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February 3, 2020
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For a practice nurse or medical doctors to establish and diagnose an individual, it is necessary to conduct a root cause analysis. This involves the determination of the factor that initiated the growth of the disease. Performing the study, therefore, makes a medical doctor or a nurse practitioner to understand the trend of the condition or the state to establish the correct medication for the patients. There are steps to be followed in conducting the analysis. These steps must, therefore, be considered as a method of ensuring that the best diagnosis is made to a patient.

Steps of Conducting Root Cause Analysis

There are six steps in conducting root cause analysis. The first step is the identification of what happened. This is done through clarification of events that led to the occurrence of the condition. It is carried out through the use of a flowchart. The second step is the determination of what should have happened. It is done through the creation of a chat based on the information and then comparing to that chat of what happened. The third step is the cause of determination. These steps involve five processes of asking ‘Five whys’ the give whys are essential in providing clarification of the reason for the occurrence of the event. The use of a fishbone diagram in which a graphics tool is for deploying possible causes becomes necessary. Developing a casual statement becomes the fourth step. This involves the process of analyzing the whys as stated in step three. They are the causal statements linked to the cause. Once a clear analysis of the purposes of the level in stage four is complete, the fifths steps are to recommend the various action steps to prevent the recurring of the event again.  The last level is therefore to write a summary of how to engage the critical stakeholders in effecting the changes towards improvement.

Case Scenario of Patient B

Patient B is brought to the hospital with a pain in the left leg. This indicates the insufficient supply of the oxygen in the body and little oxygen reaching the left side of the limp. Moreover, there is generally a low blood pressure for the patient. Astudy on the root cause of the symptoms reveals that there was a swelling a, limited motion and ecchymosis. According to the examination of medical history, patient B had a history of impaired glucose tolerance with a combination of prostate cancer. Moreover, the patient is currently suffering from elevated cholesterol and lipid. He is presently under atorvastatin and Oxycodone medication for back pain.

Based on the data collected about the patient B, doctor Analyses the information to investigate the root cause of the problem of lack of motion of the leg and the general pain in the left side of the legs.Based on the analyzed information available to Doctor T finds that there is a necessity to make skeletal relaxation as fast as possible that aims to manipulate the of the hips. After an examination of the medical history Doctor T realizes that the root cause of the pain is the current usage of oxycodone and the current body weight which cannot be reinforced by the hip (Liu, 2019). This, therefore, becomes the leading cause of the pain, and that the solution to this problem would imply curing the portionof the current strain that is affecting his left leg.

The doctor immediately recommends withdrawal of the supplemental oxygen as a way of reducing the pain. However, this implied that there was to be a general fall of the body pressure and the heartbeat. Based on the information, that has been presented. The cure for the condition of the patient was to get a substitute for the oxycodone that would respond effectively with his body.

  1. Improvement Plan

Based on the information provided on the patient, the patient cannot be under permanent lack of supply for oxygen; this reason makes the blood pressure keeps falling, presenting the oxygen from reaching all body parts. This is likely to cause the patient to develop further complications and therefore, it becomes essential to device a way introduces a proper medical procedure to help in creating the balance between the supply of oxygen in the body based on the introduction of the oxycodone and reduction of the effect of the legs of the patient (Wei, Hongjun&Qiuxia, 2017). This will enable the patient to receive proper care that is all around and that which is based on adequate consideration by the medical health facilities. Based on the information analysis by the doctor, the patient needs to be monitored regularly, especially in terms of the blood pressure and heartbeat.

Lewin’s change theory stipulates a precise method of ensuring that the changes are initiated and established in a systematic manner that helps to come up with a complete way to treat a patient. The tree stepped model includes the unfreezing stage. This involves a process of preparing an individual for the change of medication, especially the engagement, and the testing if a patient responds to the changes that are to be introduced to the body and the specific reactions for such changes. The ready-to-change stage is also the period where there is an analysis of the effect of one drug to another. In the case of Patient B, Doctor T was evident in the processes to follow or initiate this comprehensive change. One of the changes is the withdrawal of the Oxycodone. Moreover, the admission of drugs such as diazepam had no severe effect on the patient; therefore; the doctor withdrew from the medication immediately (Jain, 2017). Based on the awareness of the kind of medicine to administer and the need to change the use of Oxycodone, the doctor was ready to initiate a new medication, even though it would be so tricky to Sedate Mr. B.

The second stage in the implementation process based on Levin’s change theory is the implementation stage; these processes involve the actual medication that is given to the patient to help in the treatment of the condition. It requires a clear determining of the effect of the drug and how quick the patient is to respond to the procedure. In the scenario, Doctor T A further decision on the treatment and the based on the withdrawal of the oxycodone leads to the discovery of a further complication which makes the patient go to a coma due to the brain death (Rezaei et al., 2018). The refreeze or making it sticks the final stage where the doctor evaluates the responses of the drug to the patient. In this case, the withdrawal led to the development of further complication as the final death of the brain which required the patient to be placed in a life-supporting machine.

Purpose of the FMEAProcess

Failure model and effect analysis is an essential tool in medical service delivery for a patient.  The failure model involves how someone or a medical procedure or prescription might fail. The effect analysis is, therefore, the consequences that emanate from it.  This process is used when the medical service offered is being redesigned after a process of quality function deployment for a patient. The procedure for conducting such a process involves collecting the cross-functional team in all the involved departments so give their expertize ideas about the process. It is then followed by identification of the scope which the procedure can take. Identifying the boundaries to which the process can go and the compatibility of the process to the patient involved.  The third procedure is the filling of the classified information about the patient in the table to enhance the analysis. These help to make an appropriate decision that becomes critical in the treatment of the patient through the procedure of continuous understanding of the development of the condition (Spraker et al., 2016). In this case, the analysis of the patient is based on the failure to respond to the medication even after a professional consideration is carried out by all the involved individuals. FMEA table is as shown below

Steps in the Improvement Plan Process * Failure Mode Likelihood of Occurrence
Probability of Detection


Risk Priority Number


The doctor decided to withdraw oxycodone Wrong procedure 3 5 5 75
The doctor decides to introduce  pain killers in the bones usinghydromorphone IVP Wrong  decision  to end the pain 2 5 4 70
The doctor decides to add an alternative drugdiazepam IVP  Wrong selection for heart pumping stabilization 8 2 6 75
          Total RPN (sum of all RPN’s): 215


Risk Priority Number


The administration of the drugs and the general care which was given to Mr. B was neglected at the first stage of the administration of the process of caring for the patients.  The Nurse left to the emergency room leaving the patient to be taken care of by a relative. This the first mistake towards the recovery. The negligence after the withdrawal of the life-supporting machine is an indication of a failed and lack of clear analysis of the situation of the parent.

Moreover, the hospital does not have a proper management mechanism that ensures that patients feel safe. The negligence and the incomes by the nurse to take emergency precaution led to oxygen deficiency in the body and therefore creating complications in the life of the patient. This makes it necessary for the doctor to recommend a procedure that fails to work due to the reach of the brain cells.

The failure of the hospital to conduct the precise analysis of the patient’s condition leads to Mr. P having a wrong prescription, especially solving one issue of the hip pain and failing to consider the consequence that will emanate through the withdrawal of oxygen supply in the body (Ng et al., 2017). Further analysis reveals that there a necessity to safeguard a management structure that allows the hospital to employ many attendants to certify that the congestion in the hospital is complete. This will enable the facility to balance their duties and provide that at each time, there is an extra nurse to take care of the patient.

Professional Nurse and Leadership

The main aim of a professional is to ensure a leadership that promotes the understanding and the ability to offer a patient-centered service to his or her clients. This type of leadership enables a health facility to come up with the steps in avoiding ordinary negligence that is often observed in t in such facilities the first step towards this vision is ensuring that each nurse embraces an ideology that will motivate him or her from within.

Promoting Quality Care

It becomes the role of a professional nurse to encourage the quality of health care. There are several ways that this can be achieved.  Reorganizing the importance of caring for the society and creating an impact becomes one motivating factor for proper nurse leadership. Quality care involves the act of recognizing the importance of clean environment and being in control of the hygiene and health of the patient can promote the recovery of the patient.

In most cases, taking care of a patient without n having to administer a complicated drug becomes the necessary procedure of the treatment. Therefore each professional nurse in an institution should strive towards giving attention to the patient without neglecting his or her role. Health quality comes with a willingness of the nurse to go an extra mile in creating a comfortable environment for the patient.  This implies that the nurse must observe any change that occurs to the patient and ensure that the patient becomes the most critical part of the care offered in a health institution.

Improving Patient Outcomes

The quality of care given in a health institution has a strong influence on the determination of the result of the treatment. This point is evident in the institution which is well staffed with patient-centered services that operate practically (Latino, 2015). The quality of the healthcare service provision depends on the willingness of professional nurses to dedicate themselves towards the quality of the health institution. Since the output depends on their effort, there are several steps that a trained nurse can influence the quality of the patient outcome.

The care given to a patient in the holding facility, especially in taking all the precautions and being accurate in the drug administration and care training becomes one of the most critical aspects. The clean health facility with proper nursing care creates a recovery environment that gives the patient a feeling and to fight further for his or her health. The effort of the nurse to encourage e the patient will help the patient to get root and develop peaceful psychology to recover.

However, the role of nursing in influencing outcome patient requiresthe leadership system and structure it begins with the leadership structure of the facility. A facility that allows nurses to explore their expertize skills without overloading will ensure proper care to the patient. The leadership skills that are impacted by the patients will enable a general change in the quality of the healthcare’s services in the institution. The case scenario given reveals that the nurses were overworked.This prevented them from taking care of the patient.  This can be avoided through ensuring proper staffing of the facility.

Influencing Quality Improvement Activities

Quality improvement activities become essential ventures for a health facility. One of the steps that are used for the improvement is entirely being in full control of the patient without allowing interference from other businesses. Moreover, when a professional nurse is assigned full control of a patient without divided attention, the probability of mistakes isreduced. It mistakes that emanate from an overworked nurse is the leading cause of poor quality. The doctor must ascertain that the nurses in the facilities follow the instruction as given and ensure that the patient is comfortable every time.

A further role of a professional nurse is to safeguard that there is a clean and adequate facility for the patient. The facilities will allow the nurse and the doctors to respond to emergencies as he or she administers medical care to the patient. There are many cases where professional nurses do not take a keen interest in their patients (Latino, 2015). This led to negligence that is known to cause death to the patient. Proper leadership is critical in ensuring increased chances of survival of the patients.  The quality of health provided will also attract the attention of the patients toward the trust they put on the nurse and hence control death rates that occur on the health facilities. The increased demand for proper care requires nurses to be professional and build trust for the public. They should also be capable of dealing with emergencies without neglecting any patient in the facilities.



Involvement of the professional nurse in the RCA and FMEA processes

The association of nurses in the Root Cause Analysis and FMEA processes is essential for the expansion of leadership skills in the nurses. Among the various ways that they will promote leadership involve the concept of taking a keen interest in a patient (Sutrisno et al., 2016). This will enable the facility to provide adequate care that ensures proper process in the medical facilities. The effort by nursing in understanding the cause of the significant problem will allow them to give the public information that will enable them to prevent such conditions in their lives. This will also enlighten the public toward a healthy life that is necessary for the lives of the communities.

The FMEA analysis becomes an essential factor to a professional nurse since he or she becomes aware of how to avoid the various mistakes that are likely to emanate from the conditions. The concept of allowing a nurse to be engaged in such processes will inspire experience in handling the patients and create a leadership structure that gives the patients the required priority toward recovery.


The concept of root cause analysis and FMEA processes are among the critical factors in ensuring proper leadership in the health facilities. They give the patients the chance to have a second chance of correcting their conditions and ensure that the nurses are in line with the requirement of the profession. It also delivers that the health facilities offer quality services that have apositive impact on the business as well as the overall health of the populace in the states.




Jain, K. (2017). Use of failure mode effect analysis (FMEA) to improve medication management process. International journal of health care quality assurance30(2), 175-186.

Latino, R. J. (2015). How is the effectiveness of root cause analysis measured in healthcare?. Journal of Healthcare Risk Management35(2), 21-30.

Liu, H. C. (2019). Healthcare Risk Management from a Proactive Perspective.In Improved FMEA Methods for Proactive Healthcare Risk Analysis (pp. 3-13).Springer, Singapore.

Ng, W. C., Teh, S. Y., Low, H. C., &Teoh, P. C. (2017, September). The Integration of FMEA with other problem solving tools: A review of enhancement opportunities. In Journal of Physics: Conference Series (Vol. 890, No. 1, p. 012139). IOP Publishing.

Rezaei, F., Yarmohammadian, M. H., Haghshenas, A., Fallah, A., &Ferdosi, M. (2018). Revised risk priority number in failure mode and effects analysis model from the perspective of healthcare system. International journal of preventive medicine9.

Spraker, M. B., Ford, E. C., Kane, G. M., Hendrickson, K. R. G., Nyflot, M., &Zeng, J. (2016). A Survey of Residents’ Experience With Patient Safety Concepts in Radiation Oncology. International Journal of Radiation Oncology• Biology• Physics96(2), E411-E412.

Sutrisno, A., Kwon, H. M., Gunawan, I., Eldridge, S., & Lee, T. R. (2016). Integrating SWOT analysis into the FMEA methodology to improve corrective action decision making.

Wei, S. I., Hongjun, D. I., &Qiuxia, W. U. (2017).A discussion of the combined application value of FMEA and RCA in the IV infusion risk management. China Medical Equipment14(6), 33-36.