CriteriaforRootCauseAnalysisRCADiscussionInitialPosting1.docx
MINNESOTA STATE UNIVERSITY, MANKATO
SCHOOL OF NURSING
NURS 420 Informatics, Quality, and Safety for RNs
Instructions: Review the Case Scenarios posted under “Course Content.” Also review the QI document by Health Quality Ontario posted under “Additional Course Readings.” Write a response using the following rubric as your guide to content required.
Criteria for Informatics, Safety, and Quality Research Paper
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Criteria
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Introduction and Background: Select one of the scenarios in which a medical error(s) occurred. The scenarios are listed under “Content.” For the selected scenario, identify the problem and
the significance of the issue in nursing and health care. Provide
background information on the scenario, and
explain the purpose of a
Root Cause Analysis
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Fishbone Diagram: Develop a fishbone diagram that addresses the defects or problems you identified in the case scenario. You are expected to post a fishbone diagram that shows the defects by category as a part of the initial posting. Then, discuss the following: What might be the problems that led to the error? What are five why questions that you might ask to get more information related to the incident? Identify what you determine to be the top cause of the error.
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Select one of the possible causes identified in the fishbone diagram. Write a 5 Whys for this cause.You do not need to select the identified root cause of the sentinel event. The 5 Whys can be written on any of the possible causes identified in the case scenario.
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Summary: Tie together the sections of the posting. Include the major
findings and
conclusions drawn from the exercise.
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Review your work to ensure that the APA format is correct and the posting is free of spelling and grammatical errors.
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