22 Tex. Admin. Code § 217.16 - Minor Incidents
(a) Definition. A
"minor incident", as defined under the Texas Nursing Practice Act, Texas
Occupations Code §
301.401(2),
means conduct by a nurse that may be a violation of the Texas Nursing Practice
Act or a Board rule but does not indicate the nurse's continued practice poses
a risk of harm to a patient or another person. This term is synonymous with
"minor error" or 'minor violation of the Texas Nursing Practice Act or Board
rule'.
(b) Purpose. The Board
believes protection of the public is not enhanced by the reporting of every
minor incident that may be a violation of the Texas Nursing Practice Act or a
Board rule. The Board also believes it may not be necessary to report directly
to the Board when there are mechanisms in place in the nurse's practice setting
to identify nursing errors, detect patterns of practice, and take corrective
action to remediate deficits in a nurse's knowledge, skill, judgment, training,
professional responsibility, or patient advocacy. This rule is intended to
provide guidance in evaluating whether nursing practice breakdown is subject to
mandatory reporting requirements. Additionally, this rule is not intended to
apply to 'employment issues' that are unrelated to the practice of nursing,
such as time, attendance, dress code, etc.
(c) A Right to Report. Nurses and other
persons are encouraged not to report minor incidents to the Board unless
required to be reported as outlined in subsection (h) of this section. However,
nothing in this rule is intended to prevent reporting of a potential violation
directly to the Board or to a nursing peer review committee.
(d) In evaluating whether an error is a minor
incident, a combination of factors must be reviewed, including the nurse's
conduct, those factors viewed to be beyond the nurse's control, and the
relationship between the two that influenced or impacted the nursing practice
breakdown.
(1) Initially, the nurse's conduct
shall be evaluated to determine whether deficit(s) in knowledge, judgment,
skills, professional responsibility, or patient advocacy contributed to the
incident.
(A) If it is determined that the
nurse's practice has no deficit(s), as described in paragraph (1) of this
subsection, the incident may not reach the level of a minor incident.
(B) If it is determined that the nurse's
practice deficit(s), as described in paragraph (1) of this subsection,
contributed to the error, then a determination of whether remediation will
address any identified deficit(s) is required.
(i) If remediation will address the
deficit(s), a remediation plan shall be developed to address the
deficit(s).
(ii) If remediation
will not address the deficit(s), then the error cannot be considered a minor
incident and the nurse must be reported to the nursing peer review committee
or, in practice settings with no nursing peer review, to the Board.
(iii) If the determination is that the nurse
could be remediated and the nurse does not complete the required remediation,
then the nurse must be reported to a nursing peer review committee or the
Board.
(2)
Additionally, the presence of factors beyond the nurse's control shall also be
evaluated for contribution to the incident, and if found, reported to the
patient safety committee, or if the facility does not have a patient safety
committee, to the chief nursing officer.
(3) When there are factors beyond the nurse's
control, the relationship between the nurse's contribution to the incident and
the factors beyond the nurse's control shall be evaluated.
(A) If factors beyond the nurse's control are
identified, the incident should be evaluated to determine if the error would
have occurred in the absence of such factors.
(B) If the error would not have occurred but
for the factors beyond the nurse's control, the incident may not be reviewable
under this rule.
(C) The presence
of factors beyond the nurse's control does not automatically exclude the
possibility that the nurse's conduct also contributed to the error. Any
identified deficits by the nurse must be addressed in accordance with paragraph
(1)(B) of this subsection, even if factors beyond the nurse's control are also
identified.
(4)
Misclassifying to Avoid Reporting. Intentionally misclassifying an incident to
avoid reporting may result in a violation of the mandatory reporting statute
(see subsection (h) of this section).
(e) Multiple Incidents.
(1) Evaluation of Conduct. In determining
whether multiple minor incidents constitute grounds for reporting, an
evaluation must be conducted to determine if the minor incidents indicate a
pattern of practice that demonstrates the nurse's continued practice poses a
risk of harm and should be reported to the nursing peer review committee or the
Board.
(2) Frequency of Incidents.
In practice settings with nursing peer review, the nurse must be reported to
the nursing peer review committee if a nurse commits five minor incidents
within a 12-month period. In practice settings with no nursing peer review, the
nurse who commits five minor incidents within a 12-month period must be
reported to the Board.
(f) Required Documentation of Minor
Incidents. A minor incident should be documented as follows: a report must be
prepared, monitored, and maintained for a minimum of 12 months that contains:
(1) a complete, detailed description of the
incident(s), including patient(s) medical record number(s), nurse(s) involved,
witnesses and, if applicable, a summary of witness statements, and any
additional relevant information;
(2) an evaluation of the
incident(s);
(3) the action taken
to correct or remedy the situation; and
(4) evidence of completed
remediation.
(g)
Responsibilities.
(1) The Chief Nursing
Officer, Nurse Administrator, or registered nurse by any title who is
responsible for nursing services shall develop and implement a policy to assure
that minor incidents are handled in compliance with this rule and any other
applicable law.
(2) The Nurse
Manager, Nurse Supervisor, or registered nurse by any title who is responsible
for managing and/or supervising nurses, regardless of the time frame or number
of minor incidents, must report a nurse to the nursing peer review committee
or, in practice settings with no nursing peer review, to the Board if he/she
believes the minor incidents indicate a pattern of practice that poses a risk
of harm that cannot be remediated.
(3) If a report is made to the nursing peer
review committee, the committee must investigate and conduct incident-based
nursing peer review in compliance with Texas Occupations Code Chapter 303 and
§
217.19 of this title.
(h) Some conduct falls outside the
definition of a minor incident and must be reported to a nursing peer review
committee or to the Board. This includes:
(1)
conduct that ignores a substantial risk that exposed a patient or other person
to significant physical, emotional or financial harm or the potential for such
harm;
(2) conduct that violates the
Texas Nursing Practice Act or a Board rule and contributed to the death or
serious injury of a patient
(3) a
practice related violation involving impairment or suspected impairment by
reason of chemical dependency, intemperate use, misuse or abuse of drugs or
alcohol, mental illness, or diminished mental capacity;
(4) a violation of Board Rule 217.12 with
actions that constitute abuse, exploitation, fraud, or a violation of
professional boundaries; or
(5)
actions that indicate the nurse lacks knowledge, skill, judgment, or
conscientiousness to such an extent that the nurse's continued practice of
nursing could reasonably be expected to pose a risk of harm to a patient or
another person, regardless of whether the conduct consists of a single incident
or a pattern of behavior.
Notes
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