Assessment 2 Root-Cause Analysis and Safety Improvement Plan The purpose of this assessment is to demonstrate your understanding of and ability to analyze the root cause of a specific safety concern in a healthcare setting. You will create a plan to improve the safety of patients related to the concern of medication administration safety based on the results of your analysis, using the literature and professional best practices as well as the existing resources at your chosen healthcare setting to provide a rationale for your plan.

Root-Cause Analysis and Safety Improvement Plan

A root cause is defined as a factor that makes an individual fail to conform to procedures as dictated. This necessitates the need to eliminate this factor completely through improvement. Root causes are usually the reason why the cause-and-effect reaction takes place with the potential to lead to the problem(s). Root cause analysis can be defined as a term that describes the approaches, tools, and techniques that are applied with the aim of uncovering the causes of a specific problem. This paper looks at a root-cause analysis of medication errors within the hospital setting, with the main focus being on the description and analysis of these medication errors.

Root-Cause Analysis of Medication Errors

A medication can be defined as a substance that is used in the treatment, prevention, or alleviation of the symptoms of a disease. An error can defined as the act of carrying out an activity using an incorrect procedure. Errors usually occur as a result of failing to complete an action as required, making a mistake, or ignorance. A medication error can, therefore, be defined as the failure of an individual to administer medication following the required procedure, which has the potential to lead to harm (World Health Organization, 2016).

There are various reasons why medication errors occur. This can be through inappropriate or irrational choice of medications, ineffective prescribing, under-prescribing, and overprescribing. Medication errors are also likely to occur when writing down the prescription (illegibility). They can occur during the manufacture of the formulation to be used. They can occur during the distribution of the formulation where the wrong drug, formulation, or label is distributed. It is also possible for medication errors to occur during the monitoring of the therapy where the therapy is altered erroneously or alteration is not done at all (Okes, 2019).

It is not clearly known how frequently medication errors occur. This is so because detection methods are likely to affect the estimated frequency of medication errors. This means that there are many medication errors which are never noticed. Among the detected medication errors, just a few of them may lead to adverse drug reactions or have the potential to lead to other serious effects. No matter how serious a medication error is, detecting it is important since it helps uncover a failure in the treatment process so as to prevent harm on another occasion (Naples et al., 2016). There are a number of reasons that support the trend of the increase in the number of deaths as a result of medication errors. Today, there has been an increase in the number of emerging drugs that are difficult to use safely and effectively. Today, medical care is becoming more and more specialized and complex. The aging of the population with complex medical needs has also led to an increase in the occurrence of medication errors. Also, medication errors have been on the rise as a result of the fact that hospitals have been seeing an increase in the throughput of patients.

The causation of medication errors is brought about by a number of factors. In many cases, medication errors committed by nurses occur due to fatigue among nurses, low nurse-patient ratio, dealing with many critically ill patients at the same time, and receiving unreadable and damaged orders from doctors (World Health Organization, 2016).