Root-Cause Analysis (RCA) in Adult Nursing Practice: Understanding the Importance and Process

A root-cause analysis helps to identify contributing factors to an incident, so that they can be addressed and mitigated in the future, thus enhancing patient safety and quality of care.

As a healthcare professional, it is essential to provide the highest quality of care to patients. However, sometimes, despite our best efforts, errors and incidents can occur, which can impact patient outcomes and safety. It is crucial to investigate and address these incidents to prevent them from happening again. One way to do this is through a root-cause analysis (RCA).

In this blog, we will explore the importance of RCA in adult nursing practice, the process of conducting an RCA, and its benefits in enhancing patient safety and quality of care.

Why is RCA important in adult nursing practice?

RCA is a systematic process of identifying the underlying causes of an incident or error. In nursing practice, it is used to investigate and address adverse events, near misses, and other incidents that may have caused harm to patients. RCA aims to identify the root cause of the problem and develop solutions to prevent it from happening again.

The importance of RCA in adult nursing practice is highlighted by the following reasons:

  1. Enhancing patient safety and quality of care RCA helps identify the underlying causes of incidents, which can then be addressed to prevent similar incidents from occurring in the future. This, in turn, can enhance patient safety and quality of care.

  2. Learning from incidents RCA involves a systematic and thorough investigation of incidents, which can provide valuable insights into how things can be improved in the future. It provides an opportunity to learn from mistakes and take appropriate measures to prevent them from happening again.

  3. Compliance with regulatory requirements RCA is a mandatory requirement for healthcare organizations to comply with regulatory requirements. Conducting RCA can help organizations demonstrate their commitment to patient safety and quality of care.

Now that we understand the importance of RCA in adult nursing practice let's delve into the process of conducting an RCA in the next section.

The RCA process typically involves the following steps:

  1. Define the problem: The first step in conducting an RCA is to define the problem. This involves identifying the critical incident or event that occurred, such as a medication error or a fall.

  2. Collect data: Once the problem has been defined, the next step is to collect data related to the incident. This can include medical records, incident reports, and witness statements.

  3. Identify contributing factors: The next step is to identify the contributing factors that led to the incident. This can include factors such as communication breakdowns, staffing issues, or equipment failures.

  4. Analyze the data: Once the contributing factors have been identified, the data needs to be analyzed to determine the root cause of the incident. This can involve using tools such as fishbone diagrams or the 5 Whys technique.

  5. Develop and implement solutions: After the root cause has been identified, solutions need to be developed and implemented to prevent the incident from occurring again. This can involve changes to policies and procedures, staff education and training, or changes to equipment or technology.

  6. Evaluate the effectiveness of the solutions: The final step in the RCA process is to evaluate the effectiveness of the solutions that have been implemented. This involves monitoring and measuring the outcomes of the changes to determine if they have been successful in preventing similar incidents from occurring in the future.

By following this process, healthcare professionals can identify the root cause of critical incidents and take steps to prevent them from occurring in the future. It is important to note that RCA is not a one-time event, but an ongoing process of continuous quality improvement in healthcare.

Writing an RCA Essay

Now that we have discussed the importance and process of conducting a root-cause analysis in adult nursing practice, let's take a look at an example of an RCA essay paper.

Sample Paper


This report investigates a patient safety incident in an Acute Medical Unit (AMU), focusing on the case of Sam, a 70-year-old male who experienced a treatment lapse in the AMU, leading to the deterioration of his condition and subsequent admission to the High Dependency Unit (HDU). Factors contributing to Sam's treatment lapse include staff shortages in the AMU, unreliable verbal communication, and hospital bed congestion, resulting in Sam not receiving the appropriate critical care intervention for his condition. A detailed description of the patient safety incident is provided in Appendix 1.

The Root Cause Analysis (RCA) process, utilizing the Fishbone Diagram, will be applied to illustrate the cause-effect relationship of potential organizational, task, environmental, and individual factors that may have led to the safety breach in Sam's initial diagnosis and admission for critical care in the AMU. Furthermore, this report will adopt the Plan-Do-Check-Act (PDCA) service improvement framework to systematically implement change processes aimed at enhancing patient admission procedures in the AMU. According to the NHS (2023),...Read More


The paper, titled "Root-Cause Analysis of a Medication Error in an Adult Inpatient Setting," was written by a nursing student and follows the RCA process outlined in the previous section. The paper uses a fishbone diagram to illustrate the contributing factors to the medication error, and provides a detailed analysis of each factor.

The paper also includes a discussion of human factors and their impact on the incident, as well as recommendations for future practice. Overall, the paper demonstrates a thorough understanding of the RCA process and its importance in promoting patient safety and quality of care.

By reviewing examples of RCA essays, nursing students can gain a better understanding of how to conduct their own RCAs and improve their critical thinking and problem-solving skills.

In the next section, we will provide an RCA essay structure guide to help nursing students organize their thoughts and write an effective RCA paper.


Now, let's take a look at an RCA essay structure to better understand how to structure and write a successful RCA essay in adult nursing practice.

Sample RCA EssayStructuree: "Root Cause Analysis of Medication Errors in a Hospital Setting"


The format of the RCA Essay should include;


The introduction should provide an overview of the critical incident and briefly explain the RCA framework that will be used. This should also introduce the purpose of the RCA, which is to identify contributing factors to medication errors and provide recommendations for improvement.

Justification of Chosen Model/Framework:

The next section should provide a justification of the chosen RCA model/framework, explaining how it aligns with the analysis of the critical incident. Supporting references should be used throughout to demonstrate the validity of the chosen model/framework.

Case Study and Analysis:

In this section, the case study and analysis of the contributing factors should be presented. This should include identifying and prioritizing the factors that may have led to the incident, critically analyzing the impact/effect of these factors in relation to risk management and human factors, and referencing appropriate literature.


The final section should present the proposed recommendations for improvement based on the analysis conducted. This should include identifying appropriate models for implementing change and discussing potential challenges to implementation.


The conclusion should summarize the main findings of the RCA and emphasize the importance of implementing the proposed recommendations.

By following this structure and incorporating relevant literature throughout, you can successfully write a Root Cause Analysis essay in adult nursing practice.


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