Conduct a Root Cause Analysis (RCA), please perform one for the following scenario in your role as Quality Director for a 300 bed Nursing Home in Manhattan:

Now that you have learned how to conduct a Root Cause Analysis (RCA), please perform one for the following scenario in your role as Quality Director for a 300 bed Nursing Home in Manhattan:

Mr. Caring, a Nursing Home patient was identified at risk for elopement

They were given a wanderguard bracelet, which is connected to the front and stairwell doors

Resident has been at facility for 15 years, is alert and oriented x 2-3, smoker, walks a small amount of feet and usually sits in a wheelchair, which they propel.

The resident is on 30 minute safety checks

At 7:00 am on Monday, you are at the facility and informed that Mr. Caring’s empty wheelchair ws found at the back door a few minutes prior.

Next steps…. do your root cause analysis to find out what happened and when you do, develop a corrective action plan to prevent it from happening again.

There are different RCA formats available. Explore the templates and select one you are comfortable with. JCAHO has a very comprehensive template available.