EXERCISE 2 My involvement in the drug error is as follows. I was working on the night shift as the only qualified nurse with 2 nursing assistants. The late shift decided to administer the 10pm medications as a way of helping me. This however was key in me making the error that I did. If I had been left to do the 10pm medications by myself‚ this error would not have occurred. Patient PF was given her medication by the late staff‚ however she had spat them out. On going to give her these
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the Institute of Medicine in 1999 reported that “nearly a million patients each year are injured in hospitals in the United States due to error. Medication errors occur more often than other categories of preventable errors (19%)‚ and most medication errors occurred during medication administration (34%) where they were more likely to directly impact the patient and cause harm.” (Gooder‚ 2011). Not long after looking at these percentages was the BCMA (Barcode
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Athanasakis‚ E. (2012). Prevention of medication errors made by nurses in clinical practice. Health Science Journal‚ 6(4)‚ 773-783. Brady‚ A.‚ Malone‚ A.‚ & Fleming‚ S. (2009). A literature review of the individual and systems factors that contribute to medication errors in nursing practice. Journal Of Nursing Management‚ 17(6)‚ 679-697. doi:10.1111/j.1365-2834.2009.00995.x Choo‚ J.‚ Hutchinson‚ A.‚ & Bucknall‚ T. (2010). Nurses ’ role in medication safety. Journal Of Nursing Management‚ 18(7)‚ 853-861.
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Root cause analysis (RCA) is a structured method used to analyze serious adverse events. The goal of RCA is to identify underlying problems that increase the likelihood of errors while avoiding the trap of focusing on mistakes by individuals. A team focuses on the identification of the errors that occurred. They analyze each error to determine the underlying factors (root causes)‚ than if eliminated‚ can reduce the risk of similar errors in the future. Next‚ they put a plan into place‚ this will
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RUNNING HEAD: RTT1 TASK 2 1 RTT1 Task 2: Root Cause Analysis‚ Change Theory‚ FMEA‚ and Nursing Western Governors University RTT1 TASK 2 2 RTT1 Task 2: Root Cause Analysis‚ Change Theory‚ FMEA‚ and Nursing Root Cause Analysis (RCA) A root cause analysis (RCA) is an essential tool that can be used to examine and understand the ways in which systems fail as well as discuss those specific failures that led to a specific adverse event and potentially implement steps or behaviors to
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professional field of experience. EDUCATION HISTORY: ➢ 2010-recently enrolled Master of Arts in Nursing (Clinical Supervision) University of San Carlos‚ Cebu City ➢ 2004 to 2006= Master of Arts in Nursing (Nursing Administration) Completed the 33 units and passed the Comprehensive examination Pamantasan ng Lungsod ng Maynila ➢ 1990-1994= Bachelor of Science in Nursing University of Perpetual Help System of Laguna Dean’s List from 1st year to 2nd year
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investigation is to determine the root cause analysis (RCA) of the sentinel event‚ which occurred in the emergency room. Once the cause is identified‚ a plan of action will be established‚ and a failure mode and effects analysis (FMEA) will be done to reduce the likelihood that the new processes
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which occurred at Nightingale Community Hospital and analyze all aspects of the event. This analysis includes a review of the personnel present‚ barriers to the personnel being able to adequately complete their job‚ and how future staff interactions may be improved. In addition‚ the analysis will review the selected quality improvement approach to be used during the completion of a root cause analysis of the event and what can be done by Nightingale Community Hospital to ensure the sentinel event
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CIN: Computers‚ Informatics‚ Nursing & Vol. 32‚ No. 12‚ 589–595 & Copyright B 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins F E A T U R E A R T I C L E Impact of an Electronic Medication Administration Record on Medication Administration Efficiency and Errors JEFFERY MCCOMAS‚ MSN‚ RN‚ CNS MICHELLE RIINGEN‚ DNP‚ RN‚ CNS-BC SON CHAE KIM‚ PhD‚ RN Congress authorized an initiative in 2004 to create a national health information technology infrastructure to improve patient outcomes through
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entitled “The danger of Medication error due to understaffed nurses.” BACKGROUND OF THE PROBLEM The nursing profession has traditionally accepted responsibility to assure that safe and accessible health care is available to the public at all times‚ including times when nurses are in short supply. The profession continues to accept such responsibility and also recognizes the need to identify strategies to promote the availability of the best nursing care during these critical
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