THE PEER REVIEW PROCESS FOR SCHOOL

NURSES

It’s the law (TOC 303)

Creates a better environmentIncreases options for addressing

errorsProvides alternate reporting

options

Can help identify system problems

What is the Role of Peer Review?

Advise as to nurse’s duty – Safe harbor NPR

Determine accountability - incident based NPR

Evaluate nurse’s ability to practice competently – minor incident NPR

Alternate reporting option for nurses

Identify system errors (secondary)

Who is responsible for implementing peer review?

A facility or ISD that employs 10 or more LVNs OR 10 or more nurses with at least 5 being RNs

CNO/Superintendent

Incident Based Peer ReviewThe incident based NPR process is

one of fact finding, analysis and study of events by nurses in a climate of collegial problem solving focused on obtaining all relevant information about an event.

Is it reportable conduct? Is the nurse responsible? Possible report and make recommendations to the BON.

IBPR ProcessDue process for the nurseTimelines

Notification to nurse being reviewed

Hearing ..between 21 and 45 days

Findings ..not > 14 days

Rebuttal..10 days

Confidentiality If possible at least one nurse on the

committee must have a working familiarity with the area of practice in which the reviewed nurse practices

IBPR Process cont’d

Mitigating Circumstances

Chemical dependency or substance abuse

Mental instability

TPAPN 1-800-288-5528

IBPR Process cont’d

Hearing Review evidence submitted

Listen to testimony

Persons with administrative responsibility over the nurse

are excluded from PRC, including attendance at the hearing

IBPR Process cont’dFindings

Is the conduct reportable to the BON?

Is the conduct a minor incident?

Does the nurse’s continued practice pose a risk of harm?

Are there 5 or more minor incidents in a 12 month period?

Reportable conduct to the BONViolate “duty to a patient”Unprofessional conductCriminal conductDeath of patient5 or more minor incidents in a 12 month period

Recommendations/ReportMinor incident

Recommendations to ISD…remediation, monitoring

Exclusions Death of patient

Criminal Conduct... assault, sexual assault, kidnapping, burglary, murder

Unprofessional Conduct…fraud, theft, patient abuse/exploitation, unsafe practice

IBPR Process cont’dIf NPR finds the reviewed nurse did not engage in

conduct subject to reporting , a committee member may not report the nurse to the BON anyway if the member’s sole source of information is from being on the committee

NPR committee must consider whether a system error might have been a contributing factor in evaluating the nurse’s conduct…nurse can only be held accountable for conduct that was a result of a deficiency in nurse’s judgment, knowledge, training or skills

Safe Harbor Peer Review Protections provided to the

nurse

The right to request PRC determination of whether conduct or assignment violated the nurse’s duty to a patient

Safe Harbor Peer Review cont’d

Protection from being disciplined by the facility for making the request

Protection from being disciplined by the BON for engaging in the conduct while awaiting the PRC decision

SHPR cont’dProcess to invoke Safe Harbor

Collaboration with Supervisor

Engage vs Refuse refusal based two reasons only:

unprofessional or criminal conduct

nurses lack of basic knowledge ..engaging would pose risk of

harm Good Faith

SHPR Process cont’d

Quick Request form (www.bon.state.tx.us)

Before engaging in conduct

Give to supervisor

Any written form/format is acceptable to initiate request for Safe harbor

SHPR Process cont’d

Comprehensive Request Form (www.bon.state.tx.us)

Must use BON form

Before leaving at end of day

Give to supervisor

Supervisor/CNO responsible to file with Peer Review Committee ASAP

SHPR Process cont’d

Exemptions from Safe Harbor

Unprofessional Conduct

Fraud, theft, abuse

SHPR Process cont’dOutcomes/Resolution

Review must be completed and CNO notified of findings within 14 days of request

Within 48 hours of receiving PRC decision, CNO must notify nurse of findings and whether administrator believes in good faith that findings are correct or incorrect

SHPR Process cont’d

Nurse’s protection from the BON expires 48 hours after nurse is notified of findings

The school nurses role in the PR process

Be familiar with: NPA(TOC) 301.352TAC 217.11, Standards of PracticeTAC 217.12, Unprofessional ConductTAC 217.16, Minor IncidentTAC 217.19, Reportable conductTAC 217.20, Safe Harbor BON Six Step Decision Making Model for Scope of Practice

What is the BON’s responsibility?

To protect the public from unsafe nurses

To investigate the allegation

To determine accountability of the nurse

To determine disciplinary actions if violation occurred

Process For Establishing A Peer Review Committee

Who are you going to serve?One regionMultiple regions RNs, LVNs

Determine composition of PRC 3/4, 2/3 Nurse familiar with practice setting

Determine logistics of meeting placeCentral to area served?Site of chair?

Process For Establishing A Peer Review Committee

Develop operational guidelines that align with your regional bylaws/elections

Process For Establishing A Peer Review Committee

Create a Peer Review Document that outlines the process

Hint… TNA’s ABC’s of Peer Review

Process For Establishing A Peer Review Committee

Create Letters

Introduction Agreement (yearly, open ended) Confidentiality

Process For Establishing A Peer Review Committee

Send Letters of Introduction and Agreement to Superintendents

Region esc websiteSend Peer Review Document to those who return letter of agreement

Chairperson maintains list of participating ISDs

Records Maintenance systemSealed with case # Retain for 10 yrs

___________________________ISD designates Texas School Nurse Organization, Region IV, Peer Review Committee, as agent for purposes of The Nursing Practice Act for the State of Texas. As agent, TSNO Region IV and the school district can exchange information without breach of confidentiality.

The committee will fulfill all obligations described in the Peer Review Document . In general it will:

Receive a report from a school district employee for assessment of nursing practice.

Make a recommendation about nursing practice to the ISD.Maintain confidentialityThe school district will:Publicize plan to school nurses and administrators.Authorize a designated administrator to receive reports.File a report with the Board of Nurse Examiners, if

necessary.Maintain confidentialityThis agreement will automatically renew every year unless

the school district notifies the Peer Review Chairman in writing that they are opting out of the program.

Peer Review Letter of Agreement

The Texas School Nurse Organization, Region IV(TSNO), maintains a Peer Review Committee to answer the Legislative mandate for peer review. It is a collective interdistrict peer review committee for the 56 ISD’s in Region IV. While the guidelines for the law specify that an employing agency with 10 or more nurses must establish a peer review system, we welcome all school districts’ participation regardless of number of nurses employed. TSNO, Region IV, is the local school nurses’ association with the identical geographic territory of the Region IV Education Service Center. It is also the local chapter of the state organization.

Reasons for school districts in Region IV to come together for the peer review process include:

Each district will not have to set up a separate committee, therefore it will be less time consuming for a school district and their employees.

TSNO, Region IV members are familiar with school nursing practice.TSNO, Region IV will support and assist school nurses. TSNO, Region IV requests that each participating district accept the

following:If necessary, allow release time for an RN serving on the

committee.Meetings are RARELY held during school hours. Agree to abide by the requirements of the law for confidentiality.Provide cooperation to the committee and access to records for any

RN/LVN employee referred for “review”.Refer to one of the following if you have any questions, input, or

concerns:www.bon.state.tx.us (Board of Nurse Examiners)

Letter of Introduction

Resources BON Peer Review FAQs BON Protecting Your Patients and Your Practice BON Six Step Decision Making Model TNA ABCs of Nursing Peer Review Melinda Hester, RN, DNP(BON) Nancy Roper-Willson, RN, JD, MSN, MA, (Attorney

at Law) www.tea.state.tx.us (superintendent list) www.bon.state.tx.us www.texasnurses.org Dmorin822@gmail.com

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