The patient has been admitted to a 20-bed medical unit for treatment of acute diverticulitis. The provider has ordered Ultram (Tramadol hydrochloride) 50 mg p.o. every 6 hours prn pain. The patient is requesting a pain medication, as it has been 8 hours since his last dose. The nurse selects the individually wrapped medication from the patient’s assigned medication drawer and scans the barcode to determine if it is the correct medication. The scanner is not working again. As she wants to administer the pain medication as soon as possible, she types in the Internal Entry Number (IEN) and the computer indicates the medication is Ultracet 37.5/325 mg but the package says Ultram 50 mg. The nurse calls the pharmacy and the pharmacist says there is only one number different between Ultram and Ultracet and, since the package says Ultram, to administer the medication because she must have typed in the wrong number. The nurse administers the medication, and within 30 minutes the patient shows signs of an allergic reaction. The nurse checks the record and determines the patient is allergic to acetaminophen. The patient is treated for the allergic reaction, and a medication incident form is completed. The nurse manager asks for a Root Cause Analysis (RCA) to be completed for the medication error.

Review the case scenario included in this week’s media resources, and examine the process flow chart, cause/effect diagram, and Pareto chart related to the case scenario.

In the scenario, 

The nurse manager and the director of pharmacy blame each other for the error. The facilitator (quality assurance person) asks everyone to avoid blaming and focus on applying the tools to analyze the data and get to the root cause of the error.

While all of these tools contribute, for this Assignment : Select one tool to analyze.

·  

· Analyze the composition of the RCA team. 

· Explain what knowledge they can contribute to the RCA.

· Describe the collaboration in the case study that led to effective problem solving. Identify the evidence you observe in the scenario that demonstrates effective collaboration and the avoidance of blaming.

· Explain the team’s process in testing for and eliminating root causes that were not contributing.

· Select one of the performance improvement charts presented in the scenario and critique its effectiveness by explaining how it contributes to identifying the root cause and determining a solution to prevent repeat medication errors.

· Identify the contributing factors, and discuss how to prevent this kind of error from occurring in the future.

Support your response with references from the professional nursing literature. Your posts need to be written at the capstone level (see checklist)

NOTE; This should be a 5-paragraph (at least 550 words) response.

Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old). (Refer to AWE Checklist, Capstone)

Spath, P. (2018). Introduction to healthcare quality management (3rd ed.). Chicago, IL: Health Administration Press.

• Chapter 4, “Evaluating      Performance” (pp. 79-118)
• Chapter 5, “Continuous      Improvement” (pp. 119-142)
• Chapter 6, “Performance Improvement Tools”      (pp. 143-174)

Note: Although these chapters are previously assigned readings, please review them in preparation for this week’s material.

Yoder-Wise, P. S. (2019). Leading and managing in nursing (7th ed.). St. Louis, MO: Mosby.

• Chapter 18, “Leading Change” (pp. 319-335)

https://class.content.laureate.net/a6596733e7b39b81cb24d77c15f22999.html#section_container0 

BACKGROUND

The client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her since she was 9 years old). She presents to your office today following a 21 day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month. 

Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control” which resulted in his calling the police and her subsequent admission to an inpatient psych unit.

During today’s assessment, she appears quite calm, and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She tells you that she knows this because the television is telling her so. 

She currently weighs 140 lbs, and is 5’ 5”

SUBJECTIVE

Client reports that her mood is “good.” She denies auditory/visual hallucinations, but believes that the television does talk to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards the PMHNP, but then calms down.

You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits. 

Client admits that she stopped taking her Risperdal about a week after she got out of the hospital because she thinks her husband is going to poison her so that he can marry an American woman. 

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Her speech is slow and at times, interrupted by periods of silence. Self-reported mood is euthymic. Affect constricted. Although the client denies visual or auditory hallucinations, she appears to be “listening” to something. Delusional and paranoid thought processes as described, above. Insight and judgment are impaired. She is currently denying suicidal or homicidal ideation.

The PMHNP administers the PANSS which reveals the following scores:

-40 for the positive symptoms scale

-20 for the negative symptom scale

-60 for general psychopathology scale

Diagnosis: Schizophrenia, paranoid type

At each decision point stop to complete the following:

• Decision #1
  • Which decision did you select?
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
• Decision #2
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
• Decision #3
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

  

-Explain the concept of a  knowledge worker (in nursing).

-Define and explain nursing informatics and

– highlight the role of a nurse leader as a knowledge worker.

Include  –

-your examination of the data that you could use, 

-how the data might be accessed/collected, and 

-what knowledge might be derived from that data. 

Be sure to incorporate feedback received from your colleagues’ responses

Develop a simple infographic to help explain these concepts. 

Please note that this is not a Powerpoint!!, it should be an infographic. Again, please read the information under resources on how to create an infographic-I can give more info if needed. It is very simple

NOTE: For guidance on infographics, including how to create one in PowerPoint, see “How to Make an Infographic in PowerPoint” presented in the Resources.

Your PowerPoint should Include the hypothetical scenario you originally shared in the Discussion Forum (I will attach if needed).

1.  We will be looking at the predictability of racism. You will need to address all the following questions after you watch the Ted Talk- 
2. Do you think that racism is predictable? Please use what you have learned from the video to answer this.
3. What factor mentioned do you think plays a larger part in the prevalence of racist attitudes: education level or geography/neighborhood? Again please use the Ted Talk as your primary source of reference
4. What do you think of the solutions to the problem of racism which were proposed in this talk? Please use the Ted Talk to address this question.
5. How do these solutions address or fail to address the types of racism we learned after watching the video? 
6. Remember to critically analyze these statements in order to answer them fully. Use the Video as your reference to answer these questions. View this TED talk on racism, politics, and solutions and then answer the following questions:

 

Design nursing care strategies which incorporate genetic and genomic risk factors.

Scenario

You are a new graduate nurse caring for a patient that received a positive result from a genetic or genomic testing technology. Part of your role as a general nurse in genetic and genomic care is to provide accurate information, ensure appropriate patient referral, and serve as a patient advocate.

Instructions

Develop a plan of care that identifies nursing strategies that incorporate genetic and genomic risk factors, three interprofessional resources, and three referral resources for a client that has a positive result from a genetic or genomic testing technology that you explain.

Your plan of care will be presented in a Word document that includes the following sections:

• Explanation a specific genetic or genomic testing technology
• Describe what positive results of the testing technology indicates
• Design a plan of nursing care strategies based on positive results
• Describe three interprofessional resources in planning care for clients with genetic and genomic needs
• Determine three resources for facilitation of genetic and genomic referrals

Resources