The root cause analysis team comprises of a risk manager, the nurse and the pharmaceutical head. The nurse can contribute knowledge about institutional medication policies of the hospital and patient treatment details (Hayes et al., 2016). The pharmaceutical head can contribute knowledge about storage, availability, composition and mechanism of action of each drug (Wang et al., 2015). The risk manager can contribute knowledge about patient health risks of incorrect medication administration along with rapid mitigation in case of error repetition (Nanji et al., 2016).
A team collaboration approach was adopted which includes clarified communication, establishment of trust, specification of roles, balancing of activities and working towards a common goal fulfillment of the organization (Weaver, Dy & Rosen, 2014). In this case, evidence of collaboration and avoidance of blaming can be observed in the preparation of a process flow chart along with the creation of a root cause analysis team.
The two processes which were not contributing to problem solution included usage of nursing online documentation and computerized physician order entry. This is due to the fact that electronic health records are often met with considerable shortcomings such as reduced patient interaction, clinical oversight, difficult computer interface, lack of experiences, burnout and typing errors along with lack of consideration of individual patient needs. These factors often lead to medication errors (Schiff et al., 2015).
One of the performance improvement charts presented in this case is a Pareto Chart. A Pareto Chart has been identified as one of the best evaluation methods for the management of organizational quality. Hence, usage of this chart will prove beneficial, since it will clearly highlight the factor which is contributing most towards medical errors along with mentioning additional common causes of defects (Antony et al., 2018).
One of the key contributing factors to electronic health records such as NDMR and CPOE. Often employees face difficulties in understanding their usage resulting in higher incidence of errors. Such records also reduce patient interaction and need identification by the medical staff due to requirement of continuous updating information (Page, Baysari & Westbrook, 2017). Another contributing factor is the reduced availability of staff in the nursing and pharmaceutical departments, which often makes it difficult to manage required duties due to prevalence of excessive work load and lack of adequate experience and knowledge (Hammoudi, Ismaile & Abu Yahya, 2018).
For the purpose of preventing further admission of patients to the emergency departments, there is a need to consider a number of causative factors which require extensive delegation activities by a nurse leader. Considering the dynamic and changing organizational roles encountered in present day healthcare settings, there is a need for nurses to adopt duties beyond the mere treatment of patient somatic symptoms. Hence, undertaking effective leadership and delegation activities is of utmost importance of present day nurses which will not only lead to the reduction of occurrence of avoidable situations, but also in the improved fulfillment of tasks and improved treatment provision to the patients (Suh, Yee & Kim, 2017).
For this case study, usage of a transformational nursing leadership style would be appropriate. Transformational nursing leaders initiate effective leadership by effective delegation of tasks in accordance to the capabilities and experiences acquired by subordinate nurses, along with empowering, inspiring and encouraging enrolled nurses for further improvement and learning (Fischer, 2016). A number of factors which can be avoided have been documented for patients with cognitive impairment like Alzheimer’s, encountering frequent visits to the emergency department (Lin et al., 2015). A major factor is the incidence of wandering by such patients, resulting in being lost and possibilities of acquiring harm.
Hence, a transformational leader can prevent this by delegating newly enrolled nurses for timely monitoring of such patients, which would be appropriate for their level of competence (Gagnon-Roy et al., 2018). Another avoidable factor is the harm patient’s suffer due to self-neglect or difficulty in understanding instructions concerned with movement, eating and medication. For prevention, the transformational nurse leader can senior or registered nurses who have adequate experience in continuously instructing and observing such patients during conductance of these activities (Hildebrand, Taylor & Bradway, 2014).
The occurrence of falls have been associated as a major avoidable factor, which can be prevented by the transformational nurse leader by allocating nurses to conduct falls risk assessment, timely monitoring and an emergency medical team to mitigate the occurrences of the same (Tannenbaum et al., 2015). Hence, a transformational nurse leader must consider these factors in order to prevent frequent, avoidable visits to the emergency department of the associated hospital and accordingly delegate nursing staff with respect to their various levels of experience.
A hospital or clinical organization is associated with high quality when the associated patients report customer satisfaction, improved on-site health along with beneficial future positive health outcomes. As highlighted in the previous sections, clinical settings call for services beyond patient treatment, where nurses form the cornerstone in the conductance of essential activities directly associated with ensuring high quality hospital performance as opined by the American Nurses Association and the American Nurses Credential Center (Dy et al., 2015).
The role of the nurses involves performance of various activities which will increase hospital quality. These include evaluating patient clinical and treatment reports to assess their compliance with hospital regulatory standards, establishing collaborative duties with additional departments of the hospital for multidisciplinary patient care and, interaction with other hospitals if the need arises, conductance of various follow-up procedure of respective patients to evaluate their health outcomes and obtaining patient feedback for further assessment of hospital quality (Stimpfel, Rosen & McHugh, 2014). Referring to the healthcare organization which I am familiar with, it was observed that the prevalent organizational culture adopted is a vertical or top-down approach. Despite the documented benefits of this approach in the fulfillment of organizational objectives, such an approach has been associated with autocracy due to excessive hierarchical adherence (Schreibman & Stahmer, 2014).
The chief nursing officer of this organization has been associated with usage of a transactional mode of leadership, which was merely effective in the short run since the leader granted rewards for task fulfillment, with however, punishments and lack of consideration of unique employee needs (Scully, 2015). For performing financial changes associated with patient safety, there is a need to consider the activities of various quality assurance and clinical departments, which the selected organizational culture did not consider since it used a one-way, top down communication approach, considering only the needs of the hierarchy (Manary et al., 2015).
Hence, in order to transform this hospital to a high performance once, there is a need to use transactional leadership which will inspire and consider every employees needs, along with usage of a horizontal organizational culture since flatter modes of communication encourages interaction amongst various hospital departments instead of consideration of a single, autocratic hierarchy (McCleskey, 2014).
References
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Dy, S. M., Kiley, K. B., Ast, K., Lupu, D., Norton, S. A., McMillan, S. C., … & Casarett, D. J. (2015). Measuring what matters: top-ranked quality indicators for hospice and palliative care from the American Academy of Hospice and Palliative Medicine and Hospice and Palliative Nurses Association. Journal of pain and symptom management, 49(4), 773-781.
Gagnon-Roy, M., Hami, B., Généreux, M., Veillette, N., Sirois, M. J., Egan, M., & Provencher, V. (2018). Preventing emergency department (ED) visits and hospitalisations of older adults with cognitive impairment compared with the general senior population: what do we know about avoidable incidents? Results from a scoping review. BMJ open, 8(4), e019908.
Hammoudi, B. M., Ismaile, S., & Abu Yahya, O. (2018). Factors associated with medication administration errors and why nurses fail to report them. Scandinavian journal of caring sciences, 32(3), 1038-1046.
Hayes, C., Jackson, D., Davidson, P. M., & Power, T. (2015). Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administration. Journal of clinical nursing, 24(21-22), 3063-3076.
Hildebrand, C., Taylor, M., & Bradway, C. (2014). Elder self?neglect: The failure of coping because of cognitive and functional impairments. Journal of the American Association of Nurse Practitioners, 26(8), 452-462.
Lin, W. C., Bharel, M., Zhang, J., O’Connell, E., & Clark, R. E. (2015). Frequent emergency department visits and hospitalizations among homeless people with Medicaid: implications for Medicaid expansion. American journal of public health, 105(S5), S716-S722.
Manary, M., Staelin, R., Kosel, K., Schulman, K. A., & Glickman, S. W. (2015). Organizational characteristics and patient experiences with hospital care: A survey study of hospital chief patient experience officers. American Journal of Medical Quality, 30(5), 432-440.
McCleskey, J. A. (2014). Situational, transformational, and transactional leadership and leadership development. Journal of Business Studies Quarterly, 5(4), 117.
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Page, N., Baysari, M. T., & Westbrook, J. I. (2017). A systematic review of the effectiveness of interruptive medication prescribing alerts in hospital CPOE systems to change prescriber behavior and improve patient safety. International journal of medical informatics, 105, 22-30.
Schiff, G. D., Amato, M. G., Eguale, T., Boehne, J. J., Wright, A., Koppel, R., … & Bates, D. W. (2015). Computerised physician order entry-related medication errors: analysis of reported errors and vulnerability testing of current systems. BMJ Qual Saf, 24(4), 264-271.
Schreibman, L., & Stahmer, A. C. (2014). A randomized trial comparison of the effects of verbal and pictorial naturalistic communication strategies on spoken language for young children with autism. Journal of autism and developmental disorders, 44(5), 1244-1251.
Scully, N. J. (2015). Leadership in nursing: The importance of recognising inherent values and attributes to secure a positive future for the profession. Collegian, 22(4), 439-444.
Stimpfel, A. W., Rosen, J. E., & McHugh, M. D. (2014). Understanding the role of the professional practice environment on quality of care in Magnet® and non-Magnet hospitals. The Journal of nursing administration, 44(1), 10.
Tannenbaum, C., Diaby, V., Singh, D., Perreault, S., Luc, M., & Vasiliadis, H. M. (2015). Sedative-hypnotic medicines and falls in community-dwelling older adults: a cost-effectiveness (decision-tree) analysis from a US Medicare perspective. Drugs & aging, 32(4), 305-314.
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Weaver, S. J., Dy, S. M., & Rosen, M. A. (2014). Team-training in healthcare: a narrative synthesis of the literature. BMJ Qual Saf, 23(5), 359-372.
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