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Discuss how the professional nurse may function as a leader in promoting quality care and influencing quality improvement activities.
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.
It is 3:30 p.m. on a Thursday and a 67-year-old patient, arrives at the six-room emergency department (ED) of a sixty-bed rural hospital. He has been brought to the hospital by his son and neighbor. At this time, he 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.
he was admitted to the triage room where his vital signs were B/P 120/80, HR-88 (regular), T-98.6, R-32, and his weight was recorded at 175 pounds. he states that he has no known allergies and no previous falls. He states, â€œMy hip area and leg hurt really bad. I have never had anything like this before.â€ 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). his 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. The admitting nurse finds that he has a history of impaired glucose tolerance and prostate cancer. At his last visit with his primary care physician, laboratory data revealed elevated cholesterol and lipids. his current medications are atorvastatin and oxycodone for chronic back pain. After the nurse completes his assessment, she informs the ED physician of admission findings and the ED physician proceeds to examine him.
Staffing on this day consists of two nurses (one RN and one LPN), one secretary, and one emergency department physician. Respiratory therapy is in-house and available as needed. At the time of his arrival, the ED staff is caring for two other patients. One patient is a 43-year-old 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 eight-year-old 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 , the ED physician, writes the order for Nurse to administer diazepam 5 mg IVP to him. The medication diazepam is administered IVP at 4:05 p.m. After five minutes, the diazepam appears to have had no effect on him, and ED physician instructs Nurse to administer hydromorphone 2 mg IVP. The medication (hydromorphone) is administered IVP at 4:15 p.m. After five minutes, ed physician is still not satisfied with the level of sedation he has achieved and instructs Nurse to administer another 2 mg of hydromorphone IVP and an additional 5 mg of diazepam IVP. The physicianâ€s medical history, ed physician notes that the patientâ€s weight and current regular use of oxycodone appear to be making it more difficult to sedate him.
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