| Course | HA540 Health Care Operations and Quality Assessment |
|---|---|
| Unit | Unit 6 |
| Paper type | Patient safety analysis |
| Length | About 900 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | Master of Health Administration (MHA) |
| Updated | October 2026 |
Free sample paper for HA540 Unit 6
A Blood Thinner Restart Date Left Off the Discharge Sheet Scores 270: A Failure Mode and Effects Analysis of the Path From Recovery to Home After Sedated Endoscopy at a Composite Hospital Unit, With Every Score Shown
[Student Name]
Purdue University Global
HA540: Health Care Operations and Quality Assessment
Unit 6 Patient Safety Analysis
[Instructor Name]
[Date]
The unit, the scores and every count are composite and bracketed for the writer's own data; no event is described, as the analysis is prospective.
Scope and Team
Scope runs from a patient's arrival in recovery to the follow-up call the next day, including the assignment of pathology results. The team: the recovery charge nurse, two recovery nurses, an endoscopist, a pharmacist, the unit clerk, a quality specialist and a patient adviser who had a colonoscopy at the unit last year. A scope drawn wider, such as the whole visit, would produce vague failure modes that no one owns.
Subprocesses
1. Recovery monitoring and discharge readiness.
2. Escort verification.
3. Discharge instructions, including diet, warning signs and medicines.
4. Handover to the escort.
5. Next-day call and pathology follow-up.
How the Failure Modes Were Found
The team met [three] times for an hour. In the first meeting, each member walked one subprocess aloud while the others asked what could go wrong at each step; the patient adviser described what she remembered, and did not remember, from her own discharge. In the second, the team grouped about [30] raw ideas into eight distinct failure modes and listed causes and current controls for each. In the third, members scored each mode alone before discussing, so that the endoscopist's view did not set the scores for everyone. Where scores differed by more than two points, the team talked until it agreed or recorded the higher score.
Scoring Scales
Severity, one to ten: one means no effect on the patient; ten means death or permanent harm. Occurrence, one to ten: one means less than once a year; ten means several times a week. Detection, one to ten: one means the failure is almost certain to be caught before it reaches the patient; ten means it would not be caught. A detection score of seven means the failure would usually reach the patient before anyone noticed. The risk priority number multiplies the three. The method follows the health care version developed for prospective risk analysis in a national hospital system (DeRosier et al., 2002).
Failure Modes and Scores
Anticoagulant restart date missing or conflicting on the discharge sheet. Effect: clot or bleed after the patient guesses. Causes: free-text field; endoscopist busy with next case. Controls: nurse asks verbally. Severity [9], occurrence [5], detection [6]: [270]. Patient leaves without a verified escort. Effect: impaired patient drives or travels alone. Causes: escort drops off and leaves; no number recorded. Controls: desk asks at check-in. Severity [8], occurrence [4], detection [7]: [224]. Teaching given while the patient is still drowsy and the escort is absent. Effect: instructions forgotten. Severity [6], occurrence [6], detection [5]: [180]. Pathology result not assigned to a clinician for follow-up. Effect: cancer diagnosis missed or delayed. Severity [10], occurrence [3], detection [6]: [180]. Warning signs of bleeding after polyp removal not explained. Severity [8], occurrence [3], detection [5]: [120]. Readiness to leave scored from memory rather than a scale. Severity [7], occurrence [4], detection [5]: [140]. Next-day call not made. Severity [5], occurrence [5], detection [4]: [100]. Another patient's discharge sheet printed. Severity [7], occurrence [2], detection [5]: [70]. Ranking by the product alone would place a missed cancer result fourth, behind a teaching problem, which is why severity must be read on its own.
Ranking With a Caution
Multiplying ordinal scores can hide rare but severe failures. Any failure mode with severity of nine or ten receives action regardless of its rank. That rule adds the pathology follow-up failure to the top group.
Actions, Chosen by Strength
Anticoagulant restart: make the restart date a required field that blocks the discharge order until completed. Forcing function. New scores [9], [2], [2]: [36]. Escort: record the escort's name and number at check-in and require the escort to be present for discharge teaching and sign-out. New scores [8], [2], [3]: [48]. Teaching: deliver teaching to the escort with the patient, using a written sheet, and confirm with teach-back. New scores [6], [3], [3]: [54]. Pathology: assign every specimen automatically to the ordering endoscopist, with a tracking list reviewed weekly by a nurse. New scores [10], [2], [2]: [40]. Forcing functions and standard checks are stronger than reminders, so they were chosen first.
Discharge Readiness Scale
The unit will adopt a written discharge scoring system for readiness after sedation, of the kind tested in ambulatory surgery to make discharge decisions consistent (Marshall & Chung, 1999). National sedation guidance also expects patients to leave with a responsible adult and written instructions (Early et al., 2018).
Owners and Review Dates
Required field: informatics nurse, [date]. Escort process: unit clerk and charge nurse, [date]. Teaching: nurse educator, [date]. Pathology tracking: endoscopy medical director, [date]. The team will rescore all eight failure modes in six months.
Limits
Scores are team judgments, not measurements. Occurrence estimates came from staff recall and one month of incident reports.
Conclusion
The highest risks in sending patients home are information failures, not clinical ones. Each has a structural fix.
References
DeRosier, J., Stalhandske, E., Bagian, J. P., & Nudell, T. (2002). Using health care failure mode and effect analysis: The VA National Center for Patient Safety's prospective risk analysis system. The Joint Commission Journal on Quality Improvement, 28(5), 248-267. https://doi.org/10.1016/S1070-3241(02)28025-6
Early, D. S., Lightdale, J. R., Vargo, J. J., Acosta, R. D., Chandrasekhara, V., Chathadi, K. V., Evans, J. A., Fisher, D. A., Fonkalsrud, L., Hwang, J. H., Khashab, M. A., Muthusamy, V. R., Pasha, S. F., Saltzman, J. R., Shergill, A. K., Cash, B. D., & DeWitt, J. M. (2018). Guidelines for sedation and anesthesia in GI endoscopy. Gastrointestinal Endoscopy, 87(2), 327-337. https://doi.org/10.1016/j.gie.2017.07.018
Marshall, S. I., & Chung, F. (1999). Discharge criteria and complications after ambulatory surgery. Anesthesia & Analgesia, 88(3), 508-517. https://doi.org/10.1097/00000539-199903000-00008
What the HA540 Unit 6 assignment asks for
Unit 6 in HA 540 commonly asks students to conduct a prospective risk analysis, most often a failure mode and effects analysis, on a health care process. Instructions usually require defining the scope and team, breaking the process into steps, listing failure modes with effects and causes, scoring severity, occurrence and detection, calculating risk priority numbers, choosing actions and recalculating. Keep the scope narrow enough that each failure mode has an owner. Print your scoring scales so a reader knows what each number means. Recognize that multiplying ordinal scores can hide rare but severe failures, and set a rule for those. Choose strong actions, such as forcing functions, over reminders. Cite a recognized FMEA method in APA style and assign owners and review dates.
How the HA 540 Unit 6 example is put together
The sample defines scope and a team that includes a patient adviser, then lists five subprocesses. A margin note explains why the analysis is prospective. A section describes three team meetings, with members scoring alone before discussing, flagged by a second margin note. Scales for all three scores are printed in full. Eight failure modes follow with effects, causes, controls and scores. A highlighted line warns that ranking by the product alone would place a missed cancer result fourth. A severity rule, with a third margin note, adds that mode to the top group. Actions are chosen by strength, from a required field that blocks discharge to automatic assignment of pathology results, and each is rescored. A readiness scale, owners, review dates, limits and a conclusion follow.
Where the points sit in the HA540 Unit 6 rubric
HA 540 rubrics for a patient safety analysis tend to award points for an appropriate scope and team, a complete process breakdown, realistic failure modes, defined scoring scales, correct calculations, sound prioritization, strong actions with recalculation, sources and presentation. Scope points go to a process narrow enough to act on. Team points reward including frontline staff and patients. Failure mode points depend on effects and causes stated for each. Scale points require definitions for every score. Priority points go to recognizing the limits of risk priority numbers. Action points reward forcing functions and standard work over education alone, with new scores shown. Analyses that add a severity rule alongside the ranking tend to land in the top band.
HA540 Unit 6 help from the desk
FMEA papers often lose points by drawing the scope so wide that failure modes become vague, or by scoring without defining the scales. Others rank only by risk priority number and miss rare catastrophic failures. Many propose training or reminders, which are weak actions. Draw a narrow scope, name a team that includes people who do the work and break the process into a few subprocesses. Brainstorm failure modes inside each and record effects, causes and existing controls. Print the scales, have members score independently and then agree. Add a rule that any severity of nine or ten gets action. Choose the strongest feasible action for each top risk, rescore it and assign an owner and a date to review the change.
Get an HA540 Unit 6 example written to your instructions
Share the process or event your Unit 6 safety analysis addresses, whether the prompt calls for FMEA, root cause analysis or another method, and any scales your course provides. With the directions and rubric in hand, a transparently scored first analysis, actions ordered by strength with scores recalculated after them, comes free within 24-48h. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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HA540 Unit 6 questions, answered
Where can I find a free HA540 Unit 6 sample paper?
The complete HA540 Unit 6 patient safety analysis is here, an FMEA of the discharge process after sedated endoscopy at a composite hospital unit.
What ranks highest in the HA540 Unit 6 FMEA?
A discharge sheet missing the blood thinner restart date, with a risk priority number of 270.
What is a risk priority number?
Severity multiplied by occurrence and detection, used to rank failure modes for action.
Why add a severity rule?
Multiplying scores can rank a rare, catastrophic failure below a common, minor one.
What is a forcing function?
A design that makes an error impossible or blocks a step until it is done correctly, such as a required field.