C ontinuing Education Committee: CE Workshop & ANCC 2013 Manual Update Presenters: Lolita Ramsey, RN, PhD Sharon Broscious, RN, DSN Co-Chairs/Nurse Peer Review Leaders April 20, 2013 Richmond, VA (South University) Part 2 of 2

Conflict of Interest, Commercial Support, Sponsorship VNA CEA Presenter: Lolita Ramsey, RN, PhD April 20, 2013, Richmond, VA

 Conflict of interest An affiliation or relationship of a financial nature that might bias a person’s ability to objectively participate in the planning, implementation, or review of a learning activity. Conflict of Interest

The potential for conflict of interest exists when an individual has the ability to control or influence the content of an educational activity and has a financial relationship with a commercial interest organization, the products or services of which are pertinent to the content of the educational activity*. The Nurse Planner is responsible for evaluating the presence or absence of conflict of interest and resolving any identified actual or potential conflict of interest during the planning and implementation phases of an educational activity. If the Nurse Planner has an actual or potential conflict of interest, s/he should recuse her/himself from the role as Nurse Planner for the educational activity. Conflict of Interest

*Commercial Interest, as defined by ANCC, is any entity producing, marketing, re-selling, or distributing healthcare goods or services consumed by, or used on, patients, or an entity that is owned or controlled by an entity that produces, markets, re-sells, or distributes healthcare goods or services consumed by, or used on, patients. Non-profit or government organizations, non-health care related companies and health care facilities are not considered commercial interest organizations. Conflict of Interest

*Relevant Relationships, as defined by ANCC, are relationships that are expected to result in financial benefit from a commercial interest organization the products or services of which are related to the content of the educational activity. Conflict of Interest

 No relevant relationship with a commercial interest organization exists. No resolution required.  Relevant relationship with a commercial interest organization exists. The relevant relationship with the commercial interest organization is evaluated by the Nurse Planner and determined to not be specific to the content of the educational activity. No resolution required.  Relevant relationship with a commercial interest organization exists. The relevant relationship is evaluated by the Nurse Planner and determined to be specifically related to the content of the educational activity. Resolution is required. Conflict of Interest

 Removing the individual with conflict of interest from participating in all parts of the educational activity.  Revising the role of the individual with conflict of interest so that the relationship is no longer relevant to the educational activity.  Not awarding continuing education contact hours for a portion or all of the educational activity.  Undertaking review of the educational activity by a content reviewer to evaluate for potential bias, balance in presentation, evidence-based content or other indicator of integrity and absence of bias AND monitoring the educational activity to evaluate for commercial bias in the presentation.  Undertaking review of the educational activity by a content reviewer to evaluate for potential bias, balance in presentation, evidence-based content or other indicator of integrity and absence of bias AND reviewing participant feedback to evaluate for commercial bias in the activity Conflict of Interest

1. Who has the opportunity to influence the content of the educational activity? 2. Collect biographical information and conflict of interest information from each individual who has the opportunity to influence content 3. Evaluate relationships individuals have with commercial interest organizations 4. Is relationship relevant to content of educational activity? 5. If relationship is relevant, resolution is required Decision Matrix - COI

 Commercial support Financial or in-kind contributions given by a commercial interest that are used to pay for all or part of the costs of a CNE activity. Providers of commercial support may not be providers or co-providers of an educational activity. Commercial Support

 Sponsorship. Financial or in-kind contribution from an organization that does not fit the category of a commercial interest. Sponsorship

1. Yes or No? 2. If yes, classify the organization providing the support: commercial interest or not? 3. If commercial interest = commercial support 4. If not commercial interest = sponsorship Financial or In-kind Support

 Commercial support agreement (Form D-1)  Signed by both entities  Amount  Organization may not provide, co-provide, or assist with planning  Required disclosures Commercial Support

 Sponsorship agreement (Form D-2)  Signed by both entities  Amount  May not assist with planning  Required disclosure Sponsorship

 Two organizations working together to plan, implement and evaluate an educational activity  One is provider, one is co-provider  Co-provider may not be a commercial interest organization  Provider awards contact hours  Need agreement (Form G) Co-providing

 COI:  Who can influence content  Evaluation and resolution  Disclosure  Financial or In-kind Support  Commercial interest or not  Written agreement  Disclosure COI, CS and Sponsorship

 Tendency or inclination to cause partiality, favoritism or influence Bias

 Continuing education should be continuing education – designed to promote the professional practice of the registered nurse  Should not be a vehicle used to sell a product or service Why is it important to control bias?

 All actual or potential conflicts of interest were resolved  Content is evidence based or based on best available evidence  Planning process was independent from the influence of any commercial interest organization  Activity was free from promotion Controlling for bias/ensuring content integrity

Planners are developing an educational activity. Purpose: Registered nurse consumers will be able to make informed choices about the lemonade beverage products they purchase. Objectives:  Describe the nutritional value of lemonade beverage products  Identify 3 reasons why lemonade beverage products are beneficial to consumers  Choose the best lemonade beverage product for consumers who are also registered nurses * Note: Manufacturers of lemonade are not commercial interest organization; used for this activity to demonstrate COI, bias, promotion in a fun way Putting it into practice *

What might you be concerned about if: The Best Lemonade Beverage company provided funding for the educational activity? The activity speaker was an employee of the Best Lemonade Beverage company? How might you control for bias/ensure content integrity? COI resolved Content is evidenced-based Activity was planned free from influence of the Best Lemonade Beverage Company No promotional activity Putting it into practice

 Lemonade beverage products ensure that registered nurses have enough sugar and citrus to work through a 12 hour shift  Lemonade beverage products include minerals and vitamins  Lemonade beverage products are individually packaged, ensuring that registered nurses will not be exposed to viruses and bacteria found in communal lemonade pitchers Subtle marketing influence BEST

Questions?