Root Cause Analysis and SWOT Analysis
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Root Cause Analysis and SWOT Analysis
In this case scenario, the nurses administered a double dose of medication because the
hospital system only allows documentation after administering the drug. The root cause analysis
and SWOT analysis will determine the factors contributing to this issue and how they can be
addressed.
Root Cause Analysis
The root cause analysis (RCA) is a structured framework used to analyze and determine
the contributing factors to an adverse outcome, especially in healthcare. It is an error analysis
tool that helps identify the factors contributing to avoidable errors affecting the quality of care
and adverse outcomes such as mortality (Agency for Healthcare Research and Quality, 2019).
Fishbone-Style Root Cause Analysis
Technology Policies People
Wrongful administra on of
medica on. Administered
two doses of medica on.
Equipment Processes
Environment
The System Elements That Need To Be Investigated
Some system elements that should be investigated include the people, processes, policies,
environment, technology, and equipment. These elements are likely to have contributed to the
errors individually or collaboratively. They each have a way in which they could have
contributed to the error, as explained below.
People, Staffing Levels, And the Workloads