Assessment 1: Root Cause Analysis
NURS-FPX6202:
Capella University
Instructor Name
July 2024
Identification of the Problem
Diabetes poses a significant health threat and is among the most severe and preventable medical issues. It occurs due to insulin production and function issues, leading to elevated blood glucose levels. Type 2 diabetes impacts both genders equally, and its prevalence is expected to rise considerably (Pradhan et al., 2022). In any scenario involving large populations, the expertise of nurse leaders can be invaluable. Nurse leaders can make decisions directly affecting patients and other healthcare providers, which is a significant asset. The ability of nurse leaders to make crucial decisions impacts outcomes through various stages: planning, execution, implementation, resulting, evaluation, and recovery. According to a study by Li et al. (2023), the increasing prevalence of diabetes has led to higher sales of diabetes treatments driven by both patients and the public. As diabetes rises, affected individuals must have access to improved care. Patients with diabetes at the local clinic face numerous challenges, including difficulties in adhering to prescribed therapy schedules and meeting treatment goals.
The Community Clinic Setting
The prevailing perspective is that individuals with diabetes bear primary responsibility for managing their care and treatment. Therefore, patients must acquire the knowledge, skills, and mindset to manage their diabetes effectively. Patients and their families involved in the treatment must receive comprehensive diabetes education (Yao et al., 2024). Based on the findings of this research, it is vital to offer recommendations for enhancing diabetes education, which will lead to better adherence to diabetes treatment plans. For success, patients with uncontrolled A1C levels must remain actively engaged in their care.
Research supports the importance of diabetes education in improving patient outcomes. For instance, a study by Alnaim et al. (2024) found that diabetes self-management education (DSME) notably enhanced blood sugar management in individuals with type 2 diabetes. Research by Guan et al. (2023) demonstrated that DSME and support interventions improved A1C levels, reinforcing the need for ongoing patient education and engagement.
Root Cause Analysis of Diabetes
Recent research indicates that nearly 80 percent of diabetes-related surgical procedures can be prevented (Rosta et al., 2023). Patients with diabetes can benefit from estimating and predicting inherent risks to determine whether surgery is prudent or feasible and to identify the most suitable outcomes for future medical issues. A completed root cause analysis (RCA) helps identify necessary changes to prevent similar incidents in the future (Yao et al., 2024). African Americans and other minority groups are more likely to develop diabetes compared to the general population, with Hispanics and Asians also experiencing higher rates. Goal setting, constructive feedback, and support groups can assist individuals with type 2 diabetes achieve their self-management objectives. Research by Szczerba et al. (2023) explored the causes of individuals with type 1 and 2 diabetes, focusing on all individuals with diabetes and their families. A sample including spouses, children, and other family members is required when conducting experiments.
There is a widespread lack of understanding and appreciation of the diabetes epidemic within communities, demonstrated by insufficient knowledge and reluctance to act. Many community members are succumbing to diabetes. Enhanced diabetes education is essential to help individuals adhere to prescribed dietary plans and cultural practices (Yao et al., 2024). Patients with critically high hemoglobin A1C levels must actively engage in their care. Several studies underscore the importance of these findings. For instance, a study by Li et al. (2023) highlighted the disparities in diabetes prevalence among minority populations, emphasizing the need for targeted interventions. Another study by Musazadeh et al. (2023) demonstrated the effectiveness of structured diabetes education programs in improving patient outcomes and adherence to treatment plans.
| Category | Issue | Details |
|---|---|---|
| Patient | Poor concordance with therapy | Difficulty in adhering to prescribed treatment plans. |
| Side effects | Experiencing adverse effects from medication or therapy. | |
| Doctor | No prompt on the computer screen | Lack of reminders or alerts for managing diabetes. |
| Not aware of the maximum tolerated therapy | Need to be more informed about the highest effective dose or treatment. | |
| Target | Diabetes treatment not being met | The set goals for diabetes management are not achieved. |
| Does not believe the target is appropriate | Skepticism about the relevance or attainability of the targets. | |
| Abnormal diabetes is not being followed up. | Failure to monitor and manage abnormal diabetes markers. | |
| No search for abnormal diabetes | Inadequate efforts to identify or address irregular diabetes symptoms. | |
| Nurse | Finds it difficult to manage diabetes | Challenges in managing diabetes care effectively. |
| Process | No follow-up on abnormal results | Lack of proper follow-up actions for abnormal diabetes test results. |
The five reasons
- Why do patients often fail to complete their lab work, causing delays for other patients? The gaps between their appointments should be shorter.
- Why might physicians avoid using specific targets for managing type 2 diabetes?
- What makes it so challenging for nurses to care for diabetic patients?
- What is the purpose of missed appointments and incorrect referrals? These issues indicate overcrowding, extended wait times, anticipation, and uninvited visitors.
- Why are insufficient treatment rooms and small inner facilities at the community health center?
Findings
A significant number of amputations caused by hyperglycemia could be prevented. The reduced amputation rates model estimates the number of limbs that could be saved from amputation (Pradhan et al., 2022). Individuals with diabetes have an increased risk of developing complications leading to amputation. Conducting a root cause analysis (RCA) can help identify necessary adjustments to reduce the likelihood of such incidents recurring. It has been observed that community members are not utilizing the available diabetes resources. No local authority is responsible for educating individuals about diabetes or assisting them in managing the disease’s symptoms. There are no community-based support programs for those who cannot afford healthcare or treatment due to financial constraints (Yao et al., 2024). These findings suggest that people will continue to suffer from diseases like diabetes due to the lack of access to advanced medical care and treatment options.
Challenges Faced by Healthcare Providers and Patients
Clinicians face significant challenges in managing diabetes care due to limited time and resources, which often results in reluctance to initiate insulin therapy and a need for patients to modify their habits. The evolving nature of professional responsibilities has created uncertainty, leading to frequent complaints and anxieties from patients undergoing medication adjustments (Tsapas et al., 2020). Patients and healthcare providers may need more knowledge and skills to meet target blood glucose, blood pressure, and cholesterol levels. The constantly changing treatment criteria further complicate this issue, causing errors in practice and diminishing professionals’ confidence in escalating treatment.
Patients often miss initial appointments due to poor adherence, advanced age, and psychological issues. Public misconceptions about therapy, combined with the complexity and cost of pharmaceutical regimens, hinder effective diabetes management. The increasing complexity of diabetes treatment frustrates primary care practitioners, who must compromise care quality to meet evolving goals within time constraints. Effective diabetes management requires focusing on nutrition, education, and personalized care plans to foster healthy habits (Li et al., 2023). Hospitals should evaluate patient care time and workforce efficiency, integrating multiple behavioral modification strategies to improve outcomes and prevent complications such as hypertension and arterial stiffening.
Description
Diabetes and pre-diabetes are on the rise. Research by Duan et al. (2021) reveals that over 130 million people in the United States are affected by diabetes or pre-diabetes. This increase is notably higher among racial and ethnic minorities, with African Americans and Hispanics facing significantly greater risks of hospitalization and diagnosis compared to white individuals. For example, diabetes prevalence is 77% higher in African Americans and 66% higher in Hispanics (Khunti et al., 2022). Insulin resistance, often caused by obesity and excess fatty tissue, is a significant contributor to diabetes. Race, family history, and inactivity also play a role. Effective diabetes management requires implementing evidence-based strategies, such as smart goals. For instance, cutting portions and making dietary changes can help reduce insulin levels (Rosta et al., 2023). Enhanced disease management, including e-health tools and process redesign, is essential to improve care. Increasing team accountability and focusing on nutrition and education can help patients develop healthier habits and better manage their condition (Yao et al., 2024).
Summary and Reflection
Nurses who make clinical decisions benefit both patients and the healthcare team (Khunti et al., 2022). Effective diabetes management significantly improves patients’ quality of life, especially for those whose A1C levels are uncontrolled. African Americans, Hispanics, and other minority groups have higher diabetes rates than white individuals. Proper diagnosis and treatment could prevent many diabetes-related amputations, reducing clinical compromises that frustrate physicians. Challenges include adhering to evolving standards and educating patients on healthy eating and active lifestyles. The rising prevalence of diabetes highlighted by Pradhan et al. (2022) underscores the need for improved e-healthcare technologies and restructuring care processes to support patients and caregivers better. Many families may lack adequate knowledge about diabetes and its management.
NURS FPX 6202 Assessment 1 Root Cause Analysis References
Alnaim, N., Ghadeer, A., Bunyan, A., Almulhem, A., Alsaleh, Y., AlHelal, M., Almugaizel, I., Alhashim, Z., Alhamrani, M., & Bosrour, A. (2024). Effectiveness of insulin pump therapy versus multiple daily injections for glycemic control and rate of diabetic ketoacidosis among children with type 1 diabetes mellitus. Cureus, 16(2), e54123. https://doi.org/10.7759/cureus.54123
Duan, D., Kengne, A. P., & Echouffo, J. B. (2021). Screening for diabetes and prediabetes. Endocrinology and Metabolism Clinics of North America, 50(3), 369–385. https://doi.org/10.1016/j.ecl.2021.05.002
Guan, Z., Li, H., Liu, R., Cai, C., Liu, Y., Li, J., Wang, X., Huang, S., Wu, L., Liu, D., Yu, S., Wang, Z., Shu, J., Hou, X., Yang, X., Jia, W., & Sheng, B. (2023). Artificial intelligence in diabetes management: Advancements, opportunities, and challenges. Medicine, 4(10), 101213. https://doi.org/10.1016/j.xcrm.2023.101213
Khunti, K., Aroda, R., Aschner, P., Chan, N., Prato, S., Hambling, E., Harris, S., Lamptey, R., McKee, M., Tandon, N., Valabhji, J., & Seidu, S. (2022). The impact of the COVID-19 pandemic on diabetes services: Planning for a global recovery. The Lancet. Diabetes & Endocrinology, 10(12), 890–900. https://doi.org/10.1016/S2213-8587(22)00278-9
Li, J., Zhu, C., Liang, J., Hu, J., Liu, H., Wang, Z., Guan, R., Chow, J., Yan, S., Li, L., Ma, F., & Ma, G. (2023). Cardiovascular benefits and safety of sotagliflozin in type 2 diabetes mellitus patients with heart failure or cardiovascular risk factors: A Bayesian network meta-analysis. Frontiers in Pharmacology, 14, 1303694. https://doi.org/10.3389/fphar.2023.1303694
Musazadeh, V., Kavyani, Z., Mirhosseini, N., Dehghan, P., & Vajdi, M. (2023). Effect of vitamin D supplementation on type 2 diabetes biomarkers: An umbrella of interventional meta-analyses. Diabetology & Metabolic Syndrome, 15(1), 76. https://doi.org/10.1186/s13098-023-01010-3
Pradhan, A., Glynn, J., Fruchart, C., Fadyen, G., Zaharris, S., Everett, M., Campbell, E., Oshima, R., Amarenco, P., Blom, J., Brinton, A., Eckel, H., Elam, B., Felicio, S., Ginsberg, N., Goudev, A., Ishibashi, S., Joseph, J., Kodama, T., & Koenig, W. (2022). Triglyceride lowering with pemafibrate to reduce cardiovascular risk. The New England Journal of Medicine, 387(21), 1923–1934. https://doi.org/10.1056/NEJMoa2210645
Rosta, L., Menyhart, A., Mahmeed, A., Rasadi, K., Alawi, K., Banach, M., Banerjee, Y., Ceriello, A., Cesur, M., Cosentino, F., Firenze, A., Galia, M., Goh, Y., Janez, A., Kalra, S., Kapoor, N., Lessan, N., Lotufo, P., Papanas, N., Rizvi, A., & Rizzo, M. (2023). Telemedicine for diabetes management during COVID-19: What we have learnt, what and how to implement. Frontiers in Endocrinology, 14, 1129793. https://doi.org/10.3389/fendo.2023.1129793
Szczerba, E., Barbaresko, J., Schiemann, T., Stahl, A., Schwingshackl, L., & Schlesinger, S. (2023). Diet in the management of type 2 diabetes: Umbrella review of systematic reviews with meta-analyses of randomized controlled trials. BMJ Medicine, 2(1), e000664. https://doi.org/10.1136/bmjmed-2023-000664
Tsapas, A., Avgerinos, I., Karagiannis, T., Malandris, K., Manolopoulos, A., Andreadis, P., Liakos, A., Matthews, D. R., & Bekiari, E. (2020). Comparative effectiveness of glucose-lowering drugs for type 2 diabetes: A systematic review and network meta-analysis. Annals of Internal Medicine, 173(4), 278–286. https://doi.org/10.7326/M20-0864
Yao, H., Zhang, A., Li, D., Wu, Y., Wang, C. Z., Wan, J. Y., & Yuan, C. S. (2024). Comparative effectiveness of GLP-1 receptor agonists on glycaemic control, body weight, and lipid profile for type 2 diabetes: Systematic review and network meta-analysis. BMJ, 384, e076410. https://doi.org/10.1136/bmj-2023-076410
