1. Discussion: Adverse Event from My Professional Nursing Experience
Discussion: Adverse Event from My Professional Nursing ExperienceORDER HERE FOR
ORIGINAL, PLAGIARISM-FREE PAPERS ON Discussion: Adverse Event from My Professional
Nursing ExperienceWrite a 5–7-page a comprehensive analysis on an adverse event or near
miss from your professional nursing experience. Integrate research and data on the event
and use as a basis to propose a quality improvement (QI) initiative in your current
organization.Health care organizations strive for a culture of safety. Yet despite
technological advances, quality care initiatives, oversight, ongoing education and training,
laws, legislation and regulations, medical errors continue to occur. Some are small and
easily remedied with the patient unaware of the infraction. Others can be catastrophic and
irreversible, altering the lives of patients and their caregivers and unleashing massive
reforms and costly litigation. Discussion: Adverse Event from My Professional Nursing
ExperienceShow LessThe goal of this assessment is to focus on a specific event in a health
care setting that impacts patient safety and related organizational vulnerabilities and to
propose a quality improvement initiative to prevent future incidents.By successfully
completing this assessment, you will demonstrate your proficiency in the following course
competencies and assessment criteria:Competency 1: Plan quality improvement initiatives
in response to adverse events and near-miss analyses.Evaluate quality improvement
technologies related to the event that are required to reduce risk and increase patient
safety.Competency 2: Plan quality improvement initiatives in response to routine data
surveillance.Analyze the missed steps or protocol deviations related to an adverse event or
near miss.Analyze the implications of the adverse event or near miss for all
stakeholders.Outline a quality improvement initiative to prevent a future adverse event or
near miss.Competency 3: Evaluate quality improvement initiatives using sensitive and
sound outcome measures.Incorporate relevant metrics of the adverse event or near miss
incident to support need for improvement.Competency 5: Apply effective communication
strategies to promote quality improvement of interprofessional care.Communicate analysis
and proposed initiative in a professional and effective manner, writing content clearly and
logically with correct use of grammar, punctuation, and spelling.Integrate relevant sources
to support arguments, correctly formatting citations and references using current APA
style.The purpose of the report is to assess whether specific quality indicators point to
improved patient safety, quality of care, cost and efficiency goals, and other desired metrics.
Nurses and other health professionals with specializations and/or interest in the condition,
disease, or the selected issue are your target audience.As you prepare to complete this

2. assessment, you may want to think about other related issues to deepen your
understanding or broaden your viewpoint. You are encouraged to consider the questions
below and discuss them with a fellow learner, a work associate, an interested friend, or a
member of your professional community. Note that these questions are for your own
development and exploration and do not need to be completed or submitted as part of your
assessment.Reflect on quality improvement (QI) initiatives in your workplace:What makes
a QI initiative a success? What elements must be incorporated?What opportunities are there
for interprofessional collaboration on a QI initiative in your workplace?Proficiency in
interpretation of data is critical to understanding and communicating QI outcome measures.
What can be done to improve data literacy across interprofessional teams?REQUIRED
RESOURCESMSN Program JourneyThe following is a useful map that will guide you as you
continue your MSN program. This map gives you an overview of all the steps required to
prepare for your practicum and to complete your degree. It also outlines the support that
will be available to you along the way.MSN Program Journey | Transcript.Show
LessSUGGESTED RESOURCESThe resources provided here are optional. You may use other
resources of your choice to prepare for this assessment; however, you will need to ensure
that they are appropriate, credible, and valid. The Nursing Masters (MSN) Research
Guide can help direct your research, and the Supplemental Resources and Research
Resources, both linked from the left navigation menu in your courseroom, provide
additional resources to help support you.Capella ResourcesCapella provides a thorough
selection of online resources to help you understand APA style and use it effectively.APA
Module.Adverse Events and ReportingThese resources explore how cultures focused on
safety learn from adverse events.Rafter, N., Hickey, A., Condell, S., Conroy, R., O’Connor, P.,
Vaughan, D., & Williams, D. (2014). Adverse events in healthcare: Learning from
mistakes. QJM: Monthly Journal of the Association of Physicians, 108(4), 273–277. Retrieved
from https://academic.oup.com/qjmed/article-lookup/doi/…Skinner, L., Tripp, T. R.,
Scouler, D., & Pechacek, J. M. (2015). Partnerships with aviation: Promoting a culture of
safety in health care. Creative Nursing; Minneapolis, 21(3), 179–185.The following
resources explore the benefits and challenges of incident reporting systems.Harrison, R.,
Lawton, R., & Stewart, K. (2014). Doctors’ experiences of adverse events in secondary care:
The professional and personal impact. Clinical Medicine, 14(6), 585–590.Crane, S., Sloane, P.
D., Elder, N., Cohen, L., Laughtenschlaeger, N., Walsh, K., & Zimmerman, S. (2015). Reporting
and using near-miss events to improve patient safety in diverse primary care practices: A
collaborative approach to learning from our mistakes. Journal of the American Board of
Family Medicine, 28(4), 452–460. Retrieved
from http://www.jabfm.org/content/28/4/452This resource examines organizational
factors that lead to adverse events and near-miss incidents.Patterson, M. E., & Pace, H. A.
(2016) A cross-sectional analysis investigating organizational factors that influence near-
miss error reporting among hospital pharmacists. Journal of Patient Safety, 12(2), 114–
117.Reporting SystemsThese resources provide comprehensive event reporting systems
data and performance assessment information:The Joint Commission. (2017). National
patient safety goals. Retrieved
from https://www.jointcommission.org/standards_informat…U.S. Food & Drug

3. Administration. (2017). FDA adverse event reporting system (FAERS). Retrieved
from http://www.fda.gov/Drugs/InformationOnDrugs/ucm135…Hospital Consumer
Assessment of Healthcare Providers and Systems. (2017). CAHPS hospital survey. Retrieved
from http://hcahpsonline.org/This resource provides examples of adverse events and near-
miss incidents:Agency for Healthcare Research and Quality. (2016). WebM&M cases &
commentaries. Retrieved from https://psnet.ahrq.gov/webmmPREPARATIONPrepare a
comprehensive analysis on an adverse event or near-miss from your professional nursing
experience that you or a peer experienced. Integrate research and data on the event and use
as a basis to propose a Quality Improvement (QI) initiative in your current
organization.Note: Remember, you can submit all, or a portion of, your draft to
Smarthinking for feedback, before you submit the final version of your analysis for this
assessment. However, be mindful of the turnaround time for receiving feedback, if you plan
on using this free service.The numbered points below correspond to grading criteria in the
scoring guide. The bullets below each grading criterion further delineate tasks to fulfill the
assessment requirements. Be sure that your Adverse Event or Near-miss Analysis addresses
all of the content below. You may also want to read the scoring guide to better understand
the performance levels that relate to each grading criterion.Analyze the missed steps or
protocol deviations related to an adverse event or near miss.Describe how the event
resulted from a patient’s medical management rather than from the underlying
condition.Identify and evaluate the missed steps or protocol deviations that led to the
event.Discuss the extent to which the incident was preventable.Research the impact of the
same type of adverse event or near miss in other facilities.Analyze the implications of the
adverse event or near miss for all stakeholders.Evaluate both short-term and long-term
effects on the stakeholders (patient, family, interprofessional team, facility, community).
Analyze how it was managed and who was involved.Analyze the responsibilities and actions
of the interprofessional team. Explain what measures should have been taken and identify
the responsible parties or roles.Describe any change to process or protocol implemented
after the incident.Evaluate quality improvement technologies related to the event that are
required to reduce risk and increase patient safety.Analyze the quality improvement
technologies that were put in place to increase patient safety and prevent a repeat of similar
events.Determine whether the technologies are being utilized appropriately.Explore how
other institutions integrated solutions to prevent these types of events.Incorporate relevant
metrics of the adverse event or near miss incident to support need for
improvement.Identify the salient data that is associated with the adverse event or near miss
that is generated from the facility’s dashboard. (By dashboard, we mean the data that is
generated from the information technology platform that provides integrated operational,
financial, clinical, and patient safety data for health care management.)Analyze what the
relevant metrics show.Explain research or data related to the adverse event or near miss
that is available outside of your institution. Compare internal data to external data.Outline a
quality improvement initiative to prevent a future adverse event or near miss.Explain how
the process or protocol is now managed and monitored in your facility.Evaluate how other
institutions addressed similar incidents or events.Analyze QI initiatives developed to
prevent similar incidents, and explain why they are successful. Provide evidence of their

4. success.Propose solutions for your selected institution that can be implemented to prevent
future adverse events or near-miss incidents.Communicate analysis and proposed initiative
in a professional and effective manner, writing content clearly and logically with correct use
of grammar, punctuation, and spelling.Integrate relevant sources to support arguments,
correctly formatting citations and references using current APA style.SUBMISSION
REQUIREMENTSLength of submission: A minimum of five but no more than seven double-
spaced, typed pages.Number of references: Cite a minimum of three sources (no older than
seven years, unless seminal work) of scholarly or professional evidence that support your
evaluation, recommendations, and plans.APA formatting: Resources and citations are
formatted according to current APA style and formatting.Note: Faculty may use the Writing
Feedback Tool when grading this assessment. The Writing Feedback Tool is designed to
provide you with guidance and resources to develop your writing based on five core skills.
You will find writing feedback in the Scoring Guide for the assessment, once your work has
been evaluated.Discussion: Adverse Event from My Professional Nursing Experience