Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri

The North Carolina Story

Mary P. “Polly” Johnson, RN, MSN Executive DirectorNorth Carolina Board of Nursing

Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri

North Carolina’s PREP Story

• Consistent with NCBN Mandate & Vision for The 21st Century:– To ensure minimum standards of competency and

provide the public safe nursing care– To promote safe nursing care through:

achieving excellence in nursing regulation being primary source of regulatory information collaborating with other health care

organizations in a changing healthcare environment

Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri

Essential Elements

• Voluntary, non-public, non-punitive• Collaborative approach • Motivation to improve practice• Opportunity to learn from mistakes and

upgrade knowledge, skills and abilities

Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri

Eligibility Criteria

Concern/Incident primarily related to the individual, not the system

Root cause related to practice, not misconduct

Individual’s licensure status in good standing

Licensee eligible for continued employment

Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri

Exclusionary Criteria

Drug relatedAbuseFraud/DeceitSerious harm or death Pending criminal charges

Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri

Safety Net for Public Protection

Explicit guidelines to distinguish PREP eligibility versus disciplinary review

Serves as additional tool for boards to allow earlier intervention with focus on performance improvement

Gives boards proactive/non-punitive opportunity to impact safety issues

Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri

Groundwork for PREP Pilot

Approached receptive agencies

Solicited support from NCHA and NCNA

Agencies participated in project development: Chief nurse

administrators, attorneys and risk managers

Conducted on-site education with key agency personnel

prior to implementation

Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri

Steps in the PREP Process

1st: Identification of incident/pattern - Incident -usually an error involving

established employee OR- Pattern of competency deficit(s) becomes

apparent- often new or reassigned employee

2nd: Referral to PREP– Designated agency person initiates referral– Basic information is shared with PREP Coordinator– Employee is told of PREP contact

Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri

Steps……

3rd: Determination of eligibility– Facility must determine that employee is

eligible for continued employment– Both must agree that employee appears to

be viable candidate for PREP– BON must review licensure history

4th: Assessment/Interview– Assessment of needs/learning

opportunities-usually done by agency, if appropriate

– Interview licensee-done by BON

Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri

Steps….5th Remediation plan

– Agency and BON confer to formulate plan for remediation/enhancement

– Proposed to licensee in terms of formal agreement

6th Contractual agreement - Signed by all 3 parties– Individual/system bears the cost

7th Successful completion8th Survey participants 3 mos. later

Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri

Project Growth and Development

Pilot began 6/01 with 7 hospitalsExpanded to nursing homes 7/0215 pilot agencies 7/02-6/0451 referrals June 01 – June 0445 licensees eligible – 6 ineligible35 licensees successfully

completed remediation as of May 04

Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri

31%

28%8%

28%

5% Exceeding scope

Competency

Med Errors

Documentation

InappropriateDelegation

Types of Referrals to PREP

Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri

Responses to PREP

• Improved communication and trust between hospitals and BON

• Collaborative relationships • Positive reception from nursing

community for proactive, non-punitive approach by BON

• Positive response from individuals referred to PREP

Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri

Responses….

Opportunity for boards to impact safe patient care by addressing individual and systems issues

Survey of agencies and licensees: desire for program expansion perception of fairness and

effectiveness of non-disciplinary approach to public protection

key person = program coordinator

Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri

Possibilities for PREP

• Provide data related to human factors that contribute to practice deficiencies and/or minor incidents

• Serve as a model to assist regulatory boards to redefine individual accountability in more productive manner

• Focus on improving performance, rather than expecting perfect performance

• Facilitate the shift from culture of blame to quality improvement

Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri

Keys to Success

• IndividualOpen-mindedLearn from

mistakes of self or others

Actively participate in developing remediation plan

• SystemOpen-mindedPromote non-

blaming cultureCommitment to

support employee in continued employment and remediation

Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri

Keys….

• Regulatory BoardProactiveFocused on Quality ImprovementAvailable ResourcesCollaborative and Approachable

Image in healthcare community

Presented at the 2004 CLEAR Annual ConferenceSeptember 30 – October 2 Kansas City, Missouri

NC Board of Nursing: Expanding PREP Statewide in 2004

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