List the advent chosen and include background such as prevalence of the incident.
Describe the adverse event in detail. You can make-up the scenario on the event topic chosen from the list or you can research an actual story on one of the events and utilize it for this assignment.
List who was involved in the event and their role in the event.
List the stakeholders on your CQI team. Discuss the differences among the stakeholders that might cause issues when working as a CQI team. Include barriers to their communicating effectively as a team and the communication techniques/methods utilized to inform the organization’s staff of the adverse event improvement plan.
Describe at least two operational or safety processes that might not have been followed that contributed or caused this event to take place. For instance, describe any regulations or procedures that one of the professional organizations and/or accrediting agencies would utilize to measure compliance with the standard.
Summarize the historical and contemporary issues and legal implications related to patient safety in your chosen adverse event.
Describe how processes of continuous quality monitoring could impact the adverse event you chose.
Part Two: Graph & CQI Tool (Complete Part Two of the Adverse Event template)
Graph the data
For your selected adverse event, graph the data for the two years. Include the graph in your template document. Include an analysis of the data. Determine if the frequency is increasing or decreasing. What is the data telling you? What factors could be attributed to the change?
Choose a CQI Tool that best suits your chosen Adverse Event from the following list:
Fishbone Diagram (Cause&Effect)
Use the CQI Tool to illustrate the use of the tool with your chosen adverse event. You will be responsible for creating the CQI Tool, completing the tool, taking a screenshot, and copying/pasting the screenshot under the instructions in Part Two CQI Tool in the Adverse Event template.
Part Three: Future Prevention (Complete Part Three of the Adverse Event template)
After describing the event in Part One, using a Graph and CQI tool in Part Two, apply the PDCA model to summarize the process and steps that your team would recommend to the CEO to prevent this adverse event from reoccurring. Make sure to include who (health care personnel) would be accountable at each step of the process. Complete the Explanation column in Part 3 of the Adverse Event template.