NURS-FPX4035 Assessment 2: Root-Cause Analysis and Safety Improvement Plan Sample

Enhancing Patient Safety and Quality of Care · Assessment 2 · Root-Cause Analysis and Safety Improvement Plan

Assessment
Assessment 2
Course code
NURS-FPX4035
Course
Enhancing Patient Safety and Quality of Care
Degree/program
BSN
Analytical Tools Used
Chronological event review, five-whys analysis, and contributing-factor matrix
Clinical Focus
SAFE Toileting and Mobility Bundle for inpatient fall prevention
Patient Case Details
78-year-old female with weakness, urinary urgency, prior fall history, and changing cognition
Deliverable Format
Root-cause analysis template and 4-6 page safety improvement plan

About NURS-FPX4035 Assessment 2

NURS-FPX4035 Assessment 2 requires the BSN learner to reconstruct an adverse event, identify contributing system factors, and propose an evidence-based safety improvement plan. This independent educational model demonstrates a complete systems analysis of a fictional inpatient fall involving a 78-year-old patient who sustained a hip fracture after attempting to toilet without assistance. By studying this 4-6 page structural framework, learners will master the application of a just-culture perspective, the five-whys inquiry, and a contributing-factor matrix to design a feasible prevention plan.

Course context: view the NURS-FPX4035 course hub for the course overview and complete assessment sequence.

Required Assessment Deliverables and Structure

This sample systematically evaluates a sentinel event and proposes actionable systemic improvements. It strictly covers the following mandatory sections:

  1. Event Chronology and Immediate Response: Reconstructs the timeline from the evening handoff at 18:45 to the unassisted fall at 02:15, isolating missed clinical risks and removed defenses.

  2. Root-Cause Analysis (Five-Whys): Connects the immediate cause (unassisted transfer) to the root system failure (treating fall prevention as a generic score rather than an individualized plan).

  3. Contributing Factors Matrix: Rates the relative contribution of dynamic clinical risks, missing reassessments, alarm/call-light failures, and workload variables.

  4. SAFE Toileting and Mobility Improvement Plan: Outlines six core actions: Screen and reassess, align tailored bedside plans, facilitate safe mobility, engage patient/family, communicate/escalate, and learn from events.

  5. Implementation, Measurement, and Sustainability: Details a four-phase rollout plan over six months and establishes strict metrics to prevent the reduction of falls from overloading staff or restricting mobility.

Patient Fall Root-Cause Analysis and Evidence-Based Safety Strategies

Fishbone root-cause analysis and fall-prevention safety improvement plan for NURS-FPX4035 Assessment 2.

Rubric-Aligned Competency Requirements

To achieve a distinguished score, your submission must successfully execute the following analytical steps:

  • Analyze the root causes of a specific safety event by establishing a detailed event chronology and utilizing a five-whys inquiry.

  • Identify the specific human, process, communication, and environmental factors contributing to the event using a contributing-factor matrix.

  • Apply best-practice, evidence-based strategies—such as the Fall TIPS toolkit and TeamSTEPPS communication frameworks—to address the identified system failures.

  • Create a feasible, multiphase improvement plan that names specific owners, targets, and execution steps (e.g., a 30-day preparation phase and a 60-day pilot on 8 beds).

  • Leverage existing organizational resources, prioritizing tools like the electronic health record (EHR) and incident-reporting systems for maximum impact.

  • Define precise outcome measures (e.g., a 30% reduction in total falls), process measures (e.g., teach-back success), and balancing measures (e.g., staff overtime).

  • Assessment hierarchy

    Supporting guides for evidence and implementation

    • BSN Patient Safety Assignment Guide To successfully connect the identified inpatient fall problem with evidence-based interventions and measurable patient-safety outcomes, you must consult this guide. This framework ensures your SAFE Toileting and Mobility Bundle implementation aligns perfectly with clinical best practices.
    • 9 Steps to Plan a Capella Nursing Change Proposal Organizing your multiphase implementation sequencing, stakeholder involvement, and sustainability metrics requires strict structural planning. Implementing this proposal framework guarantees your four-phase rollout plan satisfies the strategic execution standards demanded by the scoring guide.
    • How to Find Recent Nursing Research for an Assessment Securing high-quality empirical data to justify your five-whys analysis and contributing-factor matrix mandates utilizing authoritative clinical databases. Executing these research methodologies ensures you select recent scholarly evidence that robustly supports your specific resource choices and safety interventions.
    • 10 Steps to Track Evidence for Every Rubric Criterion Establishing absolute academic alignment prevents grading failures and missing criteria. Following these tracking steps ensures you precisely map your event chronology and written analysis to the individual scoring-guide requirements before executing your final submission.

    Executing these structural resource frameworks guarantees your NURS-FPX4035 Assessment 2 submission satisfies the highest academic evaluation standards. You must systematically integrate these evidence-based protocols to validate your five-whys root-cause analysis and finalize your SAFE Toileting improvement plan. Mastering this rigorous preparation sequence eliminates structural gaps, prevents rubric misalignment, and ensures your final patient-safety deliverable commands a distinguished performance rating.

    Frequently asked questions

    What does this NURS-FPX4035 Assessment 2 sample cover?

    This NURS-FPX4035 Assessment 2 sample covers a root-cause analysis and safety improvement plan for an inpatient fall. The document details a chronological event review, a five-whys analysis, and the implementation of a SAFE Toileting and Mobility Bundle.

    What must learners compare with the current NURS-FPX4035 scoring guide?

    Learners must compare their root-cause analysis, contributing-factor matrix, proposed safety plan, and selected organizational resources directly with the active Capella scoring guide. You must verify that your outcome and process measures meet current academic expectations.

    Can I submit this NURS-FPX4035 sample as my own assessment?

    No. This resource operates strictly as an independent learning model. You must develop your own original safety case, construct your own root-cause analysis, and cite every peer-reviewed source to eliminate academic integrity violations.

    Does this resource replace current course instructions?

    No. Current courseroom directions, Capella faculty guidance, practicum rules, and the official scoring guide remain the controlling authorities for your submission.

    Study and academic-use guidance

    Use this sample to study structure, evidence relationships, analytical sequencing, and scoring-guide alignment. Build your own response from the current courseroom requirements.

    • Verify the current instructions, template, evidence requirements, and scoring guide.
    • Create your own analysis, calculations, visuals, citations, and conclusions.
    • Check factual, clinical, legal, numerical, and source claims before submission.

    Independent resource: FlexPath Assignment Help is not affiliated with or endorsed by Capella University. Do not submit sample wording or analysis as your own work.

    Other NURS-FPX4035 assessments

    NURS-FPX4035 Assessment 1: Enhancing Quality and Safety Sample
    Assessment 1 · PDF available
    NURS-FPX4035 Assessment 3: Improvement Plan In-Service Presentation Sample
    Assessment 3 · PDF available
    NURS-FPX4035 Assessment 4: Improvement Plan Tool Kit Sample
    Assessment 4 · PDF available