| (B) The privileges under this subsection may be waived
only through a written waiver signed by the chair, vice chair, or
secretary of the patient safety committee.
(C) This section does not affect the application of
TOC §303.007 (NPR Law) (relating to disclosures by nursing peer
review committee) to a nursing peer review committee.
(D) A committee that receives information from another
committee shall forward any request to disclose the information to
the committee that provided the information.
(3) A CNO or Nurse Administrator shall assure that
policies are in place relating to sharing of information and documents
between an incident-based nursing peer review committee and a patient
safety committee(s) that at a minimum, address:
(A) separation of confidential incident-based nursing
peer review information from the nurse's human resource file;
(B) methods in which shared communications and documents
are labeled and maintained as to which committee originated the documents
or communications;
(C) the confidential and separate nature of incident-based
nursing peer review and patient safety committee proceedings including
shared information and documents; and
(D) the treatment of nurses who violate the policies
including when a violation may result in a nurse being reported to
the Board or a nursing peer review committee.
(i) Committee Responsibility to Evaluate and Report.
(1) In evaluating a nurse's conduct, the incident-based
nursing peer review committee shall review the evidence to determine
the extent to which any deficiency in care by the nurse was the result
of deficiencies in the nurse's judgment, knowledge, training, or skill
rather than other factors beyond the nurse's control. A determination
that a deficiency in care is attributable to a nurse must be based
on the extent to which the nurse's conduct was the result of a deficiency
in the nurse's judgment, knowledge, training, or skill.
(A) For errors involving the death or serious injury
of a patient, if a nursing peer review committee makes a determination
that a nurse has not engaged in conduct subject to reporting to the
Board, the committee must maintain documentation of the rationale
for its belief that the nurse's conduct failed to meet each of the
factors in the definition of "conduct subject to reporting", as defined
in TOC §301.401(1)(A) - (D) and subsection (a)(4)(A) - (D) of
this section.
(B) Conduct subject to reporting means conduct by a
nurse that:
(i) violates the NPA or a Board rule and contributed
to the death or serious injury of a patient;
(ii) causes a person to suspect that the nurse's practice
is impaired by chemical dependency or drug or alcohol abuse;
(iii) constitutes abuse, exploitation, fraud, or a
violation of professional boundaries; or
(iv) 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.
(2) An incident-based nursing peer review committee
shall consider whether a nurse's conduct constitutes one or more minor
incidents under §217.16 of this title. A nursing peer review
committee receiving a report involving a minor incident or incidents
must review the incident(s) and other conduct of the nurse during
the previous 12 months to determine if the nurse's continued practice
poses a risk of harm to patients or other persons and whether remediation
would be reasonably expected to adequately mitigate such risk, if
it exists. The committee must consider the factors set out in §217.16(d)
of this title. In accordance with §217.16, the committee may
determine that the nurse:
(A) can be remediated to correct the deficiencies identified
in the nurse's judgment, knowledge, training, or skill; or
(B) should be reported to the Board for either a pattern
of practice that fails to meet minimum standards, or for one or more
events that the incident-based nursing peer review committee determines
cannot be categorized as a minor incident(s); or
(C) if a nurse terminates employment while undergoing
remediation activities as directed by a nursing peer review committee
under paragraph (2)(A) of this subsection, the nursing peer review
committee may:
(I) report the nurse to the Board;
(II) report to the nursing peer review committee of
the new employer, if known, with the nurse's written consent; or
(III) re-evaluate the nurse's current conduct to determine
if the nurse did complete sufficient remediation and is deemed safe
to practice.
(3) An incident-based nursing peer review committee
is not required to submit a report to the Board if:
(A) the committee determines that the reported conduct
was a minor incident that is not required to be reported in accordance
with provisions of §217.16 of this title; or
(B) the nurse has already been reported to the Board
under TOC §301.405(b) (NPA) (employer reporting requirements).
(4) Unless the exceptions outlined in paragraph (3)(A)
and (B) of this subsection are met, an incident-based nursing peer
review committee shall report a nurse to the Board if it is determined
that the nurse has engaged in conduct subject to reporting.
(5) If the committee determines it is required to report
a nurse to the Board, the committee shall submit to the Board a written,
signed report that includes:
(A) the identity of the nurse;
(B) description of the conduct subject to reporting;
(C) a description of any corrective action taken against
the nurse;
(D) a recommendation as to whether the Board should
take formal disciplinary action against the nurse, and the basis for
the recommendation;
(E) the extent to which any deficiency in care provided
by the reported nurse was the result of a factor beyond the nurse's
control; and
(F) any additional information the Board requires.
(6) If an incident-based nursing peer review committee
determines that a deficiency in care by the nurse was the result of
a factor(s) beyond the nurse's control, in compliance with TOC §303.011(b)
(NPR Law) (related to required nursing peer review committee report
when external factors contributed to a nurse's deficiency in care),
the committee must submit a report to the applicable patient safety
committee, or to the CNO or nurse administrator if there is no patient
safety committee. A patient safety committee must report its findings
back to the incident-based nursing peer review committee.
(7) An incident-based nursing peer review committee
is not required to withhold its determination of the nurse being incident-based
nursing peer reviewed, pending feedback from a patient safety committee,
unless the committee believes that a determination from a patient
safety committee is necessary in order for the incident-based nursing
peer review committee to determine if the nurse's conduct is reportable.
(A) If an incident-based nursing peer review committee
finds that factors outside the nurse's control contributed to a deficiency
in care, in addition to reporting to a patient safety committee, the
incident-based nursing peer review committee may also make recommendations
for the nurse, up to and including reporting to the Board.
(B) An incident-based nursing peer review committee
may extend the time line for completing the incident-based nursing
peer review process (extending the 45 days by no more than an additional
45 days) if the committee members believe they need input from a patient
safety committee. The incident-based nursing peer review committee
must complete its review of the nurse within this 90-day time frame.
(8) An incident-based nursing peer review committee's
determination to report a nurse to the Board cannot be overruled,
changed, or dismissed.
(j) Nurse's Duty to Report.
(1) A report made by a nurse to a nursing incident-based
nursing peer review committee will satisfy the nurse's duty to report
to the Board under TOC §301.402 (mandatory report by a nurse)
provided that the following conditions are met:
(A) The reporting nurse shall be notified of the incident-based
nursing peer review committee's actions or findings and shall be subject
to TOC §303.006 (confidentiality of nursing peer review proceedings);
and
Cont'd... |
