C489T2.docx C489 Task 2: RCA and FMEA Western Governors University A.Root Cause Anal

Document Content and Description Below

C489T2.docx C489 Task 2: RCA and FMEA Western Governors University A.Root Cause Analysis (RCA) Root cause analysis is used to find an underlying cause of a problem through a multi-step process.... When there is no easy fix one can consider the root cause analysis as an approach to problem-solving. In order to prevent the error from continuing one needs to identify the root cause of a problem to allow the opportunity to correct and prevent in the future. 1.RCA Steps When an incident occurs a team of 4-6 people with all of the information gather to complete the RCA steps of which there are 6 used to search for the root cause of the issue. The following according to IHI are the RCA steps: 1. Identify what happened. 2. Determine what should have happened. 3. Determine causes – ask why five times. 4. Develop causal statements. 5. Generate a list of recommended actions to prevent the reoccurrence of the event. 6. Write a summary and share it. 2.Causative and Contributing Factors A gentleman as identified by Mr. B is a 67-year-old male weighing approximately 79 kg presented with left hip pain to a small 6 bed emergency room. Upon arrival Mr. B stated he had a mechanical fall when he tripped over his dog. Mr. Bs vital signs were all within normal limits however he appeared to be tachypneic, likely due to pain he rated at a 10/10 on the pain scale. Mr. B had obvious shortening of his left leg some notable edema and ecchymosis with limited range of motion. His prior medical hi. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. .. . . . . . . . . . . . . . . . . . .. . . . . [Show More]

Last updated: 1 year ago

Preview 1 out of 9 pages