What is a Fishbone Diagram?
A fishbone diagram is a tool used for categorizing the potential causes of a problem. Healthcare practitioners can use the tool in healthcare settings to identify the root cause of a problem. The diagram combines a type of mind template and the practice of brainstorming. It is considered efficient as a test case technique, especially in determining the cause and effect of a particular phenomenon or problem in various settings. The diagram is useful in troubleshooting and program development. The name of the diagram comes from its resemblance to a fish skeleton. It works from right to left, with each large bone branching out to tiny bones, each containing more details on the problem. The diagram helps the healthcare providers avoid various solutions that particularly address the symptoms of the problem rather than the entirety of the problem.
The diagram is a cause-effect diagram. The large bones signify the human factors in pharmacy, nursing, and equipment and supplies. The diagram can be utilized to inform nursing practice when preventing future errors. Healthcare practitioners can focus on human factors in nursing and pharmacy and the equipment and supplies. Human factors that may cause medication errors related to prescribing and dispensing in pharmacy include pharmacy technicians stress and burnout, pharmacy knowledge deficit, unavailability of pharmacists by phone, and lack of pharmacists on the nursing units. Human factors in nursing units include nursing staffing burnout, knowledge deficit on drug names, and failing barcodes. In the equipment and supplies, the main causes of medication errors may be related to barcode labels, failing scanners, breaking down of unit does machines, and look-alike medications. When nurses and healthcare organizations address all these factors, medication errors will reduce significantly in the nursing unit.
The provided Fishbone diagram classifies the major causes of medication errors into equipment and supplies, human factors nursing, and human factors pharmacy. Each part provides the possible causes that contribute to the major problems. This information can help nurses to prevent medication errors by addressing aspects like faulty scanners, look-alike medication labeling, and purchase of unit dose machine that is always breaking. Nurses can focus on education and training to improve knowledge on drugs and the use of 7 rights of medication administration. Additionally, nurses can call for more action in the pharmacy department that controls dispensing and labeling of medication that is observed to significantly contribute to medication errors.
Analysis of the Pareto Chart
The chart is a special example of a bar chart used in identifying areas individuals should focus in quality improvement. The length of the bars represents the cost and frequency of particular phenomena. The shortest bars are arranged with the shortest to the right and the longest bars on the left (ASQ, n.d). It is also regarded as one of the best cause analysis tools. The tool can be used in multiple scenarios involving medical errors. First, it can be used when analyzing statistics about the frequency of causes or problems in the process. Second, it can be used in the nursing unit when there are numerous problems or causes of medication errors and the unit wants to focus on the significant ones. Third, it can be used in analyzing the broad causes of medication errors in the unit by analyzing its specific components. Finally, the pareto chart can communicate the medication errors and their causes to other individuals and stakeholders. It can be a tool utilized in healthcare planning or as an indicator of healthcare quality.
The Pareto chart can be used in analyzing the number of medication errors. The number of medication errors in the unit can reveal healthcare quality in the setting. The number of medication errors is a crucial statistic healthcare organizations need (ASQ, n.d). The nature of the statistics can be used to determine the severity of medication errors in the unit. For example, one in every five individuals in the nursing unit is likely to suffer medication errors. The information displayed in the Pareto chart can prevent future medication errors. The displayed Pareto chart shows that the main causes of medication errors are defective scanners, followed by look-alike medications and medication labelling. The nurses can focus their resources on the significant causes of medication errors.
The provided Pareto chart indicates the causes and number of medication errors observed in Downtown Medical in 2015. In total there were 272 medication errors resulting from various causes. Defective scanners caused 102 errors, look-alike medication labeling 60, pharmacy tech stress/error 60, manual entry internal entry number 20, no pharmacy resource phone or voicemail, 15, knowledge deficit on 7 rights nursing 8, and knowledge deficit of generic trade names 7 errors. The chart also indicates that most errors fall under the vital few section where a small number of sources account for most of the observed errors. The useful many section is only represented by errors resulting from a lack of generic drug name understanding. The diagram indicates that solutions should be tailored towards addressing the issues of defective scanners, look-alike labeling, and pharmacy tech stress/errors that account for 82% of the total errors. A much smaller, but more precisely focused effort can significantly improve medication errors in the facility.
Analysis of A Run Chart
A run chart is represented in a line graph of medication errors plotted over time. Collection and plotting f the data over time can help healthcare practitioners to find patterns and trends in the processes (MDH, 2020). The run charts do not have any control limits hence cannot show if a particular phenomenon is stable. However, they indicate how processes are running. The Run chart is crucial, especially when implementing a project. It can monitor the success of a particular solution to a significant problem. The run charts show individual medication error data points in a systematic order.
The run chart is a powerful and easy to use tool used in process improvement. The run chart can be used to study observed data for trends and patterns over a a specified duration (Carl & Lew, n.d.). The healthcare providers can then utilize the trends and patterns to focus their attention on significant factors resulting in medication errors. The chart can determine the common causes of medication errors or special cause variation. The run chart can also be related to patient satisfaction. In patient satisfaction measures can be obtained from the patients, then nurses and healthcare practitioners can identify factors related to patient satisfaction. For example, in pain management, a nurse can measure the satisfaction scores of different pharmacological and non-pharmacological agents used in managing pain. The agents with the highest patient satisfaction scores can be incorporated into the healthcare setting. Summarily, the chart identifies which pain agents have the highest level of patient satisfaction.
The provided run chart indicates patient satisfaction with pain management from 2014 to 2016. In the beginning, the patient satisfaction level was 70% and improved to a maximum of 78% over two months before dropping to 65% in June 2014. There was a slight improvement over the next few months but again the satisfaction levels decreased in the first two months of 2015. It seems that there were improvements in the facility that led to a rapid increase in the patient satisfaction levels with pain management from March 2015. A few reasons that could cause these changes include staff education, new policies regarding pain management, and hourly rounding to assess pain in patients. Patient satisfaction is observed to have increased gradually from 80% in March 2015 to 97% in May 2016. The run chart indicates that pain management among patients is excellent leading to increased patient satisfaction.
Process flow chart
It is a chart or a diagram of quality improvement steps in a process and their sequence. The process flow chart is unique to quality improvement. Constructing it is one of the main unique processes to quality improvement (ASQ, n.d.). The process flow chart has various benefits. Firstly, healthcare professionals a clear understanding of processes involved in of problems in healthcare and other settings. The process is shown sequentially in a chart which healthcare providers can reference. The flow chart can indicate the sequence in which medication errors occur in the healthcare setting. It can also provide a sequence that the healthcare providers should follow to minimise medication errors in the department. A flow chart can also be used as a reference point to inform the employees of various policies and regulations governing the five rights of medication administration. It can also be used to identify if the healthcare providers are implementing the policies to reduce medication errors in the nursing unit. It can be used to inform an intervention in the healthcare setting.
The provided process flowchart describes how medication is acquired from pharmacy, scanned, administered, and documented by the nurse. When the barcode scanner fails to show the drug, the nurse manually enters the number or contacts pharmacy for clarification before the medication is administered. In cases where the barcode fails, the nurse calls the supervisor for guidance. The information from the flowchart indicates that fixing defective scanners can avoid extra processes like manual entry of medication number and calls to the pharmacy for clarification. These extra processes like calling the pharmacy and manual entry can be an extra source of errors in the facility. Additionally, the flowchart indicates that nurses can contact their supervisors when barcode scanning of medication fails to aid in follow-up and early detection of errors.
Application of the practice problem and Fishbone diagram
`The fishbone diagram can be utilized in managing medication errors in the nursing unit in the psychiatric institution. Common causes of medication errors are human factors in pharmacy, nursing, equipment, and supplies. All these elements need to be assessed and proper measures implemented to reduce medication errors.
In the facility, the main factors causing medication errors include inadequate staffing, knowledge deficit on the right of medication administration and generic Vs trade names. Other nursing factors that can result to medication errors include nursing burn-out, understaffing, and staffing burnout.
In Equipment and supplies, the nursing unit’s main factors resulting in medication errors include failing technology. Failing technology include failing barcodes. The factors that can result in medication errors related to technology include failing barcodes, network issues, and technology failure. Healthcare professionals should focus on the technological issues that result to medication errors.
There is adequate evidence supporting the role of distractions in the healthcare environment that promote medication errors. Too much responsibility of nurses, multitasking, and carrying out simultaneous activities can promote medication errors. The availability of students to supervise, responding to telephone calls, and other complexities of the healthcare environment make it difficult to control medication administration effectively.
Equipment and supplies
Today’s healthcare system is characterized by the use of computers to order and dispense drugs. Additionally, calculations are made using computers and patient data is stored in the Electronic Health Records (EHRs) to guide patient care. Faulty EHR systems can cause documentation problems that can cause medication errors. Wrong labels on the drugs, ordering of wrong dosages, and supply of expired drugs can contribute to medication errors. Supplies like syringes with improper labeling or faulty volume scales can cause the administration of wrong drug dosages to patients.
Training and experience
The level of experience can translate to the number of errors due to administration or omission observed. Registered nurse Vs. Advanced nurse care delivery may differ while factors like memory and recall can be affected by the level of education. Nursing students are likely to cause more errors than qualified staff.
Several other factors that may fail to fit in broad categories can cause medication errors. High-level design decisions, faulty management systems, not following care delivery procedures, deliberate violation of practice, and the complexity of the patient’s illness can contribute to medication errors.
American Society for Quality (ASQ) (n.d). What is a Pareto chart? https://asq.org/quality-resources/pareto#:~:text=A%20Pareto%20chart%20is%20a,which%20situations%20are%20more%20significant.
American Society for Quality (ASQ) (n.d). What is a flow chart? https://asq.org/quality-resources/flowchart.
Carl, B. & Lew, Y. (n.d.). Run Chart: A simple and powerful tool for process improvement. Iixsigma. https://www.isixsigma.com/tools-templates/control-charts/run-charts-a-simple-and-powerful-tool-for-process-improvement/
Minnesota Department of Health (MDH) (2020). What is a run chart? https://www.health.state.mn.us/communities/practice/resources/phqitoolbox/runchart.html.
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