Reference no: EM133507325

Sarah, the registered nurse (RN) director of nursing, has 24-hour accountability for an 80-bed, long-term care facility. In addition to Sarah, who is an experienced manager and clinician, a full-time geriatric nurse practitioner joined the staff a week ago and is being oriented at the facility's mainoffices across town. The facility ensures 24-hour coverage by RNs. Registered Practical Nurses (RPNs)work 12-hour shifts as charge nurses. Most medications are administered by RPNs. PSWs, chaplains,housekeepers, and dietary personnel compose the rest of the staff. A medical director provides on-call services and visits the facility at least once a week for several hours. In addition, the facilitycontracts for services from physical therapists, occupational therapists, and social workers.One of Sarah's primary concerns is patient safety. In the past 2 months, the medication error rate hasincreased. The charts are kept at the nursing station in a secured area and are in paper format only.The pharmacist reports that more than 700 different medications have been supplied to the facilityduring the past month. Review of medication incident reports shows that most of these errors havebeen caused by the interactions of or adverse reactions to medications. These were prescribed byvarious physicians who have been seeing a large number of patients for the first time as the result ofinfluenza complications. Pharmacists from a contracted agency visit the facility once a week to reviewresidents' charts for the appropriateness of medications prescribed. The facility has a quality review committee that meets every month to review events of the pastmonth, including follow-up of any unusual incidents.Utilize this case information to answer the following questions:

1. Is a change needed? What is the perceived problem? What standards will support and guideany change that may be needed?

2. What kind of assessment should Sarah complete? What framework or strategy should she useinitially to collect data comprehensively about the factors in the change situation? What questions should she ask?

3. At what point would Sarah involve other individuals, and why? How would she apply systemsthinking to this issue?

4. Would you consider this a low- or a high-complexity change situation? What change inmanagement approaches will probably be needed? Justify your selections.

5. Whom do you perceive as potential change agents who will champion patient safety measuresassociated with the medication administration system in the facility?

6. What is the role of staff followers in this situation?

7. How will Sarah select appropriate strategies that will relate to the behavioural styles and responses of the staff and the major players and allow for optimal constructive participation inthis situation?