Taxonomy of Error, Root Cause Analysis, and Practice Responsibility (TERCAP) Proposal

Part One: Summary of Completed TERCAP Report

Taxonomy of Error, Root Cause Analysis, and Practice Responsibility, abbreviated as TERCAP, is an improvement framework that analyzes performance in the different healthcare sectors to identify the root causes of malpractice. TERCAP enables researchers to assess various healthcare departments such as administration, finance, human resource, and the scope of practice to identify areas that require improvement (Mohsenpour et al., 2017). In addition, TERCAP provides solutions to underperforming areas such as policy change and training to avoid deterioration of health service.

The case scenario of a 54-year-old neglected in the ward leading to a fall is an example of hospital malpractice that TERCAP can address (Rozo et al., 2017). Problems identified in the facility include increased nurse workload, mismanagement, high turnover, poor work culture, and disregard for the core values of nursing. The patient was admitted for back surgery because of acute back pain that brought them depression and lack of sleep. Instead of lessening the back pain, the nurse’s negligence magnified the back pain after the patient fell off the bed attempting to go to the toilet. The nurse malpractice was steered by poor management because the nurse was 29 weeks pregnant and working for 12 hours daily (Rozo et al., 2017). These factors can be categorized into situational, nursing, human, and organizational factors.

Part Two: Factors and Actions

Situational factors are external influences such as working condition that impacts an individual’s operation. For example, a situational factor in the scenario was nursing burnout because of the tight work schedule. The 24-year-old pregnant nurse was subjected to a tight work schedule of 12 hours and was in charge of 14 patients (Rozo et al., 2017). This rigid work system impacted the nurse and the patient because it led to non-responsiveness, which led to an adverse event. These factors can be avoided by hiring more staff to help manage the duties such as monitoring patients and administering drugs.

Nursing factors evident in the scenario include poor clinical skills and unit management. The nurse did not plan her intervention strategies to ensure her patients are monitored frequently and provided adequate care (Mohsenpour et al., 2017). Therefore, the planning, intervention, and evaluation processes failed in execution. The reason is that there was no systematic procedure created to ensure that the patient received adequate care to align with the core nursing values. According to Rozo et al. (2017), hindrances for better clinical practices can be avoided by enhancing the institution’s work culture through solid policies and procedures. Improving conformity to organizational policies requires better management that ensures that the welfare of staff and patients are accommodated.

Human factors are individual characteristics such as cognitive and emotional stability that impact operations. For example, the nurse was tired because she was in her last trimester of pregnancy, limiting vigorous activities such as frequent patient monitoring (Mohsenpour et al., 2017). Similarly, she experienced work stressors because of overload, which caused fatigue and burnout. Addressing this issue would require immediate action whereby the leadership would create flexible schedules for their staff to ensure they get psychosocial support to enhance their service delivery (Mohsenpour et al., 2017). In addition, teaching staff relaxation strategies such as taking a nap and meditation may help relieve stress and fatigue.

Organizational factors are institutional faults such as understaffing and ineffective communication that affects operations. The occurrences in the hospital, such as delayed patient monitoring and unresponsiveness, indicate a shortage in staffing. According to the National Council of State Boards of Nursing (2018), the communication barrier is a significant threat considering the patient complained that they were instructed to ask for assistance, something the patient could not recall because of the effects of drugs. Also, the patient complained that they pressed the bell button for assistance, but no one came to their rescue (Rozo et al., 2017). Unresponsiveness is a problem that is steered by ineffective communication. Addressing poor management and miscommunication will enhance future operations necessary for quality patient outcomes.

To rectify this problem, restructuring the leadership system to a transformational system may help strengthen care. The reason is that transformational leaders are mentors, and they address the root causes of the problem before authorizing the continuation of a process (NCSBN, 2018). In this scenario, a transformational leader would have assessed the patient and the resources available to care for this patient. If there was a limitation, including a staff shortage, the patient should have been referred to a more competent hospital (Rozo et al., 2017). Additionally, miscommunication can be addressed by training staff on the best communication strategies such as active listening, friendliness, and respect to enhance better practices.

The nurse violated the core principles of practice recommended by the American Nurses Association (ANA), including non-maleficence and beneficence (NCSBN, 2018). The nursing board penalizes nurses for various reasons such as gross negligence, unethical patient care practices such as misdiagnosis, and data breach that affects autonomy. The nurse committed various malpractices, including patient dereliction, which was unintentional because of the facility’s poor management practices (NCSBN, 2018). The hospital employed a nurse with only nine months of experience to manage the entire unit. Considering she committed a crime, it is justified that she be subjected to disciplinary action such as reprimanding the nurse and placing her under mandatory unpaid training for that unit.

As a nursing disciplinary team, I would recommend reprimand and mandatory unpaid training. The nurse requires intensive training on patient safety and nursing violation codes. This training will ensure that the nurse acquires the skills necessary to maintain patients’ safety in the future (Mohsenpour et al., 2017). The training will also highlight the violation codes such as the ANA codes of practice and security rules such as the Health Insurance Portability and Accountability Act (HIPPA).

Part Three: Continuing Education

The TERCAP analysis provides a framework for improvement, and some of its concepts incorporated into learning include:

• Nursing codes of practice – this topic will provide the necessary skills for better practices because competency and evidence-based practice are highlighted.
• Paid maternity leaves for pregnant employees – this topic is to provide personal safety awareness to enhance individual advocacy and productivity.
• Work-life balance – this topic is integral for nurses to balance their personal a work responsibility to avoid stressors that limit productivity.
• TERCAP concepts – this framework will be highlighted to enable supervisors and nurses to assess underperforming areas and develop solutions before affecting quality operations (Mohsenpour et al., 2017).

Conclusion

TERCAP is a framework that helps assess the root cause to help facilitate developmental nursing initiatives. Through TERCAP, nursing supervisors can assess errors such as financial misappropriation, medical errors, and burnout. The case scenario depicts areas of concern in an operational health facility such as unresponsiveness, poor clinical skills, and ways to reduce this occurrence, such as adequate staffing. Problems exhibited by the nurse require that she receives basic training on patient and individual safety, clinical practices, and self-management to enhance productivity.

References

Mohsenpour, M., Hosseini, M., Abbaszadeh, A., Shahboulaghi, F. M., & Khankeh, H. (2017). Nursing error: An integrated review of the literature. Indian Journal of Medical Ethics, 2(2), 75-81.

National Council of State Boards of Nursing. (2018). Progress and precision: The NCSBN 2018 environmental scan. Journal of Nursing Regulation, 8(4), S3-S48. Web.

Rozo, J. A., Olson, D. M., Thu, H., & Stutzman, S. E. (2017). Situational factors associated with burnout among emergency department nurses. Workplace Health & Safety, 65(6), 262-265.