Upload
others
View
13
Download
0
Embed Size (px)
Citation preview
Patient Safety
§ Over 200,000 deaths annually due to error
§ NCSBN data from other studies indicate high rates of recidivism by nurses who are disciplined by employers and/or boards of nursing.
§ Staff fear repercussions of error and do not report
§ Many errors “system-related”
Data from the U.S. Criminal Justice System
§ Punishment does not necessarily improve behavior
§ Emphasis is needed on examining what happened and how can we prevent you from doing this again.
§ Support and resources lessen the chance of recidivating.
Consequences of Discipline
§ Nurses tend to hide errors § Prevents fixing the system § Risk to patient
§ Focus is often negative
§ Sometimes necessary and effective under the right circumstances.
What does all this mean?
§ Regulation and health care facilities need to work together.
§ We need to effectively prevent errors.
§ Examine environment/system as well as individual errors.
What does all this mean?
§ Punishment may not be the best option for preventing future errors or poor performance.
§ Remediation, counseling, supervision are tools that need to be considered as part of disciplinary action.
Nurse Discipline
§ Need for greater consistency
§ Need to reduce the rate of recidivism
§ Need to reduce error and place emphasis on remediation.
§ Need to tie the process to the patient safety movement.
Focus of evaluation
System error § May be due to a deficit in
the facilities policies and/or procedures
§ May be due to other providers in the health care system
§ Often a combination of factors
§ remediation
Nurse’s role in error § concealment/falsification
of records § substantial or
unjustifiable risk § reasonably prudent
nurse § mitigating factors § history of similar error § previous facility
Strategy: review the system & behavioral factors for all practice error & professional misconduct cases.
Regulatory Decision Pathway
Goals § protect the public § incorporate just culture principles § increase consistency in discipline
Designed for § Board of Nursing discipline decisions § cases of practice errors or unprofessional conduct
Focuses on § patient safety § whether system failure and/or behavioral choices by the nurse contributed to the error § remediation of nurses
Regulatory Decision Pathway (RDP)
Initial development
§ NCSBN team drafted the pathway, summer 2012
§ Presented at Annual Meeting 2012
BONs Review & Revision
§ Solicited 18 BONs to review & pilot the tool, Winter 2012
§ Received feedback from 13 BONs
§ Incorporated feedback into tool, Spring 2013
BON Evaluation results
§ 13 BONs reviewed the tool
§ 183 cases were used in reviews
§ Majority of BONs thought the tool was § Clear § Useful to BON discussions § Effective in leading to consensus in BON decisions § Led to conclusions the BON agreed with
§ 50% of BONS are considering changing current process as a result of RDP
Revisions Spring 2013 Issues identified by BONs § concealing/falsifying
records § contributing or mitigating
factors § counseling & coaching § responsibility for action
plans § unprofessional conduct
cases § definitions § directions for tool
Revisions § moved concealing/falsifying records
from deliberate harm § added contributing or mitigating
factors to pathway § added counseling & coaching to
Human Error § changed responsibility for action
plans to nurse § included a description of tool &
cases designed for at top of tool § expanded definitions § explicit directions
The Regulatory Decision Pathway (RDP) was designed for Board of Nursing discipline decisions in cases of prac5ce errors or unprofessional conduct.
With the use of the RDP, the board’s discussion is focused on whether system failure and/or behavioral choices by the nurse contributed to the error.
Through the use of RDP the board will determine the type of behavior exhibited and whether disciplinary ac5on or other ac5on would assist in protec5ng the
public.