Karla Bitz, PhD, RN, FRE

North Dakota Board of Nursing

WHAT IS PBR @ NDBON?

OBJECTIVE

Provide an overview of the

implementation process used by the NDBON to incorporate the elements of TERCAP into its investigative process

Patient

Boards of Nursing

InvestigatorsResearch

Enhance the effectiveness of the investigative process

Consistent, standardized, and comprehensive data collection

Track case elements and recurring themes

WHY DO IT? (cont’d)

Discover characteristics of nurses at risk

Provide continuity in investigations Increase competence in addressing

Practice Breakdown Better understand why errors occur

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 Board’s files are subject to ND Open

Record Law Individual identifiers are not included Analyze aggregate data

2006 – Strategic Plan 2007 – Implemented TERCAP !

INTERNAL OPERATIONS

Potential Violation Report Response Form Investigative Case Interview Investigative Case Summary Disciplinary Review Panel Discipline Statistics

LESSONS LEARNED Commitment Shifts focus from name,

shame, and blame Culture Change - will take time Don’t have to recreate the

process

LESSONS LEARNED (cont’d)

Opportunity for comprehensive review of investigative process

HELP is available, Use it! TERCAP Committee NCSBN staff Protocol Webinars

JUST TRY IT!

Kathy Chastain, RN, MSNCarol Walker, RN, MS

TERCAP IMPLEMENTATION:North Carolina BON ProcessTERCAP IMPLEMENTATION:North Carolina BON Process

Project ValueProject Value

Patient safety Nursing education Nursing regulation Advancement of nursing profession Research for Healthcare Community NCBON

Project ChallengesProject Challenges

Harness magnitude of project Relevance to expanse of practice User friendly for 50+ BONs Board staff acceptance

NCBON Staff AcceptanceNCBON Staff Acceptance

Value to each Investigator Incorporate into current process

- Current system flaws identified

Needed Facilitator CharacteristicsNeeded Facilitator Characteristics

Perceive project value Energy Enthusiasm Commitment Perseverance Endurance Creativity

Needed Facilitator CharacteristicsNeeded Facilitator Characteristics

Maintain vision Patience Accept little immediate satisfaction Appreciate each step in process

NCBON Current Investigation ProcessNCBON Current Investigation Process

No Investigation tool Inconsistent documentation format New computer documentation

system

Feb 07 TERCAP Data EntryFeb 07 TERCAP Data Entry

Realization:

*Resistance to additional change

*TERCAP History

Decision: Restrict staff entering data

Problem: Case selection/skewed data

TERCAP Data EntryTERCAP Data Entry

Realization: Data scattered Data not obtained

Resolution: Developed paper tool*Increased data collection*Centralized collected data

Problem: Remember to use

TERCAP Data EntryTERCAP Data Entry

Realization:

*Additional time needed to enter data

Resolution:

*Incorporate into case

documentation process

TERCAP Data EntryTERCAP Data Entry

Realization:

Need to revise internal Inquiry/

Investigation documentation

Resolution:

Opportunity to initiate uniform documentation

TERCAP is NOT a

Short Term Project!!