1) What is TERCAPŠ?
In an effort to promote safe nursing practice, the National Council of State Boards of Nursing (NCSBN), worked with its member boards to initiate the TERCAPŠ (Taxonomy of Error, Root Cause Analysis and Practice Responsibility) Adverse Error Reporting System. The TERCAPŠ Project meets the recommendation made in the Institute of Medicine's (IOM) Report Keeping Patient's Safe concerning the role of Boards in promoting patient safety. The goal of this project is to learn from incidences of nursing practice breakdown in order to evaluate the multiple factors that may be involved in nursing practice errors. Practice breakdown is defined broadly as the disruption or absence of any aspects of good nursing practice. The NCSBN TERCAPŠ Adverse Error Reporting System is a national initiative designed to collect practice breakdown data from Boards of Nursing (BONs) to identify the root cause of nursing practice breakdown from systems and individual perspectives.
2) What is the Texas TERCAPŠ Pilot Project?
In 2011, the 82nd Texas Legislature passed SB 193 allowing the Board to adopt an error classification system, such as the TERCAPŠ, for utilization by nursing peer review committees. Consistent with SB 193, the Board is utilizing TERCAPŠ as a model for identifying practice issues that are normally reviewed by a nursing peer review committee during the peer review process. Once the committee determines that the nursing practice error is not required to be reported as a part of a complaint or disciplinary process, the incident will be entered into the Texas TERCAPŠ Online State-Wide Error Reporting System. Information will be de-identified and is confidential. Recognizing and highlighting factors involved in nursing practice breakdown will promote a better understanding of the etiology of nursing practice errors. Further, evaluating causative factors and developing methods to mitigate nursing practice errors should facilitate a proactive approach to promoting patient safety: an approach that the Board believes is the best way to fulfill its mission to protect the public.
3) How can my hospital become a part of the Texas TERCAPŠ Pilot Project?
A call or invitation has been sent to hospital-based employers to participate in the Texas TERCAPŠ Pilot whereas they would utilize the TERCAPŠ instrument for reviewing all nursing peer review cases http://www.bon.texas.gov/practice/pdfs/TERCAP-Hospital-Invitation.pdf. A signed contract is necessary and must be on file with the Texas Board of Nursing in order to participate in the Texas TERCAPŠ Pilot Project. The contract is located at http://www.bon.texas.gov/practice/pdfs/TERCAP-Agreement.pdf.
Completed and signed contracts can be emailed to Laura Lewis at laura.lewis@bon.texas.gov or faxed to her attention at 512-305-8101. You may also mail to:
Texas Board of Nursing
Attention: Laura Lewis
333 Guadalupe, Suite 3-460
Austin, Texas 78701
4) What information from the nursing peer review process will be shared in the Texas TERCAPŠ Pilot Project?
The NCSBN TERCAP Adverse Error Event Reporting System is currently used as a tool for collecting information about practice breakdown data from disciplinary cases within Boards of Nursing around the country. The Texas TERCAP Pilot seeks to capture practice breakdown that is being evaluated by a peer review committee but does not reach the level of being reported to the Board. Consequently, error events to be submitted under the pilot will only be those nursing peer reviewed incidents that are not required to be reported to the Board as part of the complaint or disciplinary process. In general the incidents that would go into the TERCAP state-wide online data base would be incidents that the nursing peer review committee has determined are not normally required to be reported to the Board. This would include minor incidents, which are events that indicate the nurse's continued practice does not pose a risk of harm to patients or other person; or when remediation could reasonably be expected to adequately mitigate any such risk and the nurse successfully completes the remediation. See Texas Administrative Code, Rule 217.16, Minor Incidents. A practice breakdown is defined broadly as the disruption or absence of any of the aspects of good practice. Often these cases involve errors or near misses. Peer Review cases meeting the following criteria would be included in the Texas TERCAP Online State-Wide Error Reporting System:
- The peer review case concerns a nurse who was involved in a practice breakdown.
- The peer review case involves one or more identifiable patients (if more than one patient was involved, data is to be gathered and submitted on the patient with the most harm or risk of harm).
- The case allows for all or almost all of the data collection instrument fields to be completed.
- The case is reviewed by the institution's peer review committee and not deemed reportable to the BON.
As a reminder, conduct that is subject to reporting to the Texas Board of Nursing is defined by the Texas Occupations Code Section 301.401 of the Nursing Practice Act (NPA) http://www.bon.texas.gov/nursinglaw/npa1.html#401 and includes:
(A) violations of the NPA or Board rules and contributed to the death or serious injury of a patient;
(B) causes a person to suspect that the nurse's practice is impaired by chemical dependency or drug or alcohol abuse;
(C) constitutes abuse, exploitation, fraud, or a violation of professional boundaries; or
(D) indicates that 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.
5) Our hospital is interested in the Texas TERCAPŠ Pilot Project. We are concerned about the confidentiality of information that may be collected and evaluated as a result of the pilot. What mechanisms are available to ensure our hospital's information is protected?
The information entered and collected in the database will be de-identified and anonymous. Consistent with Section 303.012-(c), the Board of Nursing will maintain confidentiality of information collected from hospitals who submit data into the error classification system. The data collected will not contain information identifying specific patients, nurses or facilities. Except for the purposes of research, the data will not be reported to any other individual or agency. The data collected is not subject to disclosure under Chapter 552 of the Government Code and will not be subject to use in any disciplinary proceeding. The confidentiality statement is located at http://www.bon.texas.gov/practice/pdfs/TERCAP-BON-Confidentiality.pdf.
6) How long will the Texas TERCAPŠ Pilot be conducted?
The Texas TERCAPŠ Pilot Project will begin in August 2012 and continue through August 2014.
7) What if we only want to use the TERCAPŠ instrument but do not want to participate in the Pilot Project?
Hospital employers and nursing peer review committees wishing to utilize the TERCAPŠ instrument as a template for conducting nursing peer review proceedings must have submitted a completed and signed contract in order to participate in the Texas TERCAPŠ Pilot Project. The TERCAPŠ instrument is the property of the National Council of State Boards of Nursing. Therefore, only hospitals participating in the TERCAPŠ Pilot Project will be able to utilize the TERCAPŠ instrument for nursing peer review.