N4223-Wk 3 Assignment Peer Review 2021-1 PDF

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N4223 Professional Trends

Week 3 Reflection Assignment – Peer Review Date:

9/12/2021

Overview: Peer Review In this Reflection Assignment, reflect upon what you have learned about the Minor Incident Rule and Peer Review Committee processes as you consider the actions of fictitious nurses and committee members in scenarios. USE THE TEXAS BOARD OF NURSING RULES and link to the Texas BON Rule 217.16. Refer to your course readings and lectures as you complete the assignment. Performance Objectives:  Differentiate between the the Minor Incident Rule (217.16 a) vs. a Reportable Incident 217.16 h)  Describe the due process protections (Rule 217.19) for a nurse who is peer-reviewed. Rubric T a s k

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Part 1: Applying Rule 217.16 Minor Incident (217.16 a) vs. a Reportable incident (217.16 h): A minor incident - 217.16(a) – a nurses’ actions may be a violation of a board rule, but does not indicate the nurses continued practice poses a risk of harm to a patient or another person. A reportable incident is- 217.16(h) - conduct that falls outside of the definition of a minor incident and must be reported to a Peer Review Committee or the BON.

N4223 2021

N4223 Professional Trends Let’s come up with an easy way to remember what a minor incident is. If you are ever in this situation or are participating on a peer review committee evaluating a fellow nurse’s actions, think about the word “harp.”    

H- no significant Harm A- nurse must take Accountability R- easily Remediated P- no Pattern of this behavior

Minor incidents must still be documented, tracked, and remedied. The nurse must be reported to the nursing Peer Review committee if a nurse commits five (5) minor incidents within a 12-month period. Look at this case study scenario below. “The Nurse is caring for a newly admitted 67-year-old male patient with infectious endocarditis due to a bacterial infection of his prosthetic heart valve. After blood cultures come back positive for staphylococcus aureus, IV Vancomycin is ordered. The patient tells the Nurse and the doctor that the last time he got this medication, he experienced hives and hot, itchy skin but he was not allergic to it. The doctor ordered the medication to be infused slowly as to avoid Red Man Syndrome (500 mg IV bag at a rate of two hours as opposed to the standard one hour). The Nurse sets the IV pump incorrectly, and the infusion is given within a 30-minute period. The patient experiences an allergic reaction. The Nurse calls the doctor and immediately gives 50 mg diphenhydramine and ranitidine 50 mg via IV with orders. The patient experienced mild flushing, but the episode resolved within 20 minutes. The Nurse is a wellseasoned nurse with over 20 years of experience and no prior history of incidents who took immediate responsibility for this error when meeting with the unit manager. As to remediation, the Nurse will now need another RN to witness and sign when she administers IV medication for the next 60 days. The Nurse agrees to this plan." Using the Texas BON Rule 217.16, review (a) a Minor Incident vs. (h) a reportable incident. This information can be found at https://www.bon.texas.gov/rr_current/217-16.asp Based on your assessment of the criteria, was this a Minor Incident or reportable event? Why or Why not? Write professionally written sentences with examples from the Rule to support your thoughts for full credit in the box below.

Minor or Reportable? This scenario is a minor incident which according to the BON Rule 217.16 is not reportable at this time. Why? Why not? Include examples from the Rule. According to the BON Rule 217.16 the situation falls under the minor incident due to the following: the nurse in the scenario showed a deficit in judgement that contributed to the error. Secondly, a remediation plan was implemented by the hospital and accepted by the nurse. Lastly, the Nurse has no prior history of incidents which indicates that the nurse does not necessarily possess a risk of harm to the patients.

Part 2: Applying Rule 217.19 Incident-Based Peer Review

N4223 2021

N4223 Professional Trends

First, review Incident-Based Peer Review. The purpose of an IBPR is to determine whether a nurse should be reported to the Texas Board of Nursing (BON) for professional misconduct or licensure violations based on one or more such events. Use the link provided to review: https://www.bon.texas.gov/rr_current/217-19.asp. Apply the information to this case study. "The Nurse is charting at the nurse’s station where there are co-workers, physicians and a unit secretary gathered. The Nurse and the nurse manager have not been seeing eye to eye lately (verbal altercations both in the halls and in the cafeteria recently). The nurse manager approaches the Nurse and loudly states, “I am glad you are here. Just to let you know, the Incident Based Peer Review Committee is meeting tomorrow, and we are investigating your recent questionable behavior. I know you have made many recent medication errors and safety violations noted by the Patient Safety Committee. I also heard that you are dating that patient who was in Room 256B last month. I thought you would want to know this was happening. You could be in big trouble and probably fired. I don’t have anything official to give you, but you better find a lawyer, although I doubt you can with this short notice.” How did this nurse manager violate the IBPR? Refer to the Rule listed below and discuss in the text box. Rule 219.17 a (2) Bad Faith - knowingly or recklessly acting without the supported of reasonable or legal basis, misrepresenting the facts surrounding the facts under review, acting out of malice or personal animosity towards the nurse, acting from a conflict of interest, or knowingly or recklessly denying due process. How did this nurse manager violate the IBPR based on this rule? Please write professionally written sentences with examples from the Rule to support your thoughts for full credit in the box below. In this scenario the manager violated the IBPR by acting out of malice and from a conflict of interest towards the nurse according to the Rule 219.17 a (2). The manager clearly decided to announce the Peer Review in front of other colleagues to possibly humiliate the nurse and/or demonstrate power. Lastly, according to the rule 219.17 ( C ) the nurse needs to be provided an official written notice stating why she/he is being evaluated and copies of the rules and facility policies and procedure plans to which the manager failed to do as she stated she had “ nothing official to give”.

N4223 2021...