Friday, August 11, 2017

Organizational Systems and Quality Leadership - WGU RTT1 Task 2 (FMEA-Focused)

Nurse treating the patient in the background; happy nurse in forefront
Image Courtesy: Designed by Pressfoto (freepik.com)

Introduction
In this post, I will discuss in detail how to get over to the part involving FMEA in RTT1 Task 2. The task, overall, is quite complex, but this FMEA part, and what follows it, is far more challenging. Personally, I have had to write more revisions for this part alone than any other paper for WGU.

Given that not much help is available online (my personal experience), and your mentor will share with you the FMEA application material that does not focus on nursing, it can be really frustrating (I know!); hence, I am trying to make your life easier and hope that you will save countless hours of your precious time by going through my post.

FMEA (Failure Modes and Effects Analysis) is a useful tool, and WGU urges that its students know how to apply it to their workplace, and, trust me, they are not fooling us here. It really is useful.

Root Cause Analysis
The task starts with (A) the Root Cause Analysis (RCA) that focuses on understanding the basic causes of Mr. B's sad demise: Lack of staff, crowded ER, lack of coordination, and monitoring plus more doses than needed.

Improvement Plan
In the next section, Improvement Plan (B), you have to discuss an improvement plan (employing tools such as PDSA, checklists, audits, feedback, etc.) that will ensure such sentinel events as those with Mr. B won't repeat. So, you would say that flex staff will be added, coordination will be improved, etc.

Change Theory
Ahead is the section that asks you to discuss in detail the role of a Change Theory (B1) in your plan. This part is to show the grader that you know how to theorize change in your organization and situate your Improvement plan - as proposed above (B). Quite a few change theories are available, and you can use just one theory here.

FMEA
And, NOW, the FMEA section (C). First things first. The FMEA tool is very complex and is used by major organizations. For you, as the instructions clearly lay, the task is to apply it to just one process addressing each step. This is the key.

It is connected to all the sections that precede, i.e. your RCA and the Improvement Plan.

So, let's say that we have devised an improvement plan that (with other areas as highlighted above) focuses on patients like Mr. B. Probably, we are convinced that Mr. B (and similar patients) have an ASA Score III or higher. There are quite a few issues that caused his unwanted demise, but it was the sedation policy that can be our focus here: Remember just on process.

To cut short, FMEA helps us to identify risks and manage any failures before they can occur. So now, we want to apply FMEA here so that things won't get again to the same point as they did for Mr. B. In other words, we want to make sure our new ASA-related sedation policy won't fail and our patients will be treated well. As we noted above, there are quite a few other things than just the sedation administration. It involves addition of the flex staff, training of all the staff (RN, flex, physician, and the anesthesiologist), and coordination among them in such a way that a patient with ASA III or greater is administered the dosage within the limit of safety.

EDIT: Syllabus REVISION hath arriveth!!! There are now more than 1 versions of this paper as per the profile of  a student. Remember, WGU's syllabus is proprietary?

So, in another version, that you might have, there are no Pre-steps and Three-Steps (by the way it's way too confusing, isn't it?). Instead. all of these steps are combined as Necessary steps for FMEA that you are required to take. BUT...these are the same as given below. Just combine them and number them from 1 to 6/7. 

Pre-steps 
This section might sound quite complicated to you, but it is NOT. We just need to apply our common sense here. For instance, we're saying that a patient with ASA score III or greater would be handled under this plan. We have already highlighted many changes from staff, training, to coordination.

So, simply put, the pre-steps are to focus on the mechanism of FMEA before it is employed. It is like preparing your horses before the actual journey.

Thus, in your pre-steps, highlight the addition of the flex staff so that such a patient is not left unattended. Training of all the staff would alert them all for such a patient. Next, let's introduce a checklist here. This checklist, noting the ASA score, will be filled, signed, and pooled together by all the relevant staff: the RN (or flex), the physician, and the anesthesiologist: The Multidisciplinary Team. Unless signed by all of these stakeholders, NO further treatment can be offered to such a patient, etc.

In addition, let's also introduce here the Risk Priority Number scale to assign numeric value to the likelihood of occurrence or frequency, detection, and the severity or seriousness pointersThe RPN is to be discussed in the Three-Steps section below; here we're just introducing it, so say that, the MD team would be trained to use RPN beforehand.

Hence, the summary of our pre-steps can read: Patients with ASA score III or higher are monitored with great care; all the staff collaborates closely to treat the patient, and the conscious sedation policy (including any other treatment) is administered with strict monitoring involving the use of a checklist when the team is trained for using this tool. A decision is made collaboratively only.

Three Steps
Here the application of RPN is discussed in detail. First discuss the tool in some detail (using credible references). Next, we would say that because a patient like Mr. B has ASA score III or greater, the score would be much higher for severity (or seriousness), moderately high for frequency (it's relative here - it depends on the age group a town has; however, for the town like we have in the scenario, we can go for moderate score for frequency), much lowly scored for detection because we've already experienced a case that resulted in Mr. B's sad demise.

Hence, the pooled ratings would certainly alert the MD team to be extra cautious, etc., etc.

You do NOT want to forget that this entire process of applying FMEA would be cyclic and will be improved by time. You can say that a flowchart will be introduced to improve our FMEA process, etc. We need more detail here than I have written - or you're going to disappoint the WGU guys grading your paper! :-D

The sad news is, we're NOT done here :-(. The complication continues as WGU wants to make sure you understand how you can test the plan in an actual intervention!

EDIT: Whereas in this version you need to focus on just ONE process, in another version, that you might be receiving, you have list 4 such processes in the FMEA table. Be mindful of that. However, it's easy. Pick any four: (1) Staff training, (2) Staff's concept development, (3) building a team for random assessment, (4) Collaboration...., etc.

This brings us to C4. Interventions.

Here discussing a tool like PDSA (Plan, Do, Study, and Act) is mandatory, or the WGU guys will be very upset with you!

First, you are to state a plan question: How can a patient with ASA score III or greater can be treated carefully with our new conscious sedation policy?

Now The Plan: The checklist will be our major source for data to find out if our plan is working. It is because we've planned that no treatment is possible UNLESS the checklist has signed feedback/remarks by at least the RN/Flex staff, the physician, and the anesthesiologist. Thus, our plan is to use this data to test the vigor of our Improvement Plan.

DO: We can't just start testing this plan to all the patients meeting this criterion (ASA). So, here we will say that we will handpick just ONE patient first and carry out this intervention i.e., see how our checklist is working for him/her.

Study: As our intervention is put to reality check, we will see how it is going: Whether we are improving or not, etc. Here, we need all other data as well: pre-admission record and history, ongoing treatment and handling, and the success of the intervention. Do you see that every bit of our plan is coming along so very clear and is laid down step-by-step? This is what those guys at WGU want to see (my experience).

The Act prompt can highlight that we will ensure further improvement is made to any weaknesses in the plan found through our PDSA, for example, we might consider introducing a smartphone application for the checklist, etc.

For D. Key Role of Nurses, you can write a detailed portion highlighting the immense importance attached to this role in health care not just in US but all over the world.

GOOD NEWS! We're done.

I hope with this carefully crafted post, I have helped you save some of your precious time. Happy Nursing!

Last, if you like the tutorial/walk-through, do not forget to drop a line or so. Should you need any further assistance, I would be happy to response.

Email me at: meokhan2/at/gmail/dot/com

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