| (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.
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