Discuss: Fish bone Diagram and a Narrative

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Discuss: Fish bone Diagram and a Narrative

Discuss: Fish bone Diagram and a Narrative

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Question Description
On our critical care units (cardiovascular ICU and regular ICU), we are focusing on VAP prevention by examining our VAP protocols. We have recently experienced a rise in the number of VAPs occurring on both Unit A CVICU and Unit B ICU. Our current protocol used on both ICU units for care of the intubated patient includes elevating the head of bed approximately, providing oral care every shift and turning the patient every two hours. When appropriate, and ordered by the physician, we also initiate a ‘sedation vacation’, where the patient is brought out of sedation for 30 minutes then re-sedated. This is done following an algorithm and is validated with the consent of a physician prior to initiation. Consent is usually obtained when the physician is on the unit and is good for 24 hours. These steps have worked wonderfully up until the past year when the number of VAPS on the Intensive Care Units steadily rose. We thought we were following best practices but now we are not sure. Our goal is zero VAPS, but we are not sure that this is even possible. Can you help us figure out what our problem is (or problems are) and how we can fix them?


This is an individual assignment. Using your assigned case study, create a cause-effect diagram or “fishbone” diagram. The fishbone diagram enables visualization of potential causes of a specific problem. This is part of your root cause analysis (RCA) you will include in your final QI Report of Project; be sure you understand how/where this aspect fits. Using root cause analysis techniques in clinical audit* is one resource that defines and describes the fishbone diagram. The Quality Improvement Essentials Toolkit* contains instructions and a template for creating your fishbone diagram (see “Cause and Effect Diagram” on IHI website).

These are components that must completed as part of your final QI Report of Project. Together, these tasks directly relate to course objective “use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.”

* item found in QI Project Resources

You should include the following:

Submit fishbone diagram (i.e., cause and effect diagram)
Provide a narrative describing all potential factors/causes contributing to the problem identified in your case study

I also attached a pdf file with an example, instructions needed and a template for the FISH BONE diagram.

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

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The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.



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