Evolve Case Study: Management of Emergent Care Clinic

PlanningThe first action of the charge nurse for the day shift in the Emergent Care Clinic is to prepare the assignments for the day shift. In addition to the charge nurse, three RNs, one PN, and two UAPs are scheduled from 7 a.m. to 7 p.m.1. Which client should the charge nurse assign to the PN?A) A 45-year-old male reporting left arm pain and gastrointestinal upset.Feedback: INCORRECT This client requires frequent assessment by an RN because symptoms may be cardiac in origin.B) A 25-year-old female complaining of increased urinary frequency and burning.Feedback: CORRECT Because this client is exhibiting signs of a urinary tract infection, she is the least acute, which makes her the most appropriate assignment for the PN. C) A 30-year-old female who states that she has the worst headache of her entire life.Feedback: INCORRECT Reports of “the worst headache” may indicate a cerebral bleed that requires frequent RN assessment.D) A 60-year-old male with a respiratory rate of 36 breaths per minute who reports dizziness.Feedback: INCORRECT A client with an increased respiratory rate is unstable and requires frequent RN assessment.Points Earned: 1.0/1.0 Correct Answer(s):BPlanningMr. Jackson, the 45-year-old male client reporting left arm pain and gastrointestinal upset is assigned to a registered nurse.2. It is most important for the RN to admit Mr. Jackson to which room in the Emergent Care Clinic?A) A room that has an adjacent bathroom since the client reports gastrointestinal upset.Feedback: INCORRECT This would be convenient, but the GI problem is not the most critical symptom.B) A private room that allows for a more confidential interview of the client’s symptoms.Feedback: INCORRECT The nurse should take measures to ensure confidentiality even in a semiprivate room. C) The room with the closest proximity to the nurse’s station.Feedback: INCORRECT Close proximity to the nurse’s station is important, but it does not override obtaining critically needed data.D) A room with continuous electrocardiogram (ECG) monitoring availability.Feedback: CORRECT Reports of left arm pain may indicate myocardial ischemia, and monitoring the ECG is critical.Close proximity to the nurse’s station is important, but it does not override obtaining critically needed data.The RN admits Mr. Jackson to a clinic room and connects him to the continuous cardiac telemetry monitor so that his heart rhythm can be monitored in the room and at the nurse’s station.Points Earned: 1.0/1.0 Correct Answer(s):DDelegationThe UAP assists the nurse in getting Mr. Jackson admitted.3. Which task should the RN delegate to the UAP?A) Obtain initial vital signs.Feedback: CORRECT Vital signs may be delegated to the UAP and then reported to the RN.      B) Assess the client’s left arm pain.Feedback: INCORRECT Assessment should be done by the RN. Some facilities allow the UAPs to collect data on pain levels, but the RN should do a complete pain assessment.C) Teach the client signs and symptoms to report.Feedback: INCORRECT Because educating the client is not within the scope of practice for the UAP, the RN should not delegate this task to the UAP.D) Initiate the plan of care.Feedback: INCORRECT Because initiating a care plan is not within the scope of practice for the UAP, the RN should not delegate this task to the UAP.Points Earned: 1.0/1.0 Correct Answer(s):ADelegationThe UAP obtains Mr. Jackson’s vital signs and reports the results to the RN. Reported vital signs for Mr. Jackson are: T 98.8° FP 88R 28BP 155/864. Which action should the nurse delegate to the UAP next?A) Recheck the client’s blood pressure.Feedback: INCORRECT Although the blood pressure is elevated, there is no indication that it is inaccurate. Obtaining another one at this time is not critical.  B) Stock the client’s room with standard supplies.Feedback: INCORRECT Stocking of the room should be done between clients or after other tasks have been completed.C) Attempt to contact Mr. Jackson’s wife by phone.Feedback: INCORRECT Next of kin may need to be contacted, but it is not the priority action at this time.D) Apply a continuous pulse oximeter monitor to the client.Feedback: CORRECT The increased respiratory rate indicates that continuous monitoring is the primary concern for this client. The oxygen saturation level also needs to be monitored continuously. The pulse oximeter may be applied by the UAP, but the monitoring and assessment is done by the RN.  The UAP applies the continuous pulse oximeter to Mr. Jackson’s finger. The client's Oxygen saturation was 93%. The RN applies an automated blood pressure cuff to assess his BP every 15 minutes.Points Earned: 1.0/1.0 Correct Answer(s):DEstablishing Priorities - AssessmentMr. Jackson also reports dull, aching pain from his left shoulder radiating to his left arm. He states the pain comes and goes, and he rates the pain a 5 on a pain scale of 0 to 10.The RN applies electrodes from the ECG machine to obtain a tracing of Mr. Jackson’s heart function.  The nurse analyzes Mr. Jackson’s ECG strip, which shows a normal sinus rhythm.  5. Which prescription should the nurse plan to implement first for Mr. Jackson?A) 12 lead ECG.Feedback: INCORRECT A 12 lead ECG is not the first priority because the continuous ECG monitor shows normal sinus rhythm.B) Electrolyte panel and cardiac enzymes.Feedback: INCORRECT Lab results will provide important data about the client’s condition, but this prescription does not have the highest priority.C) Oxygen at 2 liters per nasal cannula.Feedback: CORRECT The client has increased respirations and low oxygen saturation. Increasing the client’s oxygen should be addressed first in this case.D) Intravenous saline lock.Feedback: INCORRECT An IV should be started, but this intervention will not improve the most critical abnormal vital sign.After applying oxygen to Mr. Jackson, his oxygen saturation improves to 96% with respirations of 24. The nurse draws blood for laboratory analysis, starts an IV saline lock, and calls the UAP to prepare the client for a 12 lead ECG.Points Earned: 1.0/1.0 Correct Answer(s):C6. Which inquiry is most important for the nurse to make first?A) Client’s financial status.Feedback: INCORRECT Financial status may be part of the comprehensive assessment, but it is not the first priority. Each client should be treated with the same standard of care regardless of financial status or insurance coverage.B) History of psychological problems.Feedback: INCORRECT Psychological assessment may be part of the comprehensive assessment, but there is no evidence at this time that this is of primary concern.C) Medications currently taking.Feedback: CORRECT It is essential to obtain information on current medications when the client arrives. Many health problems are caused from side effects or missed doses.D) Social support system.Feedback: INCORRECT Assessment of the social support system should be done during the comprehensive assessment, but it is not the primary concern in this case.Mr. Jackson informs the nurse that he does not take any prescription medications and is not now on any over-the-counter medications or vitamin supplements. He says that he just returned from a long business trip overseas. Furthermore, he states that he has had no previous health problems.Points Earned: 1.0/1.0 Correct Answer(s):C7. After receiving the Mr. Jackson’s laboratory results, which data is most important to report to the primary healthcare provider (HCP)?A) Serum potassium 2.9 mEq/L.Feedback: CORRECT Because this is a critically low result that could contribute to cardiac complications, it should be reported immediately.B) Fingerstick glucose 108 mg/dl.Feedback: INCORRECT A capillary glucose level of 108 mg/dl is within normal limits. Abnormal lab data should be reported first.C) Serum magnesium 1.7 mg/dl.Feedback: INCORRECT A serum magnesium level of 1.7 mg/dl is borderline low, but it is not the most critical lab value reported.D) Negative cardiac enzymes.Feedback: INCORRECT Negative cardiac enzymes are normal. Abnormal lab data should be reported first.Points Earned: 1.0/1.0 Correct Answer(s):AEstablishing PrioritiesThe nurse notes that Mr. Jackson is now having occasional premature ventricular contractions (PVCs). The primary HCP prescribes a potassium supplement and sublingual nitroglycerin.Potassium chloride is prescribed 60 mEq PO Stat. The supply is potassium chloride 20 mEq per capsule. The charge nurse notes Mr. Jackson’s primary nurse has pulled 4 capsules from the automated medication delivery system.  8. How many capsule(s) should the nurse give? (Enter numerical value only. If rounding is necessary, round to the whole number.)Feedback: CORRECT D/H x V =X60/20 x 1 capsule= X3 capsules = X60 mEq (prescribed dose) divided by 20 mEq (supply) = 3 capsules.Points Earned: 1.0/1.0 Correct Answer(s):3The primary nurse gives the correct dose of the medication. After being treated with the potassium and nitroglycerin, Mr. Jackson no longer has any PVCs, and he rates his pain as a 0 on a scale of 0-10. His vital signs are stabilized and his oxygen is discontinued. The RN teaches him about signs and symptoms of electrolyte imbalance and the importance of staying hydrated while traveling. Mr. Jackson is discharged with a referral to a cardiologist for an outpatient stress test later that afternoon.LeadershipThe next day, the nurse manager of the clinic plans a staff meeting with the nurses and UAPs to communicate some changes in the scheduling protocol for the clinic.9. Which method for scheduling the staff meeting allows for the best continuity of care for the clients and the best communication between management and employees?A) Schedule a meeting with all of the nurses for an hour, then meet with the UAPs for an hour.Feedback: INCORRECT This method would break continuity of care because the clients would not have access to the nurses for an hour.B) The nurse manager should outline the scheduling change protocol in an e-mail and distribute it to the staff.Feedback: INCORRECT This is a one-way communication method that does not allow for an exchange of ideas or a question/answer session between the nurse manager and the staff.C) Meet with half of the nurses and UAPs before lunch, then the other half of the nurses and UAPs after lunch.Feedback: CORRECT Because this method ensures that there are nurses and UAPs monitoring the clients at all times, it does not break continuity of care. Unlike e-mail, the face-to-face meeting allows for the exchange of ideas and questions and answers.D) Place a sign on the door stating the clinic will be closed for one hour during the day.Feedback: INCORRECT This clinic is open 24 hours a day. Not only would closing for an hour be very difficult, it does not provide continuity of care.Points Earned: 1.0/1.0 Correct Answer(s):CThe nurse manager conducts the meetings and presents two different protocols for scheduling. The staff nurses and UAPs vote on the two different options.10. The nurse manager demonstrates which type of leadership by allowing the nurses and UAPs to vote on the staffing protocol?A) Patriarchal. Feedback: INCORRECT Patriarchal leadership typically controls members through rewards and threats.B) Democratic.Feedback: CORRECT Voting is an example of democratic leadership which promotes and supports participant involvement.C) Paternal.Feedback: INCORRECT Paternal styles of leadership are authoritarian and do not support input from all participants.  D) Laissez-faire.Feedback: INCORRECT Laissez-faire is French for “leave alone.” Using this style, the staff would create their own protocols and the manager would not interfere.The democratic style of leadership is usually most effective, but there may be times when other styles are more appropriate.Points Earned: 1.0/1.0 Correct Answer(s):B11. In which situation should a patriarchal/paternal leadership style be used by the charge nurse?A) During an emergency situation or mass disaster.Feedback: CORRECT When decisions must be made quickly and there is not time for participants to provide input, the patriarchal/paternal leadership style is effective. Example: Code team leader.B) When creating a protocol on how to do a nursing procedure.Feedback: INCORRECT The nurses who are going to be using the protocol should always have input into its creation, so a democratic style is more appropriate in this situation.C) Brainstorming ways to improve client satisfaction.Feedback: INCORRECT Brainstorming of ideas lends itself to a democratic or laissez-faire style of leadership.D) When participating in an interdisciplinary team conference.Feedback: INCORRECT Patriarchal/paternal style is not effective within the interdisciplinary team because all members of the team should participate and have input.   Points Earned: 1.0/1.0 Correct Answer(s):ACommunicationDuring the staff meeting, the nurse manager asks the nurses and UAPs to provide feedback about the daily operations of the clinic.One of the full-time RNs states, “I am always assigned the busiest clients in the clinic, and it isn’t fair.”12. How should the nurse manager respond?A) “You are full time and the most experienced nurse.”Feedback: INCORRECT This response does not address the nurse’s feelings.B) “This is not the time or place to voice your concerns.”Feedback: INCORRECT This dismisses the nurse’s comments after the nurse manager asked for feedback.C) “Busy clients provide a better opportunity for learning.”Feedback: INCORRECT This does not address the nurse’s concern or allow the nurse to elaborate.D) “You sound frustrated; tell me why you feel this way.”Feedback: CORRECT This is an open-ended statement. It does not sound judgmental, and it gives the nurse the chance to voice the concern.Points Earned: 1.0/1.0 Correct Answer(s):DAfter hearing the nurse’s response, the nurse manager schedules a one-on-one meeting with the nurse to investigate the issue. After the meeting, one of the PNs tells the nurse manager that there is reason to believe one of the nurse practitioners is stealing narcotics.13. What action should the nurse manager take first?A) Confront the nurse practitioner in question.Feedback: INCORRECT Another action should be taken first.B) Ask the PN to explain specifically what has happened.Feedback: CORRECT The nurse manager needs to gather more information prior to confronting the nurse practitioner, asking for a urine or blood sample, or reporting the nurse practitioner to the State Board of Nursing. Specific details will be needed to determine if the report is credible. The board or other authority may be contacted after the report is substantiated.C) Ask the nurse practitioner for a urine or blood sample now.Feedback: INCORRECT Another action should be taken first.D) Report the nurse to the State Board of Nursing.Feedback: INCORRECT Another action should be taken first.Points Earned: 1.0/1.0 Correct Answer(s):BWhen asked about the specifics of the accusation, the PN states that the nurse practitioner was observed taking out five pre-filled vials of morphine from the automatic drug dispenser and placing them in her pocket.The nurse manager investigates and determines that five vials of morphine sulfate were removed from the automatic drug dispenser using the nurse practitioner’s login identification (ID), but no clients had prescriptions for morphine on this shift.14. Which approach should the nurse manager use to confront the nurse practitioner?A) Tell the nurse practitioner there is evidence that proves she is guilty of stealing narcotics.Feedback: INCORRECT This assumes guilt and does not give the nurse practitioner a chance to defend herself if she is not guilty.B) Call another unit meeting that includes the nurse practitioner, and confront her in a group setting.Feedback: INCORRECT Although interventions are sometimes scheduled, a unit meeting would not be an appropriate forum to speak to the nurse practitioner about this problem.C) Remain silent and watch the nurse practitioner for the rest of the shift to gather more evidence.Feedback: INCORRECT This option allows the nurse practitioner to continue to care for clients when she may be under the influence of drugs.D) Explain the accusation to the nurse practitioner and give her a chance to reply.Feedback: CORRECT This is a matter-of-fact approach in which the evidence is presented. If the nurse practitioner is guilty and decides to admit the wrongdoing, it will eliminate the need for an ongoing investigation and will be more therapeutic for the recovery process.The nurse practitioner admits to stealing the narcotics. The nurse manager accompanies the impaired nurse to the employee assistance program office. After counseling, the impaired nurse voluntarily admits herself to a drug rehabilitation unit.   Points Earned: 1.0/1.0 Correct Answer(s):DLegalJust before the change of shift, Billy Young, a 6-year-old boy, is brought to the clinic by his grandmother, Ms. Washington. The charge nurses ask Ms. Washington what happened to Billy. The grandmother states that Billy fell out of his swing, and she thinks he broke his arm.The charge nurse observes Billy holding his right arm, but he is not crying and is currently playing with a toy car.15. Which action should the charge nurse take first?A) Assess Billy’s vital signs.Feedback: INCORRECT Assessing a client’s vital signs is not always the first intervention. Another action should be taken first.B) Ask the grandmother if she is Billy’s legal guardian.Feedback: CORRECT The priority action for the charge nurse is to determine if the grandmother can legally give consent for the staff at the Emergent Care Clinic to treat Billy.C) Assess Billy’s pain level.Feedback: INCORRECT Assessing a client’s level of pain is important, but it is not the priority action in this situation.D) Determine how high Billy was when he fell.Feedback: INCORRECT The height of the fall may give the HCP information about the injury, but it is not the first priority.Billy’s grandmother states that she is the child’s legal guardian, and she gives her consent to treat him. The RN asks Ms. Washington if she has any proof of legal guardianship for Billy. Ms. Washington shows the charge nurse her custody papers for Billy. The charge nurse assigns a male RN with five years pediatric experience to care for Billy.Points Earned: 1.0/1.0 Correct Answer(s):B16. Under what circumstance can healthcare personnel treat a child even when the legal guardian cannot be contacted?A) When the child is in any kind of pain.Feedback: INCORRECT Pain is not a criteria used for legal consent of a minor.B) After an attempt has been made to contact the legal guardian.Feedback: INCORRECT Attempting to call the guardian does not provide legal consent.C) There is a life-threatening situation.Feedback: CORRECT If the child’s life is in danger, the child can be legally treated even when consent cannot be obtained.D) The person who brings the child to the hospital gives verbal consent.Feedback: INCORRECT Bringing the child to the hospital does not provide for legal consent.Points Earned: 1.0/1.0 Correct Answer(s):CBilly’s grandmother states that she has had custody of him since he was a baby. She says his biological mother visits him about once a month.In the examining room, the nurse helps Billy take off his shirt and notices that he has bruises in multiple stages of healing on his back. The nurse asks Billy how he got the injuries, and Billy says, “I don’t know.”The grandmother states, “He falls a lot.”17. Which action should the nurse take first?A) Tell the grandmother she is not allowed to be alone with Billy anymore.Feedback: INCORRECT Although the nurse may assign a UAP to stay with the client if abuse is suspected, more information needs to be gathered before the grandmother is confronted.B) Ask the HCP for a referral to social services.Feedback: INCORRECT There has not been enough information gathered yet to ask for a social services referral.C) Call child protective services and report suspected abuse.Feedback: INCORRECT More information should be gathered before reporting to CPS.D) Complete the rest of the nursing assessment.Feedback: CORRECT The nurse should complete the assessment, paying particular attention to any other signs of injury or abuse.The nurse completes the rest of the assessment and notices what appear to be cigarette burns on the back of Billy’s legs. Billy does not cry when his injured arm is assessed. The nurse assigns a UAP to stay with Billy while he notifies the primary HCP.Points Earned: 1.0/1.0 Correct Answer(s):DClient AdvocacyThe HCP calls the grandmother out of the room to ask her a few questions while the nurse interviews Billy alone. When asked again about his injuries, Billy says his mother gets mad sometimes when he is "not good." Billy says he tells his grandmother, but she doesn’t do anything.  When the nurse reports Billy’s statements to the HCP, the HCP states, “I know this family, they are my neighbors, and I would believe the grandmother before I would believe the child.”18. Which action should the nurse take?A) Attempt to contact Billy’s mother to verify the story.Feedback: INCORRECT Attempting to contact the child’s mother falls outside of the role of the nurse.B) Document Billy’s statements and follow the HCP’s advice.Feedback: INCORRECT Because the HCP’s view is obviously skewed by the personal involvement with the family, another action should be taken. C) Assure Billy he can stay with his grandmother if his mother doesn’t visit.Feedback: INCORRECT This falls outside of the nurse’s realm of expertise. Because the nurse does not know what the authorities will do, this information could be inaccurate. D) Request the HCP to withdraw from the case. Feedback: CORRECT The nurse must be a client advocate and insist on unbiased continuity of care. Since there is personal involvement with the family, the nurse should ask the HCP to withdraw from the case and allow another HCP to be assigned to Billy’s care. The HCP refuses to withdraw from the case and instructs the nurse not to contact Child Protective Services (CPS). The HCP vows to keep an eye on Billy and his grandmother.The RN notifies the nurse manager of the situation and requests help with the problem.Points Earned: 1.0/1.0 Correct Answer(s):D19. Which action should the nurse take next?A) Obtain Billy’s home address and schedule a visit to check on him.Feedback: INCORRECT Making a home visit falls outside the scope of the RN’s practice as an employee of the clinic.B) Notify CPS and inform the HCP’s supervisor of the situation.Feedback: CORRECT The nurse is ethically and legally bound to report suspected child abuse to CPS. The HCP’s unethical behavior should also be reported.C) Tell the grandmother that visits from Billy’s mother should stop.Feedback: INCORRECT The nurse has no authority to tell the grandmother what she should or should not do.D) Make arrangements for Billy to stay the night in a foster home.Feedback: INCORRECT This type of social service falls outside the nurse’s scope of practice in this setting.After CPS and social services are notified, Billy receives treatment for his arm by another HCP. He is discharged to the care of a social worker for the night.Points Earned: 1.0/1.0 Correct Answer(s):BPerformance ImprovementA nurse manager has many responsibilities. One of those responsibilities is ensuring the Emergent Care Clinic’s performance improvement (PI) plan is implemented.20. How should nurse manager use performance improvement programs? (Select all that apply. To proceed, de-select any incorrect answer(s) and try again.) A) Discovery of facility deficiencies.Feedback: CORRECT When statistics are gathered as part of a PI plan and compared to expected outcomes or standards, the facility’s deficiencies are found. Once deficiencies are found, they can be eliminated or corrected.B) Implementation of critical pathways. Feedback: INCORRECT Critical pathways are plans for the client, not the facility. Records may be monitored to determine if critical pathways are being followed as part of a PI plan.C) Guidelines for the use of charting by exception. Feedback: INCORRECT All PI plans do not provide guidelines for charting by exception. An individual facility might include this as part of a review for a PI plan.D) Investigation of the degree to which standards of care are being met.Feedback: CORRECT Client records are confidentially reviewed by nurses for trends and statistics and compared with benchmark standards.E) As required reporting mechanism by accrediting agencies. Feedback: CORRECT The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and other accrediting agencies do require documentation of performance improvement programs for their participating facilities.Points Earned: 1.0/3.0 Correct Answer(s):A, D, EAs part of the PI plan, the nurse manager reviews trends in client satisfaction surveys. It is noted that 76% of clients are dissatisfied with the amount of time they had to wait in the waiting room.21. Which action should the nurse manager take first?A) Ask management for an increase in budget to hire additional staff to decrease wait time.Feedback: INCORRECT It is too early to ask for an increase in budget because the nurse manager does not know if the wait time is too long, and if so, if it is due to short staffing or another process.B) Establish a goal for an average acceptable wait time.Feedback: INCORRECT More data needs to be obtained before a goal or expected outcome can be established.C) Lead a staff meeting and present strategies to decrease the wait time.Feedback: INCORRECT More data needs to be collected before implementing strategies. D) Conduct a study to determine the current average wait time.Feedback: CORRECT Establishing the current wait time will give the nurse manager a frame of reference from which to work.The nurse manager conducts a time study and determines the average wait time for clients is 55 minutes before being admitted to a room in the Emergent Care Clinic.Points Earned: 0.0/1.0 Correct Answer(s):D22. After the nurse manager decides to conduct a root cause analysis on lengthy wait times, what action should be implemented?A) Identify best practices and compare them with the facility’s current practices.Feedback: INCORRECT Identifying best practices and comparing them with the facility’s current practices describes benchmarking.B) Collect and analyze data to determine the cause of the problem.Feedback: CORRECT This describes root cause analysis (RCA), which investigates the reason for the problem instead of just the effect.    C) Implement a plan to improve a process that falls below acceptable standards.Feedback: INCORRECT This describes a quality improvement project.D) Select structures, processes, or outcomes to review quarterly for indicators.Feedback: INCORRECT This describes a quality indicator.Points Earned: 1.0/1.0 Correct Answer(s):BContinuity of CareUpon completion of the root cause analysis, the nurse manager determines that the lengthy wait time is due to the manual processing and duplication of paperwork. After the nurse manager researches computerized data systems to help solve this problem, a recommendation is made that a system be purchased as soon as possible. The nurse manager plans to ensure a smooth transition and continuity of care for all clients when the clinic purchases a computerized data system for billing, charting, and medication administration.23. Which strategy should the nurse manager use with the staff to provide a smooth transition when implementing a computerized data system?A) Present an outline of the profit margin increase that will result from the use of the system.Feedback: INCORRECT An increase in profit margin may not be valued by every employee.B) Provide the staff with a detailed history of the company that furnishes the system.Feedback: INCORRECT Providing a detailed history of the company will likely not help the staff transition smoothly.C) Explain that the system will be purchased regardless of the opinions of the staff.Feedback: INCORRECT This type of strategy is authoritarian and will likely have a negative effect.D) Promote the advantages, but be honest about the disadvantages of using the new system.Feedback: CORRECT Explaining how the system will benefit those using it and being honest about any flaws will let the staff know what to expect, which should help ensure a smoother transition.   Points Earned: 1.0/1.0 Correct Answer(s):DA majority of the staff agrees that an electronic data system will allow them to make more efficient use of their time and improve client satisfaction. The system is purchased for all departments in the Emergent Care Clinic.24. After the education and training on the use of the electronic data system has been completed with all of the staff, which implementation strategy provides the best continuity of care to the clients?A) Implement the system one department at a time with staggering dates.Feedback: CORRECT Implementing one department at a time will allow for problems to be worked out prior to implementing it in another department and will be less stressful for the staff.B) Start the system for all departments at the same time on the same date.Feedback: INCORRECT If there are problems and the system fails, it will affect all departments and ultimately delay or interrupt continuity of care.C) Continue to use the paper pencil system until all employees agree on an implementation date.Feedback: INCORRECT Although employee input is valuable, there may never be 100% agreement.D) Initiate the new system immediately and shred all the paper charts.Feedback: INCORRECT If the system fails, the paper charts can be used as backup providing continuity of care. Therefore, they should not be shredded.Points Earned: 1.0/1.0 Correct Answer(s):AThe system is successfully implemented, and over the next six months, the wait time is shortened to 15 minutes.   Case OutcomeThe nurse manager, charge nurses, RNs, PNs, UAPs, and HCPs continue to work as an interdisciplinary team to improve processes dealing with all aspects of client care in this fast-paced Emergent Care Clinic.