Posted: May 1st, 2025

Culture of Patient Safety Case Studies

The purpose of this assignment is to explore ways a culture of patient safety is created using information and communication technologies and informatic processes that deliver safe nursing care while promoting health.

Use the “Culture of Patient Safety Case Studies” template to complete this assignment.

Culture of Patient Safety Case Studies
The purpose of this assignment is to create a culture of patient safety using information and
communication technologies and informatic processes to deliver safe nursing care while
promoting health.
Part 1: Creating a Culture of Patient Safety
Instructions: Please review the following scenario and answer each of the following questions
in 150-200 words using one to two sources to support your ideas.
Michael is a nurse working on a busy medical-surgical unit. He is responsible for the care of five
patients with complex medical needs. Michael checks on his first patient, Mrs. Wallace. She is
lying in bed with the call light button within her reach. The identification armband is in place.
Michael verifies that the IV is working and the correct IV fluid is infusing. The monitor is on, and
the limits/volumes are set appropriately.
Michael proceeds to check on his second patient, Mr. Baker. As he walks in the room, he finds
Mr. Baker on the floor and alert. Mr. Baker tells Michael that he fell trying to get into the bed
because the bed rolled away. Michael notes that the locks for the bed were not engaged. There is
no call light in the room. The monitor is turned off. Mr. Baker does not have an identification
armband on. There is an identification band on the bedside table, but it does not belong to Mr.
Baker. Michael checks the IV fluid infusing and discovers that the name on the IV bag is the
same as the identification armband on the bedside table.
National Safety and Quality Standards
• Identify two sources and applications of national safety and quality standards to guide
nursing practice.
• Describe two factors for Mrs. Wallace’s scenario that create a culture of safety.
• Support your ideas using one to two sources.
Nursing Interventions
• Describe three nursing interventions that are necessary for Mr. Baker to create a culture
of safety.
• Discuss the nurse’s accountability for reporting unsafe conditions, near misses, and
errors to reduce harm.
Interprofessional Team Members
• Identify the interprofessional team members that will need to be notified regarding Mr.
Baker’s situation.
• Select three team members and explain their role in the care of Mr. Baker’s situation.
• Explain the nurse’s role within this interprofessional team in promoting safety and
preventing errors and near misses.
Basic Safety Design Principles
Basic safety design principles help to reduce risk of harm. Examples of these include errorproofing, safeguards, and training.
• Select one of the safety design principles and explain how it applies to Mrs. Wallace
and Mr. Baker.
• Discuss the benefits of using reporting system processes to understand causes of error
and improve patient outcomes.
• Support your ideas using one to two sources.
References:
Cite a minimum of two sources in APA format to complete this assignment. Sources must be:
• Published within the last five years.
• Appropriate for the assignment criteria.
• Relevant to nursing practice.
Part 2: Delivering Safe Nursing Care Using Information and Communication
Technologies
Instructions: Please review the following scenario and answer each of the following questions
in 150-200 words using one to two sources to support your ideas.
Stephanie, a home health nurse, is visiting an elderly man, Mr. Turner, who lives with his
daughter. Prior to the visit, Stephanie reviews the electronic health record (EHR) and the
clinical decision support tools for Mr. Turner. He has a pacemaker to help with his congestive
heart failure. There is a module in his home that sends information from his device to the
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cardiologist to monitor. During this visit, Stephanie will be assisting Mr. Turner and his
daughter to send a report to the cardiologist via the module connected to the internet. Mr.
Turner is also a type II diabetic using an insulin pump that is connected to an app on his phone.
Due to the neuropathy of his feet, Mr. Turner is unstable with his gait and uses a walker to
ambulate. He wears a senior medical alert button in case he should fall. Mr. Turner is also
scheduled for a telehealth visit with his doctor during Stephanie’s visit.
Stephanie arrives at the home for the visit. As she is starting her assessment of Mr. Turner, the
insulin pump is beeping and there is an error message. Mr. Turner states that it has not been
working right the last couple of days and his daughter was going to try to fix it. He also tells
Stephanie that he has stopped wearing the medical alert button because it kept beeping and he
was unable to get it to stop beeping.
Clinical Decision Support Tools
• Describe two examples of clinical decision support tools (CDST) for Mr. Turner.
• Evaluate how decision support tools impact clinical judgment and help provide safe
patient care.
Performance Metrics
• Explain how CDST are used to report and monitor performance metrics on patient
outcomes.
• Discuss two to three examples of healthcare performance metrics.
Technology Use for Care
• Describe how the technology used to care for Mr. Turner enhances the quality and
safety of care.
• Identify two modalities that could be used to communicate care delivery for Mr.
Turner.
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Benefit of Emerging Technologies
• Select two emerging technologies that are used to improve healthcare delivery and
clinical decision making.
• Describe the benefit of these emerging technologies to improve the health promotion
for this patient.
Reporting System Processes and Functional Issues
• Identify the importance of reporting system processes and functional issues (error
messages, mis-directions, device malfunctions, etc.) according to organizational
policies and procedures.
References:
Cite a minimum of two sources in APA format to complete this assignment. Sources must be:
• Published within the last five years.
• Appropriate for the assignment criteria.
• Relevant to nursing practice.
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