Medication error root cause analysis

For over 30 years, Institute for Safe Medicine Practices (ISMP)[ has been a global leader in patient safety as the first non-profit organization dedicated to the collaborative development, education, and advocacy of safe medication practices. Nursing students may recognize publications from ISMP throughout their clinical areas. Often, ISMP safety recommendations are utilized in equipment purchasing and policy development. Information linked at the ISMP site will assist you in this assignment. The ISMP Assess-ERRTM Medication System Worksheet is a quality improvement tool There are 2 parts to this written assignment- (a) completing the ISMP worksheet and (b) a paper describing the possible root causes to this error. Part 1- review of ISMP med error worksheet with application to a case study Review and download the ISMP Assess Medication Error Worksheet. Download ISMP Assess Medication Error Worksheet. It is designed to help with error report investigations. Read and study the details of the medication error in this ISMP case study article. Download ISMP case study article. As you read the article, highlight critical information. Part 2- written analysis Students will address at least five of the possible causes (left column) outlined in the ISMP Worksheet Each cause should be identified in a separate heading within the paper. Once completed, use the worksheet as a template to describe in paragraph form/APA 7th edition student paper format, the possible causes that contributed to the negative outcomes in this case study. For each cause, write a paragraph(s)/APA 7th edition format explaining: What was/were the possible causes/contributing factor(s)? Why did you identify this as a possible cause(s)/contributing factor(s)? What are possible solutions to prevent further errors from occurring? Look from a systems-level/perspective. Validate your solutions through the use of a total of five evidence-based practice research sources (e.g. Think of a variety of solutions which may include education, policy change, equipment, remediation, etc. Be sure to think of hospital/facility/role level solutions, not individual-based solutions (i.e. hospital policy rather than individual RN practice) How and why do you think differently now? How will this new thinking impact you as a future nurse? Include your Assess-ERR worksheet when you submit your final paper of a minimum of five pages or a maximum of seven pages; do not count your cover page or reference page as part of the total length. Part 1 is completed already; and would you be able to complete this in and hour instead (11:00 pm).