 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

 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 (  Before engaging in conduct  Give to supervisor  Any written form/format is acceptable to initiate request for Safe harbor

 Comprehensive Request Form (  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)  TAC , Standards of Practice  TAC , Unprofessional Conduct  TAC , Minor Incident  TAC , Reportable conduct  TAC , 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: (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)  (superintendent list)     D