). All practitioners who perform moderate sedation must first successfully complete the hospital’s moderate sedation training module. The training module includes drug selection as well as acceptable dose ranges. Additional (backup) staff was available on the day of the incident. Nurse J had completed the moderate sedation module. Nurse J had current ACLS certification and was an experienced critical care nurse. Nurse J’s prior annual clinical evaluations by the manager demonstrated that the nurse was “meeting requirements.” Nurse J did not have a history of negligent patient care. Sufficient equipment was available and in working order in the ED on this day. Task: A.  Complete a root cause analysis (RCA) that takes into consideration causative factors, errors, and/or hazards that led to the sentinel event (this patient’s outcome).   B.  Discuss a process improvement plan that would decrease the likelihood of a reoccurrence of the outcome of the scenario. 1.  Discuss a change theory that could be used to implement the process improvement plan developed in B.   C.  Use a failure mode and effects analysis (FMEA) to project the likelihood that the process improvement plan you suggest would not fail. 1.  Identify the members of the interdisciplinary team who will be included in the FMEA. 2.  Discuss steps for preparing for the FMEA. 3.  Apply the three steps of the FMEA (severity, occurrence, and detection) to the process improvement plan created in part B. 4.  Explain how you would test the interventions from the process improvement plan from part B to improve care in a similar situation.        Note:You are not expected to carry out the full FMEA, but you should explain each step, and how you would apply it to your process improvement plan.   D.  Discuss how the professional nurse may function as a leader in promoting quality care and influencing quality improvement activities.   E.  When you use sources to support ideas and elements in a paper or project, provide acknowledgement of source information for any content that is quoted, paraphrased or summarized. Acknowledgement of source information includes in­text citation noting specifically where in the submission the source is used and a corresponding reference, which includes: •   Author •   Date •   Title •   Location of information (e.g., publisher, journal, or website URL) Note: The use of APA citation style is encouraged but is not required for this task. Evaluators will offer feedback on the acknowledgement of source information but not with regard to conformity with APA or other citation style. For tips on using APA style, please refer to the APA Resources web link found under General Information/APA Guidelines in the left­hand panel in TaskStream. Note: No more than a combined total of 30\% of a submission can be directly quoted or closely paraphrased from outside sources, even if cited correctly.