Use a supplied template to conduct a root-cause analysis of a quality or safety
issue in a health care setting of your choice and outline a plan to address the issue.
As patient safety concerns continue to be addressed in the health care settings, nurses can play an active role
in implementing safety improvement measures and plans. Often root-cause analyses are conducted and safety
improvement plans are created to address sentinel or adverse events such as medication errors, patient falls,
wrong-site surgery events, and hospital-acquired infections. Performing a root-cause analysis offers a
systematic approach for identifying causes of problems, including process and system-check failures. Once the
causes of failures have been determined, a safety improvement plan can be developed to prevent recurrences.
The baccalaureate nurse’s role as a leader is to create safety improvement plans as well as disseminate vital
information to staff nurses and other health care professionals to protect patients and improve outcomes.
As you prepare for this assessment, it would be an excellent choice to complete the Quality and Safety
Improvement Plan Knowledge Base activity and to review the various assessment resources, all of which will
help you build your knowledge of key concepts and terms related to quality and safety improvement. The terms
and concepts will be helpful as you prepare your Root-Cause Analysis and Safety Improvement Plan. Activities
Competency 1: Analyze the elements of a successful quality improvement initiative.
Apply evidence-based and best-practice strategies to address a safety issue or sentinel event pertaining to
medication administration. ;
Create a viable, evidence-based safety improvement plan for safe medication administration.
Competency 2: Analyze factors that lead to patient safety risks.
Analyze the root cause of a patient safety issue or a specific sentinel event pertaining to medication
administration in an organization.
Competency 3: Identify organizational interventions to promote patient safety.
Identify existing organizational resources that could be leveraged to improve a safety improvement plan for
safe medication administration.
Competency 5: Apply professional, scholarly, evidence-based strategies to communicate in a manner that
supports safe and effective patient care.
Communicate in writing that is clear, logical, and professional, with correct grammar and spelling, using current
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