It’s the law (TOC 303) Creates a better environment Increases options for addressing errors Provides alternate reporting options Can help identify system problems Advise as.
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Transcript It’s the law (TOC 303) Creates a better environment Increases options for addressing errors Provides alternate reporting options Can help identify system problems Advise as.
It’s the law (TOC 303)
Creates a better environment
Increases options for addressing errors
Provides alternate reporting options
Can help identify system problems
Advise as to nurse’s duty – Safe harbor NPR
Determine accountability - incident based NPR
Evaluate nurse’s ability to practice competently
– minor incident NPR
Alternate reporting option for nurses
Identify system errors (secondary)
A facility or ISD that employs 10 or
more LVNs OR 10 or more nurses
with at least 5 being RNs
CNO/Superintendent
The incident based NPR process is one
of fact finding, analysis and study of
events by nurses in a climate of
collegial problem solving focused on
obtaining all relevant information
about an event.
Is it reportable conduct?
Is the nurse responsible?
Possible report and make
recommendations to the BON.
Due process for the nurse
Timelines
Notification to nurse being
reviewed
Hearing ..between 21 and 45 days
Findings ..not > 14 days
Rebuttal..10 days
Confidentiality
If possible at least one nurse on the
committee must have a working
familiarity with the area of practice in
which the reviewed nurse practices
Mitigating Circumstances
Chemical dependency or
substance abuse
Mental instability
TPAPN 1-800-288-5528
Hearing
Review evidence submitted
Listen to testimony
Persons with administrative
responsibility over the nurse are
excluded from PRC, including
attendance at the hearing
Findings
Is the conduct reportable to the BON?
Is the conduct a minor incident?
Does the nurse’s continued practice pose a
risk of harm?
Are there 5 or more minor incidents in a
12 month period?
Reportable conduct to the BON
Violate “duty to a patient”
Unprofessional conduct
Criminal conduct
Death of patient
5 or more minor incidents in a 12 month
period
Recommendations/Report
Minor
incident
Recommendations to ISD…remediation,
monitoring
Exclusions
Death
of patient
Criminal
Conduct... assault, sexual assault,
kidnapping, burglary, murder
Unprofessional
Conduct…fraud, theft, patient
abuse/exploitation, unsafe practice
If NPR finds the reviewed nurse did not engage in
conduct subject to reporting , a committee member
may not report the nurse to the BON anyway if
the member’s sole source of information is from
being on the committee
NPR committee must consider whether a system error
might have been a contributing factor in
evaluating the nurse’s conduct…nurse can only be
held accountable for conduct that was a result of
a deficiency in nurse’s judgment, knowledge,
training or skills
Protections provided to the nurse
The right to request PRC determination
of whether conduct or assignment violated
the nurse’s duty to a patient
Protection from being disciplined by
the facility for making the request
Protection from being disciplined by
the BON for engaging in the conduct
while awaiting the PRC decision
Process to invoke Safe Harbor
Collaboration with Supervisor
Engage vs Refuse
refusal based two reasons only:
unprofessional or criminal conduct
nurses lack of basic knowledge
..engaging would pose risk of harm
Good Faith
Quick Request form (www.bon.state.tx.us)
Before engaging in conduct
Give to supervisor
Any written form/format is acceptable to initiate
request for Safe harbor
Comprehensive Request Form (www.bon.state.tx.us)
Must use BON form
Before leaving at end of day
Give to supervisor
Supervisor/CNO responsible to file with Peer Review
Committee ASAP
Exemptions from Safe Harbor
Unprofessional Conduct
Fraud, theft, abuse
Outcomes/Resolution
Review must be completed and CNO
notified of findings within 14 days of
request
Within 48 hours of receiving PRC
decision, CNO must notify nurse of
findings and whether administrator
believes in good faith that findings are
correct or incorrect
Nurse’s protection from the BON
expires 48 hours after nurse is
notified of findings
Be familiar with:
NPA(TOC) 301.352
TAC 217.11, Standards of Practice
TAC 217.12, Unprofessional Conduct
TAC 217.16, Minor Incident
TAC 217.19, Reportable conduct
TAC 217.20, Safe Harbor
BON Six Step Decision Making Model for
Scope of Practice
To protect the public from unsafe nurses
To investigate the allegation
To determine accountability of the nurse
To determine disciplinary actions if violation
occurred
Who are you going to serve?
One region
Multiple regions
RNs, LVNs
Determine composition of PRC
3/4, 2/3
Nurse familiar with practice setting
Determine logistics of meeting place
Central to area served?
Site of chair?
Develop operational guidelines that align with your
regional bylaws/elections
Create a Peer Review Document that outlines the
process
Hint… TNA’s ABC’s of Peer Review
Create Letters
Introduction
Agreement (yearly, open ended)
Confidentiality
Send Letters of Introduction and
Agreement to Superintendents
Region esc website
Send Peer Review Document to those who
return letter of agreement
Chairperson maintains list of
participating ISDs
Records Maintenance system
Sealed with case #
Retain for 10 yrs
___________________________ISD designates Texas School Nurse
Organization, Region IV, Peer Review Committee, as agent for
purposes of The Nursing Practice Act for the State of Texas. As agent,
TSNO Region IV and the school district can exchange information
without breach of confidentiality.
The committee will fulfill all obligations described in the Peer Review
Document . In general it will:
Receive a report from a school district employee for assessment of nursing
practice.
Make a recommendation about nursing practice to the ISD.
Maintain confidentiality
The school district will:
Publicize plan to school nurses and administrators.
Authorize a designated administrator to receive reports.
File a report with the Board of Nurse Examiners, if necessary.
Maintain confidentiality
This agreement will automatically renew every year unless the school
district notifies the Peer Review Chairman in writing that they are
opting out of the program.
The Texas School Nurse Organization, Region IV(TSNO), maintains a Peer Review
Committee to answer the Legislative mandate for peer review. It is a collective
interdistrict peer review committee for the 56 ISD’s in Region IV. While the
guidelines for the law specify that an employing agency with 10 or more nurses
must establish a peer review system, we welcome all school districts’
participation regardless of number of nurses employed. TSNO, Region IV, is
the local school nurses’ association with the identical geographic territory of the
Region IV Education Service Center. It is also the local chapter of the state
organization.
Reasons for school districts in Region IV to come together for the peer review
process include:
Each district will not have to set up a separate committee, therefore it will be less
time consuming for a school district and their employees.
TSNO, Region IV members are familiar with school nursing practice.
TSNO, Region IV will support and assist school nurses.
TSNO, Region IV requests that each participating district accept the following:
If necessary, allow release time for an RN serving on the committee.
Meetings are RARELY held during school hours.
Agree to abide by the requirements of the law for confidentiality.
Provide cooperation to the committee and access to records for any RN/LVN
employee referred for “review”.
Refer to one of the following if you have any questions, input, or concerns:
www.bon.state.tx.us (Board of Nurse Examiners)
BON Peer Review FAQs
BON Protecting Your Patients and Your Practice
BON Six Step Decision Making Model
TNA ABCs of Nursing Peer Review
Melinda Hester, RN, DNP(BON)
Nancy Roper-Willson, RN, JD, MSN, MA, (Attorney at
Law)
www.tea.state.tx.us (superintendent list)
www.bon.state.tx.us
www.texasnurses.org
[email protected]