Transcript Keys to the Institute of Medicine Report on Medical Errors

The North Carolina
Story
Mary P. “Polly” Johnson, RN, MSN
Executive Director
North Carolina Board of Nursing
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
North Carolina’s PREP Story
• Consistent with NCBN Mandate & Vision for The
21st Century:
– To ensure minimum standards of competency and
provide the public safe nursing care
– To promote safe nursing care through:
 achieving excellence in nursing regulation
 being primary source of regulatory information
 collaborating with other health care organizations in a
changing healthcare environment
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Essential Elements
•
•
•
•
Voluntary, non-public, non-punitive
Collaborative approach
Motivation to improve practice
Opportunity to learn from mistakes and
upgrade knowledge, skills and abilities
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Eligibility Criteria
Concern/Incident primarily related to the
individual, not the system
Root cause related to practice, not
misconduct
Individual’s licensure status in good standing
Licensee eligible for continued employment
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Exclusionary Criteria
Drug related
Abuse
Fraud/Deceit
Serious harm or death
Pending criminal charges
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Safety Net for Public Protection
 Explicit guidelines to distinguish PREP
eligibility versus disciplinary review
 Serves as additional tool for boards to
allow earlier intervention with focus on
performance improvement
 Gives boards proactive/non-punitive
opportunity to impact safety issues
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Groundwork for PREP Pilot
 Approached receptive agencies
 Solicited support from NCHA and NCNA
 Agencies participated in project development:
Chief nurse administrators, attorneys and risk managers
 Conducted on-site education with key agency
personnel prior to implementation
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Steps in the PREP Process
1st: Identification of incident/pattern
- Incident -usually an error involving
established employee OR
- Pattern of competency deficit(s) becomes
apparent- often new or reassigned employee
2nd: Referral to PREP
– Designated agency person initiates referral
– Basic information is shared with PREP Coordinator
– Employee is told of PREP contact
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Steps……
3rd: Determination of eligibility
– Facility must determine that employee is eligible for
continued employment
– Both must agree that employee appears to be viable
candidate for PREP
– BON must review licensure history
4th: Assessment/Interview
– Assessment of needs/learning opportunities-usually
done by agency, if appropriate
– Interview licensee-done by BON
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Steps….
5th Remediation plan
– Agency and BON confer to formulate plan
for remediation/enhancement
– Proposed to licensee in terms of formal
agreement
6th Contractual agreement
- Signed by all 3 parties
– Individual/system bears the cost
7th Successful completion
8th Survey participants 3 mos. later
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Project Growth and Development
Pilot began 6/01 with 7 hospitals
Expanded to nursing homes 7/02
15 pilot agencies 7/02-6/04
51 referrals June 01 – June 04
45 licensees eligible – 6 ineligible
35 licensees successfully completed
remediation as of May 04
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Types of Referrals to PREP
Exceeding scope
5%
31%
Competency
28%
M ed Errors
Documentation
8%
28%
Inappropriate
Delegation
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Responses to PREP
• Improved communication and trust
between hospitals and BON
• Collaborative relationships
• Positive reception from nursing community
for proactive, non-punitive approach by
BON
• Positive response from individuals referred
to PREP
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Responses….
Opportunity for boards to impact safe
patient care by addressing individual and
systems issues
Survey of agencies and licensees:
 desire for program expansion
 perception of fairness and effectiveness of
non-disciplinary approach to public
protection
 key person = program coordinator
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Possibilities for PREP
• Provide data related to human factors that
contribute to practice deficiencies and/or minor
incidents
• Serve as a model to assist regulatory boards to
redefine individual accountability in more
productive manner
• Focus on improving performance, rather than
expecting perfect performance
• Facilitate the shift from culture of blame to quality
improvement
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Keys to Success
• Individual
 Open-minded
 Learn from mistakes
of self or others
 Actively participate in
developing
remediation plan
• System
 Open-minded
 Promote non-blaming
culture
 Commitment to
support employee in
continued
employment and
remediation
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
Keys….
• Regulatory Board
Proactive
Focused on Quality Improvement
Available Resources
Collaborative and Approachable Image in
healthcare community
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri
NC Board of Nursing: Expanding
PREP Statewide in 2004
;
Presented at the 2004 CLEAR Annual Conference
September 30 – October 2
Kansas City, Missouri