Root Cause Analysis in Surgical and Medication Errors ...

NRSG378 Extended Clinical Reasoning – Assessment 2 Project Root Cause Analysis (RCA) Report

Using the provided case study on either Mrs Bentley’s surgical infection or Mr Jeffries’ medication error, address the following questions and instructions:

1. Discussion of Identified Root Cause: Based on the case study, identify the primary root cause of the incident. Discuss how this root cause led to the adverse outcome, considering relevant medical knowledge and patient data. (400 words)

2. Identification and Discussion of Contributing Factors: Identify at least two contributing factors that exacerbated the incident. Discuss how each factor played a role in the outcome and connect them to evidence from healthcare practice or literature. (500 words)

3. NMBA RN Standards for Practice: Identify and explain which Nursing and Midwifery Board of Australia (NMBA) Registered Nurse Standards for Practice were breached in this case. Provide detailed examples from the scenario that demonstrate the breach of each standard. (300 words)

4. Links to National Safety and Quality Health Service (NSQHS) Standards: Identify and discuss two specific NSQHS Standards that were not met in the scenario and how they relate to the root cause. Mention the specific action items from the NSQHS Standards. (400 words)

5. Recommendations: Provide three recommendations to address the contributing factors identified. Include practical examples of how these recommendations can be implemented and identify who will be responsible for carrying out each recommendation. (400 words)

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