1. Karla Bitz, PhD, RN, FRE North Dakota Board of Nursing

2. WHAT IS PBR @ NDBON?

3. OBJECTIVE Provide an overview of the implementation process used by the NDBON to incorporate the elements of TERCAP into its investigative process

4. WHO IS PBR FOR? Patient Boards of Nursing Investigators Research

5. Enhance the effectiveness of the investigative process Consistent, standardized, and comprehensive data collection Track case elements and recurring themes

9. WHY DO IT? (contd) Discover characteristics of nurses at risk Provide continuity in investigations Increase competence in addressing Practice Breakdown Better understand why errors occur

10. November 15, 2001: NDBON voted to participate in the NCSBN PBR Study December 2002: Per the SAAG, not required to obtain consent to gather the data Boards files are subject to ND Open Record Law Individual identifiers are not included Analyze aggregate data

11. 2006 – Strategic Plan 2007 – Implemented TERCAP !

12. INTERNAL OPERATIONS Potential Violation Report Response Form Investigative Case Interview Investigative Case Summary Disciplinary Review Panel Discipline Statistics

13. LESSONS LEARNED Commitment Shifts focus from name, shame, and blame Culture Change - will take time Dont have to recreate the process

16. LESSONS LEARNED (contd) Opportunity for comprehensive review of investigative process HELP is available, Use it! TERCAP Committee NCSBN staff Protocol Webinars

17. JUST TRY IT!

18. Kathy Chastain, RN, MSN Carol Walker, RN, MS TERCAP IMPLEMENTATION: North Carolina BON Process

19. Project Value n Patient safety n Nursing education n Nursing regulation n Advancement of nursing profession n Research for Healthcare Community n NCBON

20. Project Challenges n Harness magnitude of project n Relevance to expanse of practice n User friendly for 50+ BONs n Board staff acceptance

21. NCBON Staff Acceptance n Value to each Investigator n Incorporate into current process - Current system flaws identified

22. Needed Facilitator Characteristics n Perceive project value n Energy n Enthusiasm n Commitment n Perseverance n Endurance n Creativity

23. Needed Facilitator Characteristics n Maintain vision n Patience n Accept little immediate satisfaction n Appreciate each step in process

24. NCBON Current Investigation Process n No Investigation tool n Inconsistent documentation format n New computer documentation system

25. Feb 07 TERCAP Data Entry Realization: *Resistance to additional change *TERCAP History Decision: Restrict staff entering data Problem: Case selection/skewed data

26. TERCAP Data Entry Realization: Data scattered Data not obtained Resolution: Developed paper tool *Increased data collection *Centralized collected data Problem: Remember to use

27. TERCAP Data Entry Realization: *Additional time needed to enter data Resolution: *Incorporate into case documentation process

28. TERCAP Data Entry Realization: Need to revise internal Inquiry/ Investigation documentation Resolution: Opportunity to initiate uniform documentation

29. TERCAP is NOT a Short Term Project!!