Executive Summary to CEO template 07-09-22 (1)

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Ashford University *

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460

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Chemistry

Date

Nov 24, 2024

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docx

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1 Executive Summary to the CEO Your Name University of Arizona Global Campus HCA 460: Health Care Administration Capstone Instructor's Name Date (spelled out: January X, 20XX) Hint : Delete all of these green boxes before submitting the paper to your instructor. To delete the boxes: click on the edge of each box and press delete. Also note: move text up when deleting green boxes. Do not maintain extra spacing where green boxes previously were. Hint : Ctrl + Click WRITING AN EXECUTIVE SUMMARY for help understanding the purpose of this type of writing. Note that the sample on this resource is much shorter than your assignment, so take the general advice but follow this template to create an assignment that meets your instructor’s requirements.

2 Dosage Management A patient who had been discharged home on heparin due to previous blood clots experienced an overdose dose as a result of lapses in the established processes and standard workflows established by our facility, as detailed in the following Executive Summary. New processes and their results will be outlined in this summary and given to the whole workforce. Part 1: The Sentinel Event A 66-year-old woman presented to the ER on Friday, January 21, 2021, complaining of abdominal discomfort. According to the record review performed by the case manager, the female patient just had a hip replacement and has a history of clots. The patient was on a Heparin regimen.she used a blood thinner before her ERAs presentation to avoid a potentially fatal blood clot As I start asking the patient about her symptoms, she turns to the side and throws up.I saw what looked like coffee grounds in the patient's vomit while I was helping them, and my clinical judgment told me that they had probably overdosed on heparin. I immediately contacted my supervisor, and together we conducted a thorough assessment of patients, including her medical records and history, and spoke at length with the member and her family. The member was not seriously hurt and is making a complete recovery here.The following parties were informed of the mistake, and the relevant authorities have been contacted to provide their assistance to our establishment.They are now looking into what went wrong. The following organizations will report back to us with thorough data that may be used to inform both preliminary and final procedures and mitigation strategies. The FDA of the United States of America,The Food and Drug Administration (FDA) is an agency created by law to safeguard the public's health via the regulation of foods, pharmaceuticals, and other items intended for human and animal use. The Joint Commission's National Patient Safety Goal (NPSG): The National Patient Safety Goals were established with that end in mind. The objectives are centered on addressing issues related to patient safety in medical settings. Pharmaceutical Companies in the United States The National Formulary: a compendium of medication information including chemical make-up, production details, and recommended doses Part 2: Root Cause Analysis (Fishbone Diagram) (Note: This is a sample. Do not replicate the contents of this exact diagram. Right click on the image and select CUT from the list to remove it.)

3 For this section, you will create the CQI Tool (Fishbone), complete the tool, copy (or take a screenshot of) the completed work, and paste the completed diagram here. If you are unfamiliar with the Fishbone, please refer to the Using Quality Improvement Methods for Evaluating Health Care article by Siriwardena (2009). In addition, as a learning resource, the CQI tool listed below is hyperlinked to the Institute for Health Care Improvement website, which discusses and illustrates an example of the Fishbone. Tools: Cause and Effect Diagram Part 3: Root Cause Analysis Report In this section, you will create a root cause analysis. In this first paragraph, you will identify the data elements you would collect to determine the cause and give your rationale for choosing these data elements. Data elements are the numbers that are used to identify and track the happenings within the organization. For example, if the sentinel event occurred due to insufficient staff on duty at the time, the number of staff members on duty is a data element. Probable Cause Next, identify the probable cause. This may include process failure, human error, cultural biases, policy error, systems error, technology failure, or some other issue that may have contributed to your sentinel event. Include any or all of the following subsections in completing the probable cause portion of your report. Human Factors What human factors were relevant to the outcome? Hint : Ctrl + Click ACADEMIC VOICE for help using an academic voice in your writing.

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4 Process Errors What process errors were relevant to the outcome? Missed Steps Were there any steps in the process that did not occur as intended? Equipment Performance How did the equipment performance affect the outcome? Other Areas What are the other areas in the health care organization where this could happen? Staff Performance Did staff performance during the event meet the expectations? Corrective Action Plan Here, develop a corrective action plan that is geared towards eliminating future events. Explain the steps of implementing the corrective action plan. Writing at least a paragraph for each section, discuss the elements below in your response. Risk Reduction Strategies Identify the best risk reduction strategies related to your scenario. What will help the staffing team avoid this kind of event in the future? Improvement of Processes or Systems How can the processes or systems be improved to eliminate future events? Communication Barriers Discuss the communication breakdown that may have contributed to the sentinel event. What barriers may have occurred to cause the breakdown in communication? Some of these

5 may include residual intimidation, reluctance to report to a coworker, missing information at time of transition of care, etc. Training What training should be implemented to eliminate future events? This may include orientation, professional development, cultural competency, skills training, in-service, etc. Equipment What equipment should be considered to eliminate future events? This should include the technology, maintenance, and updates. Policies and Procedures What new or revised procedures should be considered to eliminate future events? Monitoring Process Describe the monitoring process that will be used to evaluate the success of the corrective action plan. Reallocation of Budgetary Resources Analyze the components that may require the reallocation of budgetary resources. In this paragraph or series of paragraphs, you will want to consider legal action that may occur against the organization due to the sentinel event, public relations (reputation leading to decreased revenue), equipment and supplies, training and education, patient-centered communication methods (informed consent, procedural education, patient involvement in the procedure [identify or mark the location of the surgical site]), staffing time for patient education, and increasing staffing related to workload balance (reallocating staff, role responsibilities, hiring temporary or permanent staff). Include your rationale for each action you

6 recommend. Additionally, explain how each part will benefit the organization (make a connection between the recommendations and how it will help in avoiding the sentinel event in the future). Conclusion Restate the conclusion or overall recommendation of the report. Recap the main points. Hint : Ctrl + Click INTRODUCTIONS & CONCLUSIONS for help developing a conclusion.

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7 References Include at least eight scholarly or credible sources in your assignment. Use APA Style to format your sources on the References page. You must include in-text citations throughout your paper to show your reader what information you used from outside sources. Author, A. A., Author, B. B., & Author, C. C. (Year). Article title. Journal Title , volume # (issue #), page range. http://doi.org/xxx.xxx.xxx.xxx Author, A. A. (Year, Month Day). Webpage title . Website Title . http://(URL) Title of Organization. (Year, Month Day). Webpage title . Website Title . http://(URL) Author, A. A. (Year Published). Title of book: Subtitle of book (edition, if other than the first). Publisher Name. https://doi.org/xxx.xxx.xxx (ebook’s DOI, or https://(URL) if not contained within a database and DOI is unavailable) Author, A. [Screen name, if different]. (Year, Month Day). Title of video [Video]. Platform Name. https:// (URL) APA academic journal reference entry APA webpage (with a person as author) reference entry APA webpage (with corporate/government author) reference entry APA etextbook reference entry APA online video entry Right-click APA: Formatting Your References List for further help. Free tutoring support is also available: 24/7 Writing Tutoring and Paper Review Delete all “hint boxes” before submitting your assignment by right- clicking on the edge of the box and selecting “Cut” from the menu.

8 *In the final version of your assignment, be sure to remove all the hints (blue boxes) and directions within the template.