Justice with Dignity Alternative to Discipline for Nurses with Practice Errors

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1 Justice with Dignity Alternative to Discipline for Nurses with Practice Errors Early Remediation ER (ER) Program Washington State NCQAC Practice Intervention and Improvement Program (PIIP) Ohio BON

2 Learner will be able to: o List 3 goals of Alternative to Discipline for Practice Error programs o Identify 3 eligibility requirements for Alternative to Discipline for Practice Error programs

3 Washington ER Program Goals o Patient safety through timely education & oversight o Quick resolution without disciplinary action o Cost savings for the Nursing Commission ER Program established in Nursing Rules o WAC to Goals Ohio PIIP Program o Provides for public protection o Non-disciplinary process for licensee in appropriate cases o Provides documentation of regulatory intervention for licensees with defined practice deficiency(s) o Section , ORC Chapter , OAC

4 Recognizes that public protection is paramount Recognizes that Just Culture analysis can be applied to cases of practice concerns Recognizes that threat of disciplinary action does NOT prevent individuals from making errors Shifts focus toward improving practice and professional responsibility

5 Washington ER Program Continued practice does NOT pose a threat to patient safety Alleged conduct results in no or minimal harm Alleged conduct involves: o Clinical practice deficiency(ies) that may be corrected through education, monitoring and/or practicum participation not to exceed 6 months o Issues of substandard care Ohio PIIP Program Entering PIIP will provide adequate public protection Likelihood that practice deficiency can be corrected through PIIP/Cooperation with investigation Consider degree of harm or potential harm or untoward outcome for patient, and vulnerability of patient Consider frequency of practice deficiency/intentional or willful

6 Washington ER Program Alleged Conduct does NOT involve: o Willful misconduct or other unprofessional conduct Substance abuse or drug diversion Patient abuse or neglect Fraud, theft, deceit Ohio PIIP Program Impairment Under current investigation for non-practice deficiency violation Prior Board disciplinary action, unless Board Supervising Member determines prior action should not preclude PIIP Licensee is not working in Ohio in nursing licensed position at time of eligibility determination

7 Substandard nursing practice Failure to properly conduct a patient assessment, document treatment or administer medications Failure to comply with scope of practice requirements Failure to comply with delegation laws & regulations

8 Washington ER Program Determine ER Program eligibility Perform preliminary investigation Refusal in ER Program results in full investigation NCQAC ER Panel develops and monitors action plan Course must be approved prior to enrollment to ensure meeting criteria Ohio PIIP Program Complaint received with TERCAP and records Initial screen for PIIP eligibility Assigned to a investigator to review records and interview respondent Review with Board Supv Mbr, determines education content Offer PIIP

9 Reviewed by Panel and staff o Complaint ER Team 3 Commission Members Case manager Legal staff Investigator Forward case to Nurse Consultant Contact Respondent Refer back to Panel o 3 Commission Member panel to make final decision on entry into program Create Action plan Usually entails approved course work

10 Program started in total cases to date o 51 cases were returned for investigation o 47 cases closed without ER action No one that has successfully completed ER program has been disciplined subsequently

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13 Ohio Factors: v Mandatory reporting state (Section , ORC) v Law authorizes Board to issue warning letters for minor violations (Section , ORC) v Immunity granted to entity that provides services related to remediation under PIIP (Section , ORC) v Implemented May 2001 v Authorized in statute v Operated by Rule

14 Licensee and practice deficiency information reviewed with Board Supervising Member Determines PIIP appropriateness Determines education to be completed Letter to licensee inquiring about PIIP interest Licensee accepts, schedule meeting PIIP and Agreement review Generally standardized establishes time frame for type and amount of education Minimum one year of workplace monitoring Complete communication waivers Requires submission of reports

15 PIIP Referrals: 400 Active, 22 Adv Letter, 29 Terminated, 47 Pending Entry, 5 New complaint, 4 No violation, 1 Entered/ completed, 163 Declined/no response, 49 Ineligible, 80

16 Practice Deficiencies Medications/MAR Failure to Assess/ Intervene Exceeded Scope Documentation Skill/Knowledge

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18 Margaret Holm, JD, RN, Nurse Practice Consultant Washington State NCQAC Lisa Emrich, MSN, RN, Program Manager for Practice and Education Ohio BON