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Coducting root cause analysis1

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Conducting Root Cause Analysis with Nursing Students: Best Practice in Nursing Education Judith Lambton, EdD, RN; and Laura Mahlmeister, PhD, RN Abstract This article describes a novel approach that allows students to actively participate in a root cause analysis, whether the error was committed in the clinical setting or in the simulation setting. This process can develop student awareness of the responsibility and professional duty to participate in creating a safer patient environment. S ince the landmark report by the Institute of Medicine (1999), To Err is Human: Building a Safer Health System, strategies for enhancing patient safety have been the subject of professional dialogue in both academia and clinical practice. Analysis of error is a critical component in the systematic approach to understand the complex interactions between and among the variables associated with patient care and clinical decision making. The virtual explosion of simulation centers in service and educational settings attests to a direction of education for health professionals toward practice and error correc- Received: February 23, 2009 Accepted: November 22, 2009 Posted: April 30, 2010 Dr. Lambton is Professor, University of San Francisco, and Dr. Mahlmeister is Educational and Legal Consultant, Mahlmeister and Associates, San Francisco, California. The authors thank Dean Karshmer, Associate Dean Lynch, and the faculty at the University of San Francisco School of Nursing who supported thi ...
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