NRSG378:PrinciplesofNursing–ExtendedClinical Reasoning
| ASSESSMENT INFORMATION | |
| Assessment Title | Assessment Task 2 – Project |
| Purpose | This assessment enables students to demonstrate sound understanding of the application of professional nursing standards, national health standards and organisational policy related to patient deterioration and a sentinel event. Students are given the opportunity to complete a root cause analysis (RCA) for one of two provided case study options. |
| Due Date | Wednesday 19th April 2023 |
| Time Due | 14:00 |
| Weighting | 40% |
| Length | Equivalent to 1600 words +/- 10% |
| Assessment Rubric | Appendix 1 of the NRSG378 unit outline |
| LEO Resource | A national pre-recorded video will be uploaded onto LEO in week five (5), which will provide students with an overview of the assessment as well as resources and advice on how to approach the task. Students are encouraged to post questions on the discussion forum on LEO and to check for answers there as a first point of query. |
| LOs Assessed | LO1, LO2, LO3, LO5 |
| Task | Students will complete a root cause analysis (RCA) using a provided template. You will choose from either ONE of two case studies below to complete a RCA, and you will be required to respond to the following sections: Provide a brief description of the event Identify and discuss the root causes which have likely contributed to the sentinel event Identify and discuss at least two (2) NMBA RN Standards which were not practiced or maintained by the nurses involved in this sentinel event, that may have led to the identified root causes. Discuss at least two (2) National Safety and Quality Health Service (NSQHS) Standards which were breached (or not met) by this health organisation, that may have led to the identified root causes. Outline a minimum of three (3) recommendations to address the root causes identified from the chosen case study. These recommendations need to include practical examples and identify who is responsible for actioning these recommendations. |
Case Study Option 1
Case Study One
A 79-year-old patient, Mrs Sergi was admitted to hospital for a routine hip replacement. Mrs Sergi had been experiencing hip pain for a few years and was alert and oriented before surgery, although she was noted to be frail and weighing 35kg.
The operation was performed at the start of the afternoon operation list and her surgery was uneventful. Mrs Sergi had a PIVC inserted in OT and the medications chart recorded that she had received 500mls of NaCl 0.9% IV intraoperatively. At the conclusion of the operation the Anaesthetist commenced a new 1L IV bag of NaCl 0.9% and ordered IV NaCl 0.9% over 10 hours x 2 bags (100 ml/hour), until the patient’s review the following day.
Mrs Sergi was transferred to PACU at 3pm into the care of the PACU team and a PACU observations chart was commenced. Mrs Sergi was soon alert and oriented and communicating coherently with PACU staff and her observations were all within normal limits and her pain well controlled. At handover to the ward nurse (Fiona), the PACU nurse mentioned that the anaesthetist wanted Mrs Sergi to have ‘as much fluid as possible’, so Fiona wrote this on the observation chart.
On RTW at 4pm Fiona settled Mrs Sergi into the ward and commenced a fluid balance chart and wrote “as much fluid as possible” in this chart too. She set up the IV pump at 200mls/hr and commenced hourly post-op obs. The ward got busy that evening and only 1 set of observations were recorded in Mrs Sergi’s chart. At handover to night staff at 9.30pm Fiona reported that Mrs Sergi had “obs within normal limits except for an elevated BP, andlowish pulse and a bit of a post-op cough, to have as much fluid as possible and her IVTneedsanewbagascharted”.
The Night nurse (Tanya) checked Mrs Sergi’s IVT at 10pm and commenced a new 1L bag of NaCl 0.9% at 200 ml/hr and noted that the patient was short of breath and confused, so she recorded this in the patients chart as “confused ?? dementia” and continued with her shift. At 3am Tanya went to change the IVT bag and noticed that Mrs Sergi was extremely short of breath and very agitated, so she called the on-call Dr for a non-urgent review. The Doctor came to the ward at 4am and found Mrs Sergi unresponsive. A MET call was initiated but Mrs Sergi could not be revived and was declared deceased at 4.30am.
Scenario adapted from Staunton, P. and Chiarella, M., 2012. Law for nurses and midwives. Chatswood, N.S.W.: Elsevier Australia.
| Case Study Option 2 | Case Study Two Mr Evans, a 45-year-old man presented to a small regional hospital Emergency Department with a laceration to his leg caused by an accident with farming equipment, and dehydration due to delays in calling for help. His laceration was cleaned and sutured, and he was rehydrated with IV fluids with good effect but he experienced some mild nausea. The doctor ordered 5mg of IV metoclopramide for nausea, and 1g of oral paracetamol for pain as a STAT dose before discharge. The nurse on duty, Lorna, was a registered nurse with 40-years’ experience, and was the Assistant Director of Nursing at the hospital. However due to staff absences, she was helping in the ED for the shift. Lorna had not worked clinically for many years, but she wanted to support her staff. She introduced herself to Mr Evans and he asked about having his medications because he wanted to go home as soon as possible. Lorna read the medication chart, but she felt unsure about administering the medications, so she consulted with experienced ED nurse, Barry, who said that he’d prepare the medications for her even though he was very busy. Barry read Mr Evan’s medication chart and prepared the IV metoclopramide and noting that the patient would possibly not tolerate tablets due to nausea, he drew up 1g of oral paracetamol elixir liquid into a syringe and put both syringes in a tray. He then gave the tray to Lorna and continued his shift. Lorna noticed that both medications were in syringes, and she assumed both were for injection. She was unaware that paracetamol could be given via IV route so she asked a passing nurse (Kate), “can paracetamol be given IV? and Kate replied “yes”. Lorna proceeded to give both medications into Mr Evan’s IV cannula. Mr Evans immediately developed symptoms of a pulmonary embolus, which proceeded to a massive stroke, and he was declared deceased after 30 minutes of resuscitation attempts. Scenario adapted from Staunton, P. and Chiarella, M., 2012. Law for nurses and midwives. Chatswood, N.S.W.: Elsevier Australia. |
| Submission | Via the Turnitin dropbox in the NRSG378 LEO site under the “Assessment” tile. |
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