The Practitioner Remediation and Enhancement Partnership PREP 4 PATIENT SAFETY Mark Speicher Board Member, Citizen Advocacy Center Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri PreP For Patient Safety A Program of the Citizen Advocacy Center (CAC) Under Contract With HRSA

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri PHILOSOPHY OF PREP 4 Patient Safety PROGRAM  Philosophy To create a new paradigm where hospitals and the Boards of Medicine and Nursing serve as safety advocates and provide a means whereby practitioners having deficits in knowledge, skills or abilities remain in the work setting and receive remediation to improve safe patient care and enhance public protection.

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri FOCUS OF PREP 4 Patient Safety Identification of problems before versus after harm occurs Non-punitive versus “blame and punish”

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri  Voluntary participation of licensee  Privacy of participation—treated as non-public information ESSENTIAL PROGRAM ELEMENTS

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Competency – practitioners who demonstrate a deficit in knowledge, skills, abilities or judgment believed to be amenable to remediation DUAL TRACKS OF PREP DUAL TRACKS OF PREP 4 Patient Safety Errors – minor violations of the practice act isolated incidents not subject to serious board action

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Identified deficiency or incident must be associated with an individual, recognizing that the individual is part of a complex environment Identified individual must be eligible for continued practice privileges or employment with participating pilot hospital CRITERIA FOR PARTICIPATION CRITERIA FOR PARTICIPATION

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri CRITERIA FOR PARTICIPATION Cases must NOT involve suspected drug diversion, reckless conduct, deceitful behavior or sexual misconduct Cases involving serious patient harm or prior disciplinary action not “PREP” cases

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Policies/Procedures for Boards and Hospital Identification of problem/deficit Consultation/determination of eligibility Assessment Remediation Plan Contractual Agreement Monitoring Reporting PROGRAM COMPONENTS SUPPORTED BY CAC

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri PATHWAYS TO ENTER PREP 4 Patient Safety 1.Hospital Initiated 2.Board Initiated

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri PARTICIPATING BOARDS BOARDS OF MEDICINE (1) California (2) Minnesota (3) Missouri (4) North Carolina (5) Oregon (6) Rhode Island BOARDS OF NURSING (1) Colorado (2) Maryland (3) Nebraska (4) North Carolina (5) Oregon (6) South Carolina (7) West Virginia (LPN)

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri POSITIVE RESPONSES TO PREP 4 Patient Safety Improved communication and trust between pilot hospitals and boards Enhanced collaboration Recognition/resolution of systems problems as by-product of internal review Favorable reception from licensees for proactive, non- punitive approach by licensing board.

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Support to Members: Assessment and Remediation CAC (Through AIM and NCSBN) conducts survey of all boards Availability and Use of Assessment and Remediation Programs Goals: Discover Utilization Rates and ID Current Programs

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Report Includes State-of-the-Art Info Background on Assessment and Remediation Current Status of Assessment and Remediation (Surveys of Medical and Nursing Boards) State-of-the-Art: Assessment State-of-the-Art: Remediation Resource Summary Future Directions

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Findings Survey Responses from 19 of 53 Nursing Boards and 46 of 63 Medical Boards Shows Low Utilization of Assessments, More but Still Low Use of Remediation Lists 40+ Assessment or Remediation Resources

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Likely Direction Use of Assessments Today –Problem ID is the assessment –Nurses get small, ongoing, formalized assessment using an employment model –Physicians get larger, one- time assessments using a peer review model –Part of a punitive process Use of Assessments Tomorrow –More Use of Assessments –Staged Assessments –Not Punitive –Part of Larger Continuing Competence Where Everyone Is Assessed Use of Remediation Today –More widely used than outside assessments –Little objective follow-up –For Boards, often part of a punitive process Use of Remediation Tomorrow –User-friendly (i.e. distance learning) –Not part of punitive process –Outcomes are tracked

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Summary  MORE THAN 125 PARTICIPANTS TO DATE WHAT WE’VE LEARNED SO FAR WHAT WE STILL HAVE TO LEARN GOAL FOR 2005: MORE BOARDS, MORE PROFESSIONS!

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri More Information on PreP For Patient Safety PREP 4 Patient Safety WEB SITE

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Mark Speicher OptiMed Resources Inc N. 9 th Ave., Phoenix AZ (602) Fax (602)