A nurse is performing a root cause analysis (RCA) for a client who had a surgical procedure that was performed on the wrong site. Which of the following questions should the nurse ask during an RCA? Select all that apply.
What was the sequence of events that led to the wrong site surgery?
What is the incidence of wrong-site surgeries in the health care facility?
What was the client's outcome following the wrong site surgery?
What caused the wrong-site surgery to occur?
What can be done to prevent wrong site surgery from recurring?
Correct Answer : A,D,E
Rationale:
A. In a root cause analysis, understanding the chronological sequence of events is critical. This question helps identify each step in the process, from preoperative preparation to the actual surgery, highlighting where errors, miscommunications, or system failures may have occurred. By mapping out the sequence, the team can pinpoint vulnerable points in protocols and processes that allowed the mistake to happen.
B. Although knowing the incidence of similar events is useful for quality improvement programs and benchmarking, this question does not focus on the specific root causes of the individual event. RCA is designed to analyze this particular case, not general statistics. Facility-wide data may inform long-term monitoring but is not part of identifying the direct causes or corrective actions for this event.
C. While outcomes are important for patient care, legal reporting, and risk management, RCA is primarily concerned with how and why the event happened rather than the consequences. The outcome might influence subsequent interventions or support measures for the patient, but it does not contribute to identifying system flaws or preventive strategies.
D. This is the central focus of RCA. Identifying the underlying causes—such as communication breakdowns, failure to follow preoperative checklists, staff fatigue, or equipment errors—allows the health care team to target system-level interventions. Root causes are often multifactorial, involving both human and organizational factors, and answering this question is essential for meaningful improvement.
E. RCA is not only about identifying causes but also about developing strategies to prevent recurrence. This includes revising policies, implementing safety checklists, staff training, and introducing redundant verification steps. Asking this question ensures that corrective actions are practical, evidence-based, and designed to strengthen patient safety and minimize risk in future procedures.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}
Explanation
Rationale for correct choices:
- Impaired: The pattern of behaviors—frequent absences, tardiness, medication errors (missed antibiotic), failure to report critical lab values (potassium 3.1 mEq/L), and inaccurate documentation—indicates the nurse may be impaired. Impairment can affect judgment, performance, and patient safety, and must be addressed immediately.
- Ineffective pain management for client: A client reporting ineffective pain control suggests possible improper medication administration or poor clinical judgment, which supports concern for impairment affecting patient care.
Rationale for incorrect choices:
- Tired: While fatigue may contribute to errors, the consistent pattern of unsafe practice (missed medications, failure to report critical labs, false documentation) suggests a more serious issue than simple tiredness.
- Burnt-out: Burnout may cause emotional exhaustion or decreased motivation, but it does not typically result in unsafe clinical behaviors such as falsifying documentation or failing to act on critical lab results.
- Working extra shifts: This may explain fatigue or stress but does not directly demonstrate unsafe or impaired clinical performance.
- Slowed speech: This is a possible sign of impairment, but it is not documented in the scenario.
Correct Answer is D
Explanation
Rationale:
A. Assigning a staff member to focus on discharge planning is an example of case management or primary nursing, not team nursing. This approach emphasizes individualized planning and continuity of care rather than shared team responsibilities.
B. One RN providing care to a small group of clients with a UAP describes primary nursing with delegated tasks, not the collaborative structure of team nursing. In team nursing, care is coordinated among multiple licensed and unlicensed personnel.
C. Assigning staff to specific tasks for a group of clients reflects functional nursing, where tasks (e.g., medication administration, hygiene) are divided among team members, but each member focuses on the task rather than collaborating holistically on patient care. Functional nursing prioritizes efficiency over individualized patient care.
D. Team nursing involves an RN leading a team of LPNs and UAPs to provide comprehensive care for a larger group of clients. The RN coordinates care, delegates tasks appropriately, and ensures holistic care is delivered collaboratively. This scenario exemplifies the team nursing model, which maximizes efficiency and utilizes the skills of various personnel under the RN’s guidance.
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