Adult-Gerontology Clinical Nurse Specialist (CNS) Practice Exam

What must a health care organization conduct after an adverse sentinel event?

1. Root cause analysis

2. Cost-benefit analysis

3. Risk-benefit analysis

4. Post mortem analysis

The correct answer is: Root cause analysis

A health care organization must conduct a root cause analysis following an adverse sentinel event to identify the underlying factors that led to the incident. This systematic process focuses on understanding what went wrong, why it happened, and how it can be prevented in the future. The objective is not merely to assign blame but to uncover systemic issues and improve safety protocols and practices. By analyzing the root causes, organizations can develop tailored interventions and enhance their practice standards, ultimately leading to improved patient safety and quality of care. This approach ensures that the lessons learned from such events lead to more effective and safer healthcare environments. In contrast, other analyses, such as cost-benefit or risk-benefit analyses, focus on financial implications or weighing risks against benefits, which do not directly address the immediate need for improvement in response to adverse events. A post mortem analysis, while relevant in certain contexts, typically refers to examining a deceased individual's health outcome rather than analyzing organizational events from a proactive safety and quality perspective.