NURS 8300 Week 9 Discussion: Root Cause Analysis
NURS 8300 Week 9 Discussion: Root Cause Analysis
NURS 8300 Week 9: The Application of Quality Improvement Models in Organizations and Systems
NURS 8300 Week 9 Discussion: Root Cause Analysis
NURS 8300 Week 9 Discussion: Root Cause Analysis
Note: Weeks 8 and 9 are linked together in an assignment that is completed within your group. Each group will receive the same grade for the final powerpoint submission at the end of Week 9. Each individual will receive a unique grade in Weeks 8 and 9 which is based on your individual contribution to the small group discussion boards as well as your participation in the final Week 9 discussion as well as the slides that you contribute to the powerpoint.
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Root cause analysis (RCA) is a standard tool used to help health care organizations learn from errors, particularly those that result in harm. RCA is applied to address three key questions about a particular situation:
- What happened?
- Why did it happen?
- What can be done to prevent it from happening again?
To prepare for and complete this Discussion:
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As a case study team, prepare a 10 slide power-point using tools provided in this case study to present your rationale and validation of the root causes your team has chosen. Be sure to include at least 4 peer reviewed research studies which evoke validation of the latest patient safety evidence in support of your root cause findings. Also address the extent to which this scenario evokes implication for value based purchasing.
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To prepare for Week 9:
Continue your small group dialogue in dissecting the case study.
By Day 3
A designated team member will post the team powerpoint and key insights that your team has gained about your choices, this type of sentinel event, and use of root cause analysis in Week 9 discussion board.
By Day 7
Each student will respond to at least two other group PowerPoints and analysis.
Submission and Grading Information
NURS 8300 Week 9: The Application of Quality Improvement Models in Organizations and Systems
Wrong-side surgeries, hospital acquired infections, medication errors, and wrongful deaths-these sorts of medical mistakes often make headline news. How can these types of errors be prevented? Throughout this course, you have been examining methods for systematically improving the quality of care and patient safety within a health care organization. Another tool that can be used to evaluate medical and system errors is a root cause analysis.
This week, you explore root cause analysis, which is one of the key methods used in health care organizations to understand and address patient safety situations.
Learning Objectives
By the end of this week, you will be able to:
- Apply qualitative and quantitative methods to identify root causes of a specific quality improvement need
- Evaluate adverse events or factors that lead to a specific quality improvement need
- Formulate goals from collected data
Photo Credit: [Blend Images/ERproductions Ltd]/[Blend Images]/Getty Images
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Joshi, M.S., Ransom, E.R., Nash, D.B., & Ransom, S.B., (Eds.). (2014). The Healthcare Quality Book, 3rd ed. Chicago, IL: Health Adminisration Press.
- Chapter 20: “How Purchasers Select and Pay for Value: the Movement to Value Based Purchasing”
Brown, J. E., Smith, N., & Sherfy, B. R. (2011). Decreasing mislabeled laboratory specimens using barcode technology and bedside printers. Journal of Nursing Care Quality, 26(1), 13–21. doi:10.1097/NCQ.0b013e3181e4e6dd
Note: You will access this article from the Walden Library databases.
A health care organization reduced their errors of labeling the wrong blood specimens when it implemented barcode scanners and computers to create labels. The study within this article gives an overview of this process and its results.
Carroll, L. J., & Rothe, J. P. (2010). Levels of reconstruction as complementarity in mixed methods research: a social theory-based conceptual framework for integrating qualitative and quantitative research. International Journal of Environmental Research and Public Health, 7(9), 3478–3488.
Note: You will access this article from the Walden Library databases.
The authors of this article propose that qualitative and quantitative research cannot be presented together without a conceptual framework. They develop a conceptual framework that can unite the qualitative and quantitative data that health care professionals and organizations can use.
Nicolini, D., Waring, J., & Mengis, J. (2011). Policy and practice in the use of root cause analysis to investigate clinical adverse events: Mind the gap. Social Science & Medicine, 73(2), 217–225. doi:10.1016/j.socscimed.2011.05.010
Note: You will access this article from the Walden Library databases.
Within this article, the authors question the effectiveness of Root Cause Analysis (RCA), which they describe as originally a learning technique that has taken on the role of a monitoring tool. They propose that a better understanding of RCA and a possible revision could increase patient safety within health care organizations.
Optional Resources
Smith, M. L., & Erwin, J. A. (2011). Final solution via root cause analysis (with a template). iSixSigma. Retrieved from http://www.isixsigma.com/tools-templates/cause-effect/final-solution-root-cause-analysis-template/
Rubric Detail
Select Grid View or List View to change the rubric’s layout.
| Excellent | Good | Fair | Poor | |
|---|---|---|---|---|
| RESPONSIVENESS TO DISCUSSION QUESTION
Discussion post minimum requirements: *The original posting must be completed by Wednesday, Day 3, at 11:59pm MST. Two response postings to two different peer original posts, on two different days, are required by Saturday, Day 6, at 11:59pm MST. Faculty member inquiries require responses, which are not included in the minimum number of posts. Your Discussion Board postings should be written in standard edited English and follow APA style for format and grammar as closely as possible given the constraints of the online platform. Be sure to support the postings with specific citations from this week’s Learning Resources as well as resources available through the Walden University online databases. Refer to the Essential Guide to APA Style for Walden Students to ensure your in-text citations and reference list are correct. |
8 (26.67%) – 8 (26.67%)
Discussion postings and responses exceed the requirements of the Discussion instructions. They: Respond to the question being asked or the prompt provided; – Go beyond what is required in some meaningful way (e.g., the post contributes a new dimension, unearths something unanticipated); -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence. – Demonstrate significant ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning -Resources as well as additional resources and has read, viewed, or considered a sampling of colleagues’ postings; -Exceed the minimum requirements for discussion posts*.
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7 (23.33%) – 7 (23.33%)
Discussion postings and responses meet the requirements of the Discussion instructions. They: -Respond to the question being asked or the prompt provided; -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence.re -Demonstrate ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning Resources and has read, viewed, or considered a sampling of colleagues’ postings -Meet the minimum requirements for discussion posts*.
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6 (20%) – 6 (20%)
Discussion postings and responses are minimally responsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or -May (lack) lack in depth, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence; and/or -Do not adequately demonstrate that the student has read, viewed, and considered the Learning -Resources and/or a sampling of colleagues’ postings; and/or has posted by the due date at least in part. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not meet the minimum requirements for discussion posts*.
|
0 (0%) – 5 (16.67%)
Discussion postings and responses are unresponsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or – Lack in substance, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not demonstrate that the student has read, viewed, and considered the Learning Resources and/or a sampling of colleagues’ postings; and/or does not meet the minimum requirements for discussion posts*.
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| CONTENT KNOWLEDGE |
8 (26.67%) – 8 (26.67%)
Discussion postings and responses: -demonstrate in-depth understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; – are well supported by pertinent research/evidence from a variety of and multiple peer- reviewed books and journals, where appropriate; -Demonstrate significant mastery and thoughtful/accurate application of content, applicable skills or strategies presented in the course.
|
7 (23.33%) – 7 (23.33%)
Discussion postings and responses: -demonstrate understanding and application of the concepts and issues presented in the course, presented with some understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; -are supported by research/evidence from peer-reviewed books and journals, where appropriate; and · demonstrate some mastery and application of content, applicable skills, or strategies presented in the course.
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6 (20%) – 6 (20%)
Discussion postings and responses: – demonstrate minimal understanding of concepts and issues presented in the course, and, although generally accurate, display some omissions and/or errors; –lack support by research/evidence and/or the research/evidence is inappropriate or marginal in quality; and/or lack of analysis, synthesis or evaluation of topic – demonstrate minimal content, skills or strategies presented in the course. ——-Contain numerous errors when using the skills or strategies presented in the course
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0 (0%) – 5 (16.67%)
Discussion postings and responses demonstrate: -A lack of understanding of the concepts and issues presented in the course; and/or are inaccurate, contain many omissions and/or errors; and/or are not supported by research/evidence; and/or lack of analysis, synthesis or evaluation of topic -Many critical errors when discussing content, applicable skills or strategies presented in the course.
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| CONTRIBUTION TO THE DISCUSSION |
8 (26.67%) – 8 (26.67%)
Discussion postings and responses significantly contribute to the quality of the discussion/interaction and thinking and learning by: -providing Rich and relevant examples; discerning and thought-provoking ideas; and stimulating thoughts and probes; – -demonstrating original thinking, new perspectives, and extensive synthesis of ideas supported by the literature.
|
7 (23.33%) – 7 (23.33%)
Discussion postings and responses contribute to the quality of the discussion/interaction and thinking and learning by -providing relevant examples; thought-provoking ideas – Demonstrating synthesis of ideas supported by the literature
|
6 (20%) – 6 (20%)
Discussion postings and responses minimally contribute to the quality of discussion/interaction and thinking and learning by: – providing few and/or irrelevant examples; and/or – providing few if any thought- provoking ideas; and/or -. Information that is restated from the literature with no/little demonstration of critical thinking or synthesis of ideas.
|
0 (0%) – 5 (16.67%)
Discussion postings and responses do not contribute to the quality of interaction/discussion and thinking and learning as they do not: -Provide examples (or examples are irrelevant); and/or -Include interesting thoughts or ideas; and/or – Demonstrate of critical thinking or synthesis of ideas
|
| QUALITY OF WRITING |
6 (20%) – 6 (20%)
Discussion postings and responses exceed doctoral -level writing expectations. They: · Use grammar and syntax that is clear, concise, and appropriate to doctoral level writing; · Make few if any errors in spelling, grammar, and syntax; · Use original language and refrain from directly quoting original source materials; -provide correct APA · Are positive, courteous, and respectful when offering suggestions, constructive feedback, or opposing viewpoints.
|
5 (16.67%) – 5 (16.67%)
Discussion postings and responses meet doctoral -level writing expectations. They: ·Use grammar and syntax that is clear and appropriate to doctoral level writing; ; · Make a few errors in spelling, grammar, and syntax; · paraphrase but refrain from directly quoting original source materials; Provide correct APA format · Are courteous and respectful when offering suggestions, constructive feedback, or opposing viewpoints;.
|
4 (13.33%) – 4 (13.33%)
Discussion postings and responses are minimally below doctoral-level writing expectations. They: · Make more than occasional errors in spelling, grammar, and syntax; · Directly quote from original source materials and/or paraphrase rather than use original language; lack correct APA format; and/or · Are less than courteous and respectful when offering suggestions, feedback, or opposing viewpoints.
|
0 (0%) – 3 (10%)
Discussion postings and responses are well below doctoral -level writing expectations. They: · Use grammar and syntax that is that is unclear · Make many errors in spelling, grammar, and syntax; and –use incorrect APA format · Are discourteous and disrespectful when offering suggestions, feedback, or opposing viewpoints.
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| Total Points: 30 |
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