American Nurses Credentialing Center COA Criteria for Provider-Directed Continuing Nursing Education Approved by LSNA

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1 LOUISIANA STATE NURSES ASSOCIATION 5713 Superior Drive, Suite A-6 Baton Rouge, LA Phone Fax /09 American Nurses Credentialing Center COA Criteria for Provider-Directed Continuing Nursing Education Approved by LSNA KE1. Assessment of Learner Needs Continuing education activities are developed in response to, and with consideration for, the unique educational needs of the target audience. 1. Describe and/or check the best description of how the need for this continuing nursing education (CN) activity was assessed. Identify the type of needs assessment used to determine the learners needs. 2. The target audience for the activity is identified. (The activity must be developed on an education level for Registered Nurses.) 3. Objectives, content, and teaching-learning strategies must be developed in response to the needs assessment. KE2. Qualified Planners and Faculty Each education activity is planned collaboratively by at least one designated Nurse Planner and one other planner. Each planning committee must have representation from all of the following areas: the relevant content expertise, the target audience, and the responsibility for adherence to ANCC accreditation criteria. Multiple areas may be represented by each person. However, the content expert cannot also represent the target audience. Nurse planners contribute oversight and must be actively involved in both the planning and the analysis of evaluation data for the educational activity. The planning committee assures the qualifications of the faculty member(s) are appropriate and adequate. 1. Applicant must submit name and credentials of the person administratively responsible for the CNE activity. A person (not required to be a nurse) is identified to be responsible for administering the CNE activity. Throughout the process, LSNA will correspond with the person identified in this space. The contact person, and the person administratively responsible may or may not be the same person, but the person administratively responsible must sign the application. 2. Planning Committee: Applicant must submit the name, degrees/credentials and Biographical Data Form (See Attachment A) which identifies professional qualifications for each person involved in planning the CNE activity. a. Each educational activity is planned collaboratively by at least one designated nurse planner who is a registered nurse and holds at least a baccalaureate degree in nursing and one other RN planner. The Nurse Planner is responsible for adhering to ANCC Accreditation Program criteria in the provision of continuing nursing education. Additionally, the Nurse Planner must PROVIDER-DIRECTED CRITERIA page 1

2 have education or experience in the field of education or adult learning which is documented on the Biographical Data Form. The Nurse Planner must demonstrate competance in performing successfully at the expected level. b. Each member of the planning committee should represent at least one of the following areas: the relevant content expertise; the target audience; and nurse planner/responsibility for adherence to ANCC accreditation criteria. Multiple areas may be represented by each person. Each planning committee must have representation for each of these three areas. Members must document their expertise for the category of participation on the bioforms. The presenter typcally fills the role of content expert. The target audience representative should be an individual to whom the activity is directed. Nurse planners contribute oversight and must be actively involved in both the planning and the analysis of evaluation data for the educational activity. The planning committee assures the qualification of the faculty member(s) as appropriate and adequate. Activities specifically planned for the APRN with prescriptive authority require that an APRN be included on the planning committee. c. Conflict of interest disclosure statements shall be obtained from all activity planning committee members to identify the presence or absence or any potentially biasrd relationship of a financial, professional, or personal nature on the part of those who have an impact on the content of an educational activity. Planners and presenters must disclose the presence or absence of conflict of interest relative to EACH ACTIVITY for self and significant other. All potential conflicts shall be resolved prior to the planning, implementation, or evaluation of the continuing nursing education activity. The definition of conflict of interest includes personal, professional and financial relationships of self and significant other. d. An original/electronic/faxed signature is acceptable; a typed name is not acceptable. An electronic signature is a scan of the actual signature not the typed name. 3. Program Faculty: The Planning Committee identifies the needed qualifications of faculty members and assures that the selected faculty members qualifications are appropriate and adequate. a. Applicant must list the faculty names, degrees and credentials on the application and use the Educational Activity Content Outline to list the faculty person(s) for each topic or content area. Submit completed Biographical Data Forms for each presenter or content specialist. (See Attachment A.) Presenters present content in an area in which they have knowledge and expertise. NOTE:Presenters must have documented qualifications that demonstrate their education and experience in the content area they are presenting. Expertise in subject matter can be evaluated based on education, professional achievements and credentials, work experience, etc. Describe how the person qualifies as an expert. b. Applicant must document the conflict of interests of the faculty on the Biographical Data Form. Conflict of Interest: To ensure that all continuing nursing education activities are free from bias, all presenters must declare conflict of interests. Conflict of interest disclosure statements shall be obtained from all activity presenters to identify the presence or absence or any potentially biasing relationship of a financial, professional, or personal nature on the part of those who have an impact on the content of an educational activity. Faculty must disclose the presence or absence of conflict of interest relative to each activity for self and significant other. All potential conflicts shall be resolved prior to the planning, implementation, or evaluation of the PROVIDER-DIRECTED CRITERIA page 2

3 continuing nursing education activity. The definition of conflict of interest includes personal, professional and financial relationships of self and significant other. c. Applicant must identify how the learner will be informed of this information. The presenters declarations of conflict of interests must be shared with the learners. d. An original/electronic/faxed signature is acceptable; a typed name is not acceptable. An electronic signature is a scan of the actual signature not the typed name. KE3. Effective Design Principles The educational activity must be developed with an identified learning goal (purpose) and explicit measurable educational objectives for the learner that are appropriate for the target audience and identifies gaps in knowledge, skills, practice (based on the needs assessment) which the activity is designed to address. Content must be congruent with the learning goal (purpose) and educational objectives. Teaching-learning strategies are congruent with the objectives and content. See Educational Activity Content Outline Attachment B1. 1. Purpose - The purpose for the activity must be clearly stated and identifies gaps in knowledge, skills, practice identified (based on the needs assessment) which the activity is designed to address. Applicant must document the continuing education activity s purpose. It is not a restatement of the objectives. 2. Identify gaps in knowledge, skills, and practice identified (based on the needs assessment) which the activity is designed to address. 3. Educational Objectives - Objectives for the CNE activity are stated in singular, behavioral and measureable terms that define the expected outcome for the learner. Applicant must state objectives in behavioral terms using the required format. Objectives must be stated from the perspective of the learner, and complete the statement: At the end of this activity, the learner will be able to. NOTE: The objectives are derived from the overall purpose of the activity. Educational objectives are written statements that describe the learner-oriented outcomes that may be expected as a result of participation in the educational activity. In the case of most CNE activities, these statements describe knowledge, skills and attitude changes, practice or customer service that should occur upon successful completion of the activity. Determination of objectives is a collaborative activity between planners and presenters. Learner-oriented objectives are expressed in measurable terms, identify observable actions, and specify one action or outcome per objective. The number of objectives for the program should be sufficient to accomplish the intended purpose of the activity. It is recommended that objectives be limited to one or two per hour. Number each objective consecutively. 4. The applicant must use the Educational Activity Content Outline. This content outline is a required format, although applicants may choose which version to use (Portrait or Landscape, Attachment B). Indicate which objective(s) is/are related to each topic area. Include a time period for each objective. Identify the presenter who will address each objective. The content is related to and congruent with the objectives. Content is described in the form of a content outline with corresponding time frames for each content area. EACH objective has a corresponding content outline. THE CONTENT MUST BE MORE THAN A RESTATEMENT OF THE OBJECTIVE. Number each content area with corresponding objectives. PROVIDER-DIRECTED CRITERIA page 3

4 5. Time allotted for the activity is congruent with the objectives and appropriate for the content being presented. NOTE: The educational activities, the level and amount of content to be provided, and the estimated number of participants dictate the amount of time which will be required. Each topic area should have a designated time frame. The time allotments for content for each objective should be sufficient to facilitate achievement of the objective by the learner. 6. Teaching-Learning Strategies - Applicant must list the teaching method used by each presenter for each topic or content area. For presenter-paced activities, the applicant must use the required format (Educational Activity Content Outline), for sample, see Attachment B2. Teaching methods/ learning strategies are congruent with the objectives, content presented, time allotted and faculty/ learner ratio. NOTE: Instructional methods that support attainment of the educational objectives should be used. The action indicated as the expected outcome determines the teaching strategies to be used. For example, a learning objective that requires the learner to successfully demonstrate a psychomotor skill should include teaching strategies that utilize demonstration and return demonstration. An objective that requires a learner to describe a phenomenon would include teaching strategies such as lecture and discussion. In addition to teaching strategies that support the learning objectives, attention must be given to the fact that principles of adult learning should be evident in the selected strategies. Teaching methods include but are not limited to: lecture, panel discussion, role play, questions and answers, demonstrations, practice, specific audiovisuals, slides (not powerpoint, which is a specific commercial program) etc. Materials and resources could include handouts, references, etc. 7. Applicant must identify criteria for judging successful completion of the activity that are consistent with the learning goal (purpose), objectives, and teaching and learning strategies. 8. Applicant must determine method for verifying participation in the activity. KE4. Awarding Contact Hours Contact hours associated with the official accreditation statement are awarded to participants for those portions of the educational activity devoted to didactic or clinical experience or to evaluating the activity. Contact hours are calculated in a logical and defensible manner. One contact hour = 60 minutes. A provider of an educational activity may award no fewer than 0.5 contact hours for an educational activity. Learning activities may be conducted asynchronously or may be bundled to allow a full learning experience to take place. Contact hours are to be awarded in units using two decimal places or less. If rounding is desired in the calculation of contact hours, the provider is to round DOWN to the nearest 1/10th or 1/100th. Time spent completing the evaluation form may be counted. (EX - 45 minutes equals 0.75 contact hours.) Contact hours MAY NOT be awarded retroactively. 1. Applicant must clearly describe the rationale used to determine the contact hours to be awarded. If the activity is a live presentation, applicant must submit a copy of the schedule. Contact hours are determined in a logical and defensible manner, consistent with the objectives, content, teaching/learning strategies, and target audience. The rationale used to determine the number of contact hours to be awarded needs to be described. For example, an agenda or schedule identifying the amount of time spent on each section of the CNE activity can be used to determine contact hours. The time spent on welcome, introductions, pre/post tests, breaks, and evaluation needs to be clearly and separately stated. Welcomes, introductions, breaks and exhibits are not included in the calculation of contact hours. The topic, pre/post tests, demonstration/return demonstration, and evaluation are included in PROVIDER-DIRECTED CRITERIA page 4

5 the calculation of contact hours. The time allotted must support the number of objectives. If the CNE activity is presented more than once in its entirety, a second schedule does not need to be submitted. The appropriate measure of credit is the 60 minute contact hour. A contact hour is 60 minutes of an organized learning activity, which is either a didactic or clinical experience. The minimum number of contact hours to be awarded is 0.5 contact hour. For example, 75 minutes of learning experience equals 1.25 contact hours. Evaluation, up to 15 minutes, is considered part of the learning activity and needs to be included in calculation of contact hours. To calculate the number of contact hours, add the total number of minutes of allowed time and divide by 60. EXAMPLE: 8:00 8:10 Welcome & introduction 10 minutes (not applicable) 8:10 8:30 Pre-test 20 minutes 8:30 9:00 Talk #1 30 minutes 9:00 9:20 Discussion 20 minutes 9:20 10:10 Talk #2 50 minutes 10:10 10:25 Break 15 minutes (not applicable) 10:25 11:15 Supervised practice 50 minutes 11:15 12:15 Lunch & exhibits 60 minutes (not applicable) 12:15 1:55 Panel discussion 100 minutes 1:55 2:10 Break 15 minutes (not applicable) 2:10 3:00 Talk #3 50 minutes 3:00 3:15 Questions and answers 15 minutes 3:15 3:30 Evaluation 15 minutes 350 minutes total 350 minutes divided by 60 = 5.83 contact hours 2. Applications for single continuing nursing education activities are approved for a period of two (2) years. KE5. Activity Evaluation A clearly defined method, which includes learner input, is used to evaluate the effectiveness (i.e. were the activity objectives met?) for each education activity. See Attachment C Sample Evaluation Form 1. Applicant must check the best description of and/or describe the method used to evaluate the activity. (page of the application) There is a clearly defined method which includes learner input, used to evaluate the effectiveness of each educational activity. 2. Applicant must submit a copy of the learner evaluation instrument with each copy of the application. Each faculty member must be evaluated individually. Achievement of the objectives from the learner s perspective must also be evaluated. ( At the end of this activity, the learner will ) The evaluation tool will include: A. Learner s achievement of each objective. B. Presenter s knowledge of content, presentation skills, and organization of content. C. Category of evaluation (i.e. learner satisfaction, knowledge enhancement, skill and attitude change, change in practice/performance, relationship of the practice change to quality of service). D. Plan to implement change. PROVIDER-DIRECTED CRITERIA page 5

6 E. Opportunity to indicate awareness of conflict of interest or lack thereof F. Opportunity to indicate that program was presented in a fair, unbiased manner 3. The nurse planner must participate in an quality inprovement (QI) process after each activity. Issues, such as, achievement of objectives, speaker effectiveness, adherence to unbiased presentation of content with no violation of conflict of interest, appropriateness of facility, and participant achievement of criteria for successful completion of the activity are to be evaluated and suggestions for improvement of future activities are to be identified. 4. Applicant must check the best description of and/or describe how the evaluation data will be used. There is a description of how evaluation data will be used to improve the activity. Revisions are made to ongoing continuing nursing education activities based on evaluation data and participant input. NOTE: One of the most important components of effective evaluation is evaluation data provided by participants. If properly designed and utilized, the evaluation can provide information about the overall activity as well as the specific components. To generate evaluation data that can be used to determine effectiveness of an activity and provide evidence for any necessary changes or improvements, a clearly defined method of evaluation should be developed as part of the planning process. 5. Applicant must check the best description of and/or describe how feedback will be provided to the learner. Feedback must be provided to the learner. KE6. Accreditation Statement The accreditation statement is a mark of the provider unit s status. All communication, marketing materials, certificate, and other documents that refer to the provider s ANCC-accredited status containing the official accreditation statement, as follows: Louisiana State Nurses Association (LSNA) is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center s COA. The accreditation statement must stand alone. In other words, it must begin and end on a line separate from other text. Applicant must submit a copy of the advertising material. Advertising material includes any method of announcing an educational event. This may include a brochure, flyer, bulletin board announcement, newsletter, memo, or web site. This material must be submitted with the application. If advertising is provided on a web site, include information on where and how to find it. Also, include a hard copy of the web site advertising. The advertising material may be the completed copy or a mock-up of the final material. If a mock-up of the advertising material was sent with the application, the final copy of the advertising material must be submitted as soon as it is printed. The advertising material must include the following statement once the application has been approved: This provider- directed continuing nursing education activity is approved for contact hours by LSNA. Louisiana State Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center s COA. PROVIDER-DIRECTED CRITERIA page 6

7 If the provider must release the advertising material prior to receiving approval and has submitted an application to LSNA the provider may state the following: This activity has been submitted to LSNA for approval to award contact hours. Louisiana State Nurses Association (LSNA) is accredited as an approver by of continuing nursing education by the American Nurses Credentialing Center s COA. Enduring documents, such as, webinars and journals, must include a statement that explains how long contact hour(s) will be awarded for an activity. This statement must appear on all marketing materials and on the title page of the educational materials. KE7. Documentation of Completion Participants receive written verification of their successful completion of an activity. See Attachment D Sample Certificate. 1. Applicant must identify criteria for verifying participation and successful completion of the learning activity and how learners will be informed of these criteria. Criteria for verifying participation and successful completion of the learning activity and how learners are informed are specified. NOTE: Criteria for verifying participation and successful completion must be determined as part of the overall planning of the activity. Educational activities may differ in expectation and requirements for verification of participation and successful completion of the activity. The learner is informed of these criteria prior to participation in the activity. Verification of participation may be achieved by a variety of methods, for example, roll call, sign-in sheets, self-reported attendance, or return of evaluation tools. Successful completion may be achieved by a variety of methods, for example, submission of a written post test and a self reported level of achievement of objectives, return demonstration, evaluation discussion with presenters, attendance at the entire activity, etc. 2. Applicant must submit a completed sample of the verification form/certificate awarded to the participants with each copy of the application. Participants will receive written verification/certificate which includes the following: A. Name of the participant learner B. Name and address of the provider of the educational activity C. Title and date of the educational activity. E. Official approval statement: F. Number of contact hours awarded KE8. Sponsorship and Commercial Support Education must be kept separate from promotional activities. Commercial support, exhibits, or the presentation of research conducted by a commercial company shall not influence the design and scientific objectivity of the educational activity. Commercially supplied funds for an educational activity that are given in any form of an educational grant or in-kind assistance shall be acknowledged in the brochures and/or printed material for the educational activity. See Attachment E Standards for Disclosure and Commercial Support. Applicant will submit a description of sponsorship or commercial support related to the activity. State all financial relationships or check that there are no financial relationships. Applicant will identify how this information will be shared. In the event that any form of commercial support is provided for an educational activity, the provider will maintain control of the education content and disclose to the PROVIDER-DIRECTED CRITERIA page 7

8 learners all financial relationships or lack thereof, between the commercial supporter and the provider or presenter. KE9. Conflict of Interest Guidelines Conflict of interest disclosure statement shall be obtained from all activity planners and presenters to identify the presence or absence of any potentially biasing relationship of a financial, professional, or personal nature on the part of those who have an impact on the content of the educational activity. Planners and presenter must disclose the presence of absence of conflict of interest relative to the activity. All potential conflicts shall be resolved prior to the planning, implementation or evaluation of the educational activity. See Attachment E Standards for Disclosure and Commercial Support. KE10. Disclosure Provided to Activity Participation Participants must receive the following information regarding each and every activity in advance of, or at the time of, the event. If the disclosure is provided verbally, there will be documentation provided by someone in the audience of the activity that the disclosure was appropriately made. See Attachment E Standards for Disclosure and Commercial Support. Disclosures provided to activity participants: (a) Notice of requirements for successful completion; (b) Conflicts of interest or no conflict of interest; (c) Disclosure of relevant financial relationships and mechanism to identify and resolve conflicts of interest; (d) Sponsorship or Commercial support; (e) Non-endorsement of products; (f) Off-label use of medications or products (g) Expiration date for awarding contact hours KE11. Record-Keeping System For the educational activity, documentation is kept in a secure, confidential and retrievable manner for 6 years. 1. Applicant must submit a written statement of the commitment to maintain the educational activity records for six (6) years. 2. The applicant agrees to the following record-keeping criteria. Check each to indicate willingness to comply. All correspondence; completed copy of application which includes (a) Planning -description of the target audience -the method and findings of the needs assessment -names, titles, and expertise of the planning committee and faculty -conflict of interest disclosure statements from planning committee and faculty and resolutions of conflict of interest, as appropriate -learning goal (purpose), objectives and content -education activity content outline -activity evaluation -methods or process used to verify participation -notice to learners identifying how successful completion will be measured -marketing and promotional materials -division of responsibilities among co-providers, if any, and -means of ensuring content integrity with commercial support, if any PROVIDER-DIRECTED CRITERIA page 8

9 (b) -written commercial support agreement as required in the standards of commercial support for any activity receiving commercial support Implementation: -title, location, and date of the educational activity -all evaluation tools used, including a summative evaluation -participant names -sample certificate of completion, -number of contact hours associated with official accreditation statement awarded to individual participants -documentation of the verbal provision of required disclosures Records of attendance; summative evaluation(s); & contact hours will be maintained in a retrievable file which is accessible to only authorized personnel for six (6) years. Records will be maintained confidentially. Records will be filed and stored at (list location) Other - Describe 3. Applicant must describe the record keeping and storage system, including retention of records, confidentiality, filing, storage, and retrieval of records. A provider must establish and maintain a record storage system that assures secure confidentiality and easy retrieval of records by authorized individuals. Records must be kept for six years and are available only to authorized individuals. NOTE: A provider is able to determine within its own setting how confidential records are maintained and handled and which personnel have access to the records. Mechanisms should be in place for systematic, easy retrieval of information by authorized individuals. PROVIDER-DIRECTED CRITERIA page 9

10 Additional Instructions for Provider-Directed Activity Specifically for APRN with Prescriptive Authority The target audience must be designed specifically for the Advanced Practice Registered Nurse with Prescriptive Authority. Other RNs can attend and receive the normal continuing nursing education contact hours, but only APRNs with prescriptive authority can receive the continuing nursing education contact hours specifically designated for APRN with prescriptive authority. Keep the following in mind: 1. Check the APRN with Prescriptive Authority category (page ). 2. The planning committee for this activity must include at least one APRN who has prescriptive authority. 3. Develop the objectives (page 10 or 11) at the Analysis, Synthesis and Evaluation levels (#4, 5, 6 in Bloom s Taxonomy). All objectives must be at these levels. 4. Ensure that the certificate (sample, page 13) reflects the awarding of APRN continuing nursing education contact hours. The following guidelines for providing these activities were established collaboratively by the Louisiana State Board of Nursing and the Louisiana State Nurses Association. The educational activity must include content relevant to advanced practice nursing and the use of pharmacological agents in the prevention of illness, and the restoration and maintenance of health. The following guidelines should be followed. 1. Target Audience The target audience must be identified as an APRN with prescriptive authority. Some activities will be specific for an APRN in a specific practice setting while others may be appropriate for several areas of practice. Any Registered Nurse (RN) who successfully completes an offering will be awarded contact hours. 2. Objectives and Content Program objectives and content must be relevant to the practice of the APRN with prescriptive authority. The objectives, content, and learning experiences must enhance the knowledge, attitudes, and skills of the APRN regarding pharmacotherapeutics at a level above that required for initial certification. The content must go beyond the basic level of the APRN. Objectives and content for pharmacotherapeutics should focus on new developments, therapies, and/or research in the APRN s area of specialization and identify the relationship to prescriptive authority. Other content may be directed toward outcomes in prevention of illnesses, and/or restoration and maintenance of health. 3. Planning Committee The planning committee for a continuing nursing education activity directed toward APRNs with prescriptive authority should include at least one APRN with prescriptive authority. Physicians and pharmacists may also have input into the planning process. PROVIDER-DIRECTED CRITERIA page 10

11 4. Presenters Presenters must have appropriate experience and education to teach advanced pharmacotherapeutics. Pharmacists, medical doctors, APRNs, or other professionals prepared at a masters or doctoral level may serve as faculty. 5. Certificates of Attendance The number of advanced pharmacotherapeutic contact hours must be indicated on the certificate of successful completion. Appropriate Provider information, as required by ANCC and LSBN, must also be included on the certificate. The provider must place the name of the APRN receiving the contact hours on the certificate. Adopted by LSBN October, 2001 PROVIDER-DIRECTED CRITERIA page 11

12 ATTACHMENT A (9/09) Biographical Data Form Louisiana State Nurses Association Biographical Data Form (2009 Criteria) Instructions: If you are a planner for this activity, complete Sections 1, 2, 4, 5 & 8. If you are a speaker/ content expert for this activity, complete Sections 1, 3, 4, 5, 6, 7 & 8. Return this form to the nurse planner by the date specified. If there is a perceived conflict, the nurse planner will discuss with you how the conflict will be resolved before your continued participation in this learning activity. Section 1: (Planner and/or Speaker) Demographic Data Name, Degrees & Credentials: Date: If RN, nursing degree(s): AD Diploma BSN Masters Doctorate Home Address OR Business Address: Day Telephone: Address: Present Position (Title) & Employer: Section 2: (Planner Information): Describe your familiarity/expertise with the following: I am knowledgeable about the nursing CNE process through: (Describe): Section 3: (Speaker Information): Faculty/Content Expert Information: Describe your expertise in this topic: I represent the target audience by: (Describe): I have content expertise in this topic by: (Describe): Other: (Describe): Planner, Faculty and Content Specialist Conflict of Interest Statement If you are in a position to control the content of this educational activity (planner, faculty, content specialist), you must disclose whether or not you have a conflict of interest. Conflict of interest disclosure identifies the presence or absence of any potentially biasing relationship of a financial, professional or personal nature. A perceived conflict of interest would occur, for example, if you have or a member of your family has, within the past 12 months, received a salary, royalty, speaking honorarium, research appointment, board of directors remuneration, or consulting fee from an organization whose product or service is being discussed in the learning activity or if you or a family member own stock in such a company. Conflict of interest would also occur if you have any potential to benefit personally or professionally from the presentation PROVIDER-DIRECTED CRITERIA page 12

13 (work for a proprietary company presenting the learning activity, have written a book about the topic, provide consulting services related to the topic, etc.) All information disclosed must be shared with the audience on the program handouts, advertising and/or audiovisual presentation. Section 4: (Planner and/or Speaker) Conflict of Interest Is there a perceived financial, professional or personal conflict of interest (self or family)? Yes No If yes, describe the perceived conflict: Section 5: (Planners and/or Speaker) Resolution of Conflict Procedures used to resolve conflict of interest or potential bias if applicable for this activity: (Check all that apply) 1. I have discussed this conflict with the nurse planner and agree to the provider unit s policy. 2. I have signed a statement that says I will present information fairly & without bias. 3. In conjunction with 1 & 2, I understand that the nurse planner or designee will monitor session to ensure conflict does not arise. 4. Not applicable since no conflict of interest. 5. Other: Describe: Section 6: (Speaker) Off-label Use Presenter/Content Specialist discussion of off-labeled uses: Yes No If yes, you must disclose this information during your presentation. How will you do this? 1. Verbal statement during the presentation 2. Information provided on handouts 3. Information provided in audiovisuals (slides, overhead, etc.) 4. Other: Describe: Section 7: (Speaker) In regard to the above requirements, please check one of the following: My presentation(s) will not refer to products, drugs or devices of a commercial company with which I have a significant relationship. I have not accepted a fee from a commercial company for this presentation. I have a significant relationship with the following commercial company(s) whose product(s) I will refer to in my presentation. I will disclose my relationship with the commercial company to the participants during the introduction of my session. I will refer to other products equally in my presentation. I have not accepted any fees from a commercial company for this presentation. List company(s): Section 8: (Planner and/or Speaker) Signature Date: Electronic Signature acceptable An authentic signature must be provided. A faxed copy with the signature or a computerized generated signature is acceptable. A typed name is NOT acceptable. PROVIDER-DIRECTED CRITERIA page 13

14 ATTACHMENT B1 Education Activity Content Outline Louisiana State Nurses Association EDUCATIONAL ACTIVITY CONTENT OUTLINE Title of activity: EDUCATIONAL OBJECTIVES List the learner s objectives in behavioral terms. At the end of this activity, the learner will be able to... CONTENT (Topics) Provide an outline of the content for each objective. Must be more than a restatement of the objective. Number each content area with corresponding objective. TIME FRAME State the time frame (in minutes) for each objective. PRESENTER List the faculty for each objective. TEACHING METHODS Describe the teaching strategies i.e. materials, delivery methods, resources, and learner feedback. PROVIDER-DIRECTED CRITERIA page 14

15 ATTACHMENT B2 Education Activity Content Outline SAMPLE Louisiana State Nurses Association Title of activity: EDUCATIONAL ACTIVITY CONTENT OUTLINE SAMPLE EDUCATIONAL OBJECTIVES CONTENT (Topics) TIME FRAME PRESENTER TEACHING METHODS List the learner s objectives in behavioral terms. At the end of this activity, the learner will be able to... Provide an outline of the content for each objective. Must be more than a restatement of the objective. Number each content area with corresponding objective. State the time frame (in minutes) for each objective. List the faculty for each objective. Describe the teaching strategies i.e. materials, delivery methods, resources, and learner feedback. 1. Analyze six case studies for 1. Case studies potential abuse situations. A. Types of abuse 1. Elder abuse 2. Child abuse 3. Adult abuse B. Clues C. Interventions D. Legal Issues E. Resources for help 40 minutes Clara Burton, MSN, RN Slide presentation Handouts Small group discussion Analyze case studies Lecture Discussion PROVIDER-DIRECTED CRITERIA page 15

16 ATTACHMENT C Evaluation Form Sample Louisiana State Nurses Association Evaluation Form Name of Organization Providing Program Name of the Program Faculty and Program Evaluation Date (Example: Tuesday, June 18, 2009) Place, City, State Presentation: Name of Presentation 1 Rate your achievement of each objective After completing this session, I am able to: 4 Excellent 3 good 2 Fair 1 Poor 0 NA 1. List the objectives in this section 2 3 Comments: Presenter: Name and Credentials of Presenter 1 (Rate the Presenter s:) Knowledge of content Presentation skills Organization of content Comments: Presentation: Name of Presentation 2 Rate your achievement of each objective After completing this session, I am able to: 1. List the objectives in this section Comments: Presenter: Name and Credentials of Presenter 2 (Rate the Presenter s:) Knowledge of content Presentation skills Organization of content Comments: PROVIDER-DIRECTED CRITERIA page 16

17 Overall Program Evaluation Rate your component of this activity To what degree did this educational activity meet your expectations. 2. Rate the value of handout content. 3. How well were program objectives defined? 4. Was the room conducive to learning? 5. To what degree did this activity: Meet your needs Increase your knowledge Change a skill or attitude Change your practice performance Improve your customer service/quality of service 1. How do you plan to implement or utilize this change (from questions 5 above) 2. Conflicts of interest or lack thereof were disclosed in writing or verbally by the planners and/or faculty. Yes No 3. General comments: PROVIDER-DIRECTED CRITERIA page 17

18 ATTACHMENT D Sample Certificate Louisiana State Nurses Association Name of Organization Offering Program Address of Program City, State Phone: (xxx) xxx-xxxx Participant s Name Has successfully completed Name of Program Provider-Directed Activity Location Held City, State Date This provider-directed continuing nursing education activity is approved for contact hours by LSNA. Louisiana State Nurses Association (LSNA) is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center s COA. Signature of Nurse Planer/Planning Committee Member PROVIDER-DIRECTED CRITERIA page 18

19 ATTACHMENT E Standards for Disclosure and Commercial Support Louisiana State Nurses Association Permission to copy has been granted by MaryMoon Allison, BSN, RN, MHSE, CAE Director, Accreditation Program American Nurses Credentialing Center 8515 Georgia Avenue, Suite 400 Silver Spring, MD August 18, 2009 Application Manual Accreditation Program (2009). American Nurses Credentialing Center. Silver Spring, MD. (pp ) Appendix B STANDARDS FOR DISCLOSURE AND COMMERCIAL SUPPORT These Standards have been adapted from the Accreditation Council for Continuing Medical Education (ACCME), which articulates its policies for disclosure and commercial support in: (1) The Standards For Commercial Support: Standards to Ensure Independence in CME Activities, as adopted by ACCME in September 2004; and (2) ACCME policies applicable to commercial support and disclosure. STANDARD 1: INDEPENDENCE 1.1 An entity has a commercial interest if it is: 1. An entity that produces, markets, sells or distributes health care goods or services consumed by, or used on, patients; OR 2. An entity that is owned or controlled, in whole or in part, by an entity that produces, markets, sells, or distributes health care goods or services consumed by, or used on, patients. An entity is NOT a commercial interest if it is: 1. A government entity; 2. A non-profit (503 ) organization; 3. A non-health care related entity This definition permits an accredited [approved] provider to be owned by an entity that is not a commercial interest. It also allows a provider to have a sister company or parent company that is a commercial interest, as long as the accredited provider has and maintains adequate corporate firewalls to prohibit any influence or control by the sister or parent company over the continuing education program of the accredited provider. In this case, ANCC would expect that the accredited provider would have an adequate corporate firewall in place to prohibit any influence or control by the sister company over the continuing education program. ANCC does not consider providers of clinical service directly to patients to be commercial interests. 1.2 A continuing nursing education provider must ensure that the following decisions were made free from the control of a commercial interest: (a) identification of continuing nursing education needs, (b) determination of educational objectives, (c) selection and presentation of content, (d) selection of all persons and organizations that will be in a position to control the content of the continuing nursing education, PROVIDER-DIRECTED CRITERIA page 19

20 (e) selection of educational methods, and (f) evaluation of the activity. 1.3 An entity with a commercial interest cannot take the role of non-accredited partner in a co-provider relationship. STANDARD 2: RESOLUTION OF PERSONAL CONFLICTS OF INTEREST 2.1 An individual must disclose any financial relationships with an entity with a commercial interest (See STANDARD 1). 2.2 The provider must be able to show that each individual who is in a position to control the content of an education activity has disclosed all financial relationships with any entity with a commercial interest in the provider. ANCC defines financial relationships as those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options, or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial relationships can also include contracted research where the institution gets the grant and manages the funds and the individual is the principal or named investigator on the grant. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking, and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received or expected. ANCC considers relationships of the person involved in the continuing nursing education activity to include financial relationships of a spouse/partner. Financial relationships must be disclosed to the learners during the time when the relationship is in effect and for 12 months afterward. With respect to personal financial relationships, contracted research includes research funding where the institution gets the grant and manages the funds and the person is the principal or named investigator on the grant. ANCC considers financial relationships in any amount occurring within the past 12 months as relevant in terms of creating a conflict of interest. 2.3 An individual who refuses to disclose financial relationships will be disqualified from being a planning committee member, a teacher, or an author of continuing nursing education and cannot have control, or responsibility for, the development, management, presentation, or evaluation of the CNE activity. 2.4 The provider must have implemented a mechanism to identify and resolve all conflicts of interest prior to the education activity being delivered to learners. 2.5 ANCC considers a conflict of interest to exist when an individual has an opportunity to affect continuing nursing education content in relation to a commercial interest with which he/she has a financial relationship. ANCC considers opportunity to affect continuing nursing education content to include content about specific agents/devices, but not necessarily about the class of agents/devices, and not necessarily content about the whole disease class in which those agents/devices are used. With respect to financial relationships with commercial interest, when a person divests himself/herself of a relationship, it is immediately not relevant to conflicts of interest but it must be disclosed to the learners for 12 months. STANDARD 3: APPROPRIATE USE OF COMMERCIAL SUPPORT PROVIDER-DIRECTED CRITERIA page 20

21 3.1 The provider must make all decisions regarding the disposition and disbursement of commercial support. ANCC defines commercial support as financial, or in-kind, contributions given by a commercial interest, which is used to pay all or part of the costs of a continuing nursing education activity. ANCC does not consider providers of clinical service directly to patients to be commercial interests. For the purposes of eligibility, ANCC considers the following types of organizations eligible for accreditation and free to control the content of continuing nursing education (Standard 1): Liability insurance providers Health insurance providers Group medical practices Acute care hospitals (for-profit and not-for-profit) For-profit rehabilitation centers For-profit nursing homes Universities with nursing development and continuing nursing education programs Specialty Nursing Organizations Constituent Member Associations Federal Nursing Services National nurses organizations based outside the United States A single-focused organization devoted1 to offering continuing nursing education 1 The single-focused organization exists for the single purpose of providing education. 3.2 A provider cannot be required by an entity with a commercial interest to accept advice or services concerning teachers, authors, or other education matters, including content, from the entity as conditions of contributing funds or services. 3.3 All commercial support associated with a continuing nursing education activity must be given with the full knowledge and approval of the provider. Written Agreement Documenting Terms of Support 3.4 The terms, conditions, and purposes of the commercial support must be documented in a written agreement with the entity that includes the provider and its educational partner(s). The agreement must include the provider, even if the support is given directly to the provider s educational partner or a co-provider. 3.5 The written agreement must specify the entity that is the source of commercial support. 3.6 Both the entity and the provider must sign the written agreement regarding the support to be provided/accepted. Expenditures for an individual providing continuing nursing education 3.7 The provider must have written policies and procedures governing honoraria and reimbursement of out-ofpocket expenses for planners, teachers, and authors. 3.8 The provider, the co-provider, or designated educational partner must directly pay any teacher or author honoraria or reimbursement of out-of-pocket expenses in compliance with the provider s written policies and procedures. 3.9 No other payment shall be given to the director of the activity, planning committee members, teachers, or authors, co-provider, or any others involved with the supported activity. PROVIDER-DIRECTED CRITERIA page 21

22 3.10 If teachers or authors are listed on the agenda as facilitating or conducting a presentation or session, but participate in the remainder of an educational event as a learner, their expenses can be reimbursed and honoraria can be paid for their teacher or author role only. Expenditures for Learners 3.11 Social events or meals at continuing nursing education activities cannot compete with, or take precedence over, the educational events The provider may not use commercial support to pay for travel, lodging, honoraria, or personal expenses for non-teacher or non-author participants of a continuing nursing education activity. The provider may use commercial support to pay for travel, lodging, honoraria, or personal expenses for bona fide employees and volunteers of the provider, co-provider or educational partner. This element applies only to nurses whose official residence is in the United States. Accountability 3.13 The provider must be able to produce accurate documentation detailing the receipt and expenditure of commercial support. STANDARD 4. APPROPRIATE MANAGEMENT OF ASSOCIATED COMMERCIAL PROMOTION Commercial exhibits and advertisements are promotional activities and not continuing nursing education. Therefore, monies paid by commercial interests to providers for these promotional activities are not considered commercial support. However, accredited providers are expected to fulfill the requirements of Standard 4, and to use sound fiscal and business practices with respect to promotional activities. 4.1 Arrangements for commercial exhibits or advertisements cannot influence planning or interfere with the presentation, nor can they be a condition of the provision of commercial support for continuing education activities. 4.2 Product-promotion material or product-specific advertisement of any type is prohibited in or during continuing nursing education activities. The juxtaposition of editorial and advertising material on the same products on subjects must be avoided. Live (staffed exhibits, presentations) or enduring (printed or electronic advertisements) promotional activities must be kept separate from continuing nursing education. Print, advertisements and promotional materials shall not be interleafed within the pages of the continuing nursing education content. Advertisements and promotional materials may face the first or last pages of printed CNE content as long as these materials are not related to the continuing nursing education content they face and are not paid for by the entities with commercial interests in the continuing nursing education activity. Computer-based, advertisements and promotional materials shall not be visible on the screen at the same time as the continuing nursing education content and shall not be interleafed between computer windows or screens of the continuing nursing education content. Audio and video recording, advertisements and promotional materials shall not be included within the continuing nursing education. There will be no commercial breaks. Live face-to-face continuing nursing education, advertisements and promotional materials shall not be displayed or distributed in the educational space immediately before, during, or after a continuing nursing education activity. Providers shall not allow representatives of an entity with commercial interests to engage in sales or promotional activities while in the space or place of the continuing nursing education activity. 4.3 Educational materials that are part of a continuing nursing education activity, such as slides, abstracts, and handouts, shall not contain any advertising, trade name, or a product-group message. PROVIDER-DIRECTED CRITERIA page 22