N3375 Module 3 Reflection Assignment – Peer Review Paper

Submit by 2359 (CT) Saturday of Module 3.

Name: Date:

Overview: Peer Review

In the Module 3 Reflection Assignment, you will 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.  REMEMBER, YOU ARE USING THE TEXAS BOARD OF NURSING RULES, NOT THE STATE YOU LIVE IN. Please use the link provided in the assignment for the Texas BON Rule 217.16.

N3375 Module 3 Reflection Assignment – Peer Review Paper

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.

Part 1: Applying Rule 217.16

Let’s review what deems a Minor Incident (217.16 a) vs. a Reportable incident- (217.16 h)-

A minor incident is– 217.16(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 PRC or BON.

Let’s come up with an easy way to remember what is a minor incident- in case you are ever in this situation, whether this happens to you or you 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

However, these minor incidents still must 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.

“Nurse Karen 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. He tells Nurse Karen 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). Karen sets the IV pump incorrectly, and the infusion is given within a 30-minute period. She 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. Karen is a well-seasoned nurse with over 20 years of experience and no prior history of incidents. She took immediate responsibility for this error when meeting with the unit manager. Karen will now need another RN to witness and sign when she administers IV medication for the next 60 days. Karen agrees to this plan.” N3375 Module 3 Reflection Assignment – Peer Review Paper

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? Please write four (4) professionally written sentences with examples from the Rule to support your thoughts for full credit.

Minor or Reportable?

This was a minor incident

Why? Or why not? Include examples from the Rule.

According to Texas BON Rule 217. 16 (a), a “minor incident” means a conduct by nurse that may be a violation of the Texas Nursing Practice Act or Board rule but does not indicate the nurse’s continued practice pose a risk of harm to a patient or another person (Texas Board of Nursing, 2021). The rule also validates the importance of taking responsibility and embracing remediation interventions.

For example, Nurse Karen took responsibility of the incident when meeting the unit manager and immediately admnistered 50 mg diphenhydramine and ranitidine 50 mg via IV with orders to remediate the situation. Finally, the case study indicates that Karen is well-seasoned nurse with over 20 years of experience and no prior history of medication errors. Therefore, it is valid to argue that the incident was not because of deficits in knowledge, judgement, skills, or professional irresponsibility.

Part 2: Applying Rule 217.19 Incident-Based Peer Review

First, review your learning about 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.

Please use the link provided at https://www.bon.texas.gov/rr_current/217-19.asp

“Nurse Sam is charting at the nurse’s station where there are co-workers, physicians and a unit secretary gathered.  Sam 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 Sam 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 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 219.19 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 four (4) professionally written sentences with examples from the Rule to support your thoughts for full credit.

The nurse manager violates various provisions of the Texas BON Rule 217:19 regarding incident-based nursing peer review and Whistleblower protections. Firstly, the manager acts contrary to §217.19 (a) (6) provision about good faith that precludes misrepresenting the facts surrounding the events under review, acting out of malice or personal animosity (Texas Board of Nursing, 2021).

Secondly, revealing information under nursing peer review violates §217.19 (b) (d) and §217.19 (h)(1) that advocate for confidentiality and safeguards to prevent impermissible disclosures of information presented to and considered by the incident-based nursing peer review committee. The law requires all parties to ensure confidentiality of proceedings and desist from disclosing information except under circumstances provided by TOC §§303.006, 303.007, and 303.0075.

Part 3: Multiple Choice Questions

Answer the following multiple-choice questions according to the Module 3 readings and lectures. They are worth 5 points each, there is only 1 correct answer.

1). According to Clevette and colleagues, examples of unsafe, common disciplinary actions reviewed by boards of nursing include all of the following EXCEPT-

a). Destruction or alteration of patient records, including fraudulent charting and/or signatures and/or replacement of records with intent to mislead or deceive.

b). Physical patient abuse, such as when a nurse hits, strikes, or performs similar physical acts of aggression involving patient contact.

c). Practicing beyond the authorized scope, such as administering medications without a physician’s order.

d). Failure to implement safeguards to ensure patient confidentiality and integrity of patients protected health information, violating HIPPA.

The answer is D: Boards of nursing review various common disciplinary actions, including destruction of patient records, physical patient abuse, and practicing beyond the authorized scope. However, BONs do not review the failure to implement safeguards to ensure patient confidentiality (Masters, 2018).

2). Rule 217.19 in Texas, Incident Based Nursing Peer Review and Whistleblower Protections provides to the nurse being peer reviewed EXCEPT-

a). Minimum protection

b). Minimum due process

c). Minimum legal representation

d). Minimum rights afforded to nurse

The answer is D: Texas BON 217.19 guarantees peer reviewed nurses’ minimum protection, minimum due process, and legal representation and not minimum rights afforded to the nurse.

3). If a nurse does not agree to the discipline set due to a complaint made against this nurse, after reviewing the proposed agreed order, they can request a-

a). Informal conference

b). Formal conference

c). Informal hearing

d). Formal hearing

The answer is A: an informal conference allows a nurse to respond to the allegations and dispute evidence or proposed disciplinary action. Also, it provides an opportunity to provide additional information for the board’s consideration.

4). Common nursing remedial education courses required if a nurse is being disciplined are-

a). medication refresher, ethics, geriatric care, nursing jurisprudence, care coordination.

b). ethics course, care coordination, documentation, medication refresher.

c). physical assessment refresher, critical thinking, documentation, medication refresher, geriatric care.

d). nursing jurisprudence, documentation, ethics, medication refresher, physical assessment refresher and critical thinking.

The Answer is D: Texas BON §217.21 (c) provides that a remedial education course in nursing should include nursing jurisprudence, ethics, medication administration, physical assessment, pharmacology, and nursing documentation (Texas Board of Nursing, 2021 N3375 Module 3 Reflection Assignment – Peer Review Paper).

N3375 Module 3 Reflection Assignment – Peer Review Paper References

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