6NH068 - Mrs Plum Case Study - Choose a RCA Model/Framework - Health Assignment Help

Assignment Task

Learning Outcomes -

LO1: Apply the principles of risk management in maintaining a safe care environment
LO2: Critically reflect on near misses, critical incidents, major incidents and serious adverse events 
LO3: Critically explore how human factors can influence and impact upon behaviour within teams and the way in which this can affect health and safety
LO4: Appraise and advocate methods used to instigate positive change to promote safety and quality of care

Case study :
Mrs Plum, 81 years old, was admitted to C ward on 25 th April. Mrs Plum was transferred from another hospital following admission from home with Norovirus. Past medical history of right leg ulcers, gallstones and hypertension. On hand over of patient and admission clerking, it is documented that the patient is not a high falls risk. Examination by clerking Dr states no limb weakness or pain, no dizziness or pins and needles present to limbs. Mobility care plan in place, bed rail assessment completed, Falls assessment completed. She was then reviewed by a Consultant and had a joint assessment performed by Physiotherapy and Occupational Therapy. The therapy assessment found the patient could independently get on and off the bed and could fully weight bear, mobilising up to five meters with a frame. Goals set on initial assessment to become independent with frame over an increased distance prior to discharge. On 5 th May entry documented in medical notes of review of knee pain (due to arthritis) by Advanced Nurse Practitioner (ANP).
Medications for pain reviewed and codeine 15mg added to as required prescription by ANP. Mrs Plum’s mobility improved and made independent with frame over distances as able by Physiotherapy on 10th May. Appropriate discharge arrangements were made, with input from occupational therapist and physiotherapist. Package of care initiated, and appropriate equipment identified for Mrs Plum’s home. On 15 th May patient’s daughter contacted the ward to confirm that she had received the equipment and would be taking it to the patients’ property on 16 th May.

On 16 th May Ward staff sent section 5 for package of care as patient ready to be discharged home. On 17 th May while being assisted to use the commode during the
night shift the patient fell to the side falling on her left hip resulting in a fracture. You have been asked to investigate the incident…

Conclusion
The conclusion is a short section that ‘ties together’ your work. You need to make sure you don’t introduce new information in this section- remember you are drawing together what you have said in the main body of the assignment. Your references in this section are likely to be mainly those already used in the main body to support points made in the analysis of your critical incident.

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