Root Cause Analysis Report: Healthcare in Pediatric Ward Settings

This report analyzes the root causes of medication errors within a pediatric ward setting, emphasizing the significance of public health and patient safety. The analysis explores various factors contributing to these errors, including outdated medical tools, inappropriate patient assessments, and issues with medication dosages and drug interactions. The report highlights the importance of updated electronic tools, accurate weight-based assessments, and the role of pharmacy staff in preventing medication errors. It also addresses the significance of staff training, administrative awareness, and the need for efficient documentation and communication with parents. The conclusion reiterates the importance of these factors in reducing medication errors and improving overall healthcare outcomes in pediatric settings. The report references several studies to support the analysis.

Running head: health care and root cause analysis
Public health and root cause analysis
Name of the Student
Name of the University
Authors Note

1Public health and root cause analysis
Nurses and doctors Provide medication Tools
Other Hospital Pediatric ward
Pediatric patient
provided the
wrong dose of
medication
based on
weight.
Inappropriate assessment of patient
Failure to converse weight kilogram to pound
Pharmacy staffs and their assessment
Wrong dosage of medication
Drug interaction
Duplicate medicines
Missing medication
Outdated weight machines
Outdated drug chart
Drug assessment tools
Inappropriate documentation
Absence of patient assessment tools
Defective administration databases
Inefficient nurses and caregivers
Absence of medical administrator
and pharmacologists
Regular visits of supervisors and lack of awareness
Lack of awareness among parents
Lack of education in hospital
facilities

2Public health and root cause analysis
Introduction
Medical errors are prevalent in the medical industry. A medication error can be occurred
due to a wrong assessment of the weight-based analysis. This error can be observed in the
pediatric ward due to their differentiating ages with growth. The essay will briefly analyse the
root cause with the reference of fishbone analysis.
Discussion
Doctors or nurses can make errors during the standardization of the unit for measuring
the weight of the children. The conversion of the weight unit from kilogram to pound or any
other unit can be erroneous. Healthcare professionals should record the data from the updated
version of electronic tools. Weight and dose per unit of weight are not appropriately provided to
the patients as well as to the healthcare providers (Wells et al., 2017). Pharmacy staff should
weigh patients in the metric weight scale. They should double-check dose and medications with
proper calculations.
A medication error can be observed for outdated medicines and wrong medications of
prescription (Khoo et al., 2017). Interactions of drugs can result in the medication error to a
patient and missing of medicine consumption.
Erroneous automatic weight machine and drug charts in hospitals provide inappropriate
information about the details of the patients. Drug assessment tools, regular checkup tools and
customised assessment tools of a hospital. Weight-based assessment tools are used for better
understanding of the child’s body weight. Retroactive and proactive tools are used for the
prevention of medication error (Zadeh, 2018).
Inefficient professionals and caregivers in the pediatric ward should be assessed regularly
by administrators. Lack of awareness and regular visits of administrators of the hospitals should
be increased to avoid the weight-based medication errors in the pediatric ward.
BMI visualiser imaging technology and computerised system administration are required
to update so that proper documentation of patients can be recorded (Virkar et al., 2019).
Defective administrative systems and outdated medical assessment tools are responsible for
medication errors among the children. Clinic staff communicated the parents to get allergy
evidence and the child’s weight.
Parents should know the details about both the medication and documents of patients.
Lack of education and training in nurses and healthcare providers are the causes of medical
errors.

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Conclusion
This error can be observed in the pediatric ward due to their differentiating ages with
growth. A medication error can be found for outdated medicines and wrong medications of
prescription. Healthcare professionals should record the data from the updated version of
electronic tools.

4Public health and root cause analysis
References
Khoo, T. B., Tan, J. W., Ng, H. P., Choo, C. M., & Teh, S. H. (2017). Paediatric in-patient
prescribing errors in Malaysia: a cross-sectional multicentre study. International journal
of clinical pharmacy, 39(3), 551-559.
Virkar, H. V., McCartan, T., Carroll, S., Cline, M., & Gadbois, R. (2019). U.S. Patent
Application No. 16/193,990.
Wells, M., Goldstein, L. N., Bentley, A., Basnett, S., & Monteith, I. (2017). The accuracy of the
Broselow tape as a weight estimation tool and a drug-dosing guide–A systematic review
and meta-analysis. Resuscitation, 121, 9-33.
Zadeh, S. E. (2018). Management of Inappropriate Behaviors by Healthcare Risk
Managers (Doctoral dissertation, Walden University).