Root Cause Analysis: Improving Patient Safety
1.What was the mistake?
The case does not specify or mention anything about improving the patient safety. Before anything is done the administration need to use the root cause analysis to identify how this incident occurred and why. The best tool that they can use for this case is Rapid cycle improvement to assure that the problem does not happen again and that is often measured. Another tool that needs to be used is FMEA because it assesses by using hazard analysis and then it is fixed by PDSA cycle. The mistakes that have occurred are common sense which at this point it seems that the staff is weather not trained or they don’t care to do their job properly. The next step is to train all staff in a clinical environment. Also, making sure
The case does not specify or mention anything about improving the patient safety. Before anything is done the administration need to use the root cause analysis to identify how this incident occurred and why. The best tool that they can use for this case is Rapid cycle improvement to assure that the problem does not happen again and that is often measured. Another tool that needs to be used is FMEA because it assesses by using hazard analysis and then it is fixed by PDSA cycle. The mistakes that have occurred are common sense which at this point it seems that the staff is weather not trained or they don’t care to do their job properly. The next step is to train all staff in a clinical environment. Also, making sure