1. Texas TERCAP Implementation
Designing the Action Plan
Mary Beth Thomas, PhD, RN
J. L. Skylar Caddell, BS, RN,C

2. The Texas Objectives
Implement with the most time efficient method that would produce quality results
Minimize the revisions needed to the existing processes
Supplement and expand the existing structure
Start with small group of RN Investigators
Implement TERCAP on cases in all phases of processing

3. The Texas Objectives -Case Mix Considerations
Open new practice cases with tools designed to collect all TERCAP data
Six to eighteen months is a typical time frame for case resolution
New cases will have full data when reviewed
Complete a TERCAP on existing practice cases when they result in Board action
Existing cases may have incomplete data

4. The Texas Objectives - Challenges & Successes
Gradual 18+/- month transition period
From data with many unknows to data that is complete as existing cases resolve and new cases move through the pipeline
Results in a period of training and refinement, using incomplete data, and facilitates increased TERCAP proficiency as authorized investigators become more experienced in TERCAP analysis

5. Texas TERCAP - Designing the Action Plan
Develop a plan & tools for data collection
See Texas TERCAP Data Needs Analysis and Data Source Determination
Develop Policy and Procedure
Formalize implementation process decisions
Creates accountability
Develop Training Plan
Emphasis on support and interrater reliability

6. Texas TERCAP Implementation
Questions and Answers

7. New Hampshire’s Experience with the TERCAP Instrument
Margaret Walker Ed.D., RN
Attorney Norman Patenaude

8. Introduction
New Hampshire’s interest in learning about the TERCAP process.
Desire for data outcomes to have an idea of our position in comparison with other jurisdictions.
Desire for data outcomes for planning and quality improvements.

9. Investigation Understanding TERCAP tool.
Investigating practice breakdown.
Investigating licensee unprofessional conduct such as drug diversion.
Obtaining information and provide ordered documentation.

10. Reporting recommendations
Investigation results are orderly.
Reports provide a synopsis of the investigation with recommendations based on law and administrative rules.

11. TERCAP tool
Investigation is given to the Executive Director who then reviews the record, notes, and Investigator recommendations.

12. Completion of TERCAP
Currently the EO completes the tool and then gives the paper copy to the secretary to input into the database.
Staffing shortages have required creative time management for tool completion and thus it is completed at home…leisurely.

13. “A HAH” Moments
Because the tool is completed away from the constant interruptions of the busy office, the EO has realized patterns of reporting themes and issues.
Diversion issues have surfaced as the highest reportable practice issue in NH since beginning the TERCAP project.

14. Quality before we receive the TERCAP report
With the Investigator/Prosecutor completing the data collection and the EO completing the TERCAP form, many conversations have resulted with the Board on current observations.

15. Early realization….
We are now working on our Alternative Program to improve processes and oversight of participants.
We have seen a smaller percentage of actual practice breakdown…does this mean that we have under-reporting of actual practice breakdown issues? We have more questions.

16. Awaiting TERCAP outcomes
Upon results, Investigator and EO plan to carefully review and analyze data to determine:
Public education offering to employers/supervisors of licensees.
Approaches to issues received in the board office.
Future recommendations for board actions.

17. Questions and Answers
This is only a beginning and we have a lot more to learn……
Thank you, Margaret and Norm
NH Board of Nursing