Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri The...
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Transcript of Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri The...
Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri
The North Carolina Story
Mary P. “Polly” Johnson, RN, MSN Executive DirectorNorth Carolina Board of Nursing
Presented at the 2004 CLEAR Annual ConferenceSeptember 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 ConferenceSeptember 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 ConferenceSeptember 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 ConferenceSeptember 30 – October 2 Kansas City, Missouri
Exclusionary Criteria
Drug relatedAbuseFraud/DeceitSerious harm or death Pending criminal charges
Presented at the 2004 CLEAR Annual ConferenceSeptember 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 ConferenceSeptember 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 ConferenceSeptember 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 ConferenceSeptember 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 ConferenceSeptember 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 completion8th Survey participants 3 mos. later
Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri
Project Growth and Development
Pilot began 6/01 with 7 hospitalsExpanded to nursing homes 7/0215 pilot agencies 7/02-6/0451 referrals June 01 – June 0445 licensees eligible – 6 ineligible35 licensees successfully
completed remediation as of May 04
Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri
31%
28%8%
28%
5% Exceeding scope
Competency
Med Errors
Documentation
InappropriateDelegation
Types of Referrals to PREP
Presented at the 2004 CLEAR Annual ConferenceSeptember 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 ConferenceSeptember 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 ConferenceSeptember 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 ConferenceSeptember 30 – October 2 Kansas City, Missouri
Keys to Success
• IndividualOpen-mindedLearn from
mistakes of self or others
Actively participate in developing remediation plan
• SystemOpen-mindedPromote non-
blaming cultureCommitment to
support employee in continued employment and remediation
Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri
Keys….
• Regulatory BoardProactiveFocused on Quality ImprovementAvailable ResourcesCollaborative and Approachable
Image in healthcare community
Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri
NC Board of Nursing: Expanding PREP Statewide in 2004
;