There should also be equal training for all nurses who deal with conscious sedation. The LPN’s should have received the same training as the RN regarding conscious sedation or at least training in identifying when backup staff is needed and when to contact a provider or call a code team. Finally, the conscious sedation policy should be updated to include a check off or have an order set that has to be ordered for conscious sedation that specifically states consistent BP Updated: 2/1/19
Running head: Organizational Systems Task 2 5 monitoring, O2 monitoring, supplemental oxygen, and ECG continuous. Full vitals should be taken every 5 minutes after procedure until patient is stable and once stable every 15minutes x 4, then q 30 x2. All monitoring equipment should be in place until patient is conscious and has a gag reflex. There should be an assigned RN or LPN monitoring the patient until they are stable and can be transferred out of procedural/surgery room. There should be sedation reverse agents available in the surgery suite prior to surgery. An anesthesiologist should be present during a conscious sedation procedure to administer the sedatives and monitor during procedure. The factors that contributed to this sentinel event have been addressed in the action plan. Other departments were included such as, anesthesia department, HR for policy updating, Nursing supervisor, ED supervisor and Training Department for additional training for all parties involved in this sentinel event. As well as IT involvement for developing order sets and other system safety measures. B1. Change Theory The Lewin’s change theory, for which Curt Lewin’s explains as a method to help people who are resistant to change, manage the process in bite size pieces. He states that by using the process of “change theory” you can help members of an organization to adopt new changes by simply using the unfreezing, change and freezing[CITATION Che17 \l 1033 ] Lewin’s believed that in order to be successful in the change it should never be abrupt and you should always have all those effected by the change to be included in the process. The above improvement plan can be approached by Lewin’s 3 step change theory. The first step is considered the unfreezing step this is when the problem is identified, and the team encourages the awareness of the need for change. In the event of Mr. B, the events that caused the sentinel event should be identified and research should be present that encourages the Updated: 2/1/19
Running head: Organizational Systems Task 2 6 awareness of the need for change. [CITATION Che17 \l 1033 ] It is helpful to have data from other ED’s that support such policy change so that staff can see the proof of how the adopted changes can lead to improvement and increase patient safety for their department. [CITATION Che17 \l 1033 ] The second step, the moving stage will require educating and involving various departments such as, IT, Human Resources, Training and Development, Respiratory Therapy, Anesthesia and Unions for changes to potential scope of work/practice. This stage involves all of
You've reached the end of your free preview.
Want to read all 12 pages?
- Fall '17
- Nursing, Failure mode and effects analysis