Capella DNP8010 2020 April Unit 8 Discussion latest

DNP8010 Management in Advanced Contemporary Nursing

Unit 8 Discussion

Errors and Root Causes

For this discussion, choose one of the following options:

Option A

After viewing Dr. Lucian Leape's video, Why Do Errors Happen? How Can We Prevent Them?, in your initial post, discuss the following questions (adapted from the IHI's group discussion questions) in relation to a personal professional experience:

What are the main obstacles preventing health care agencies and professionals from learning from one another's mistakes?

How would you classify the barriers? Are they cultural, territorial, legal, technological, political, or financial?

How would a nursing leader design an ideal system to keep identical, fatal errors from happening in different places?

How should errors and their solutions be shared across organizations?

Option B

In 2010, the Joint Commission reported that the top four root causes for reported sentinel events were lapses in communication, leadership, assessment, and human factors. In your initial post, describe a high-risk situation in which at least one of these four elements would be considered a root cause. For your initial post to this discussion, complete the following:

Describe what happened.

Explain why it happened.

Describe the proximate factors. (The article "Framework for Conducting a Root Cause Analysis and Action Plan" from the Joint Commission will help. You do not need to complete the framework, but you may find it useful in discussing the problem.)

Discuss the risk-reduction strategies that were used or that would have been effective.

Initial Post Guidelines

Your initial post should be succinct and demonstrate clarity of thought and precision in writing. Support your discussion with at least two references other than the required readings. Use appropriate and accurate APA formatting.