IN THIS ISSUE

1. North Carolina Board of Nursing Gets First PREP Participants
2. E-mail List Service (ListServe): More Useful Than Discussions?
3. We need your help! Baseline Survey Reminder
4. Upcoming events

NORTH CAROLINA NURSING BOARD BEGINS FIRST PREP PILOT

Julie George, Nurse Practice Consultant with the North Carolina Board of Nursing (and PREP Coordinator for that Board) shares some information about the first two PREP referrals received by her Board. Julie reports that she has already received two additional referrals for competency issues that are currently being evaluated. Congratulations, and thanks for sharing this information:

"Case #1--a 50 y/o female RN, with 30 years of nursing experience and 21 years experience at the employing hospital --described by hospital as having excellent clinical skills and unblemished performance record.

"Nurse 'A' performed needle insertion for induction of spinal anesthesia on a patient who was scheduled for surgery. She said she had always wanted to know what the "pop" felt like when you entered the spinal space. Nurse "A" was not a CRNA and was not authorized by law to implement anesthesia activities.

"Case #2--a 31 y/o male RN with seven (7) years of experience and five (5) years experience with the employing hospital--described by hospital as having excellent clinical skills and no prior performance concerns.

"Nurse 'B' felt sick at work and said he suffered from severe allergies. He obtained injectable Benadryl from the hospital pharmacy and administered the drug to himself, in an attempt to feel well enough to remain on duty.

"Nurse 'B' was not authorized by law to prescribe or dispense legend drugs.

"In both of the above cases, the individuals realized they did something wrong and both felt their actions resulted from a lack of knowledge of the legal scope of practice.

"Neither nurse had ever been the subject of disciplinary action by the Board.

"Incidents similar to these have historically resulted in formal letters of Reprimand (formal discipline, reportable to national data bank) from the Board for Exceeding Legal Scope of Practice. As employees of a PREP pilot hospital, both licensees were eligible for consideration for the NC PREP program.

"Prior to acceptance into the PREP program, both licensees were interviewed by the PREP Coordinator. Additionally, background information was obtained from the employers and disciplinary information was checked in NURSYS. There was no patient harm involved in either incident.

"After discussion with the nurse managers involved, it was mutually recommended that remediation include formal education related to Legal Scope of Practice. After the recommended educational intervention, the licensees will be asked to write a paper demonstrating understanding of their errors and articulating integration of new knowledge into future practice. Since both cases involved isolated incidents not felt to be representative of either licensee's usual practice, no formal workplace monitoring was recommended."

CAC COMENT...we congratulate the North Carolina Board of Nursing for moving forward with appropriate educational/remedial interventions in these, their first two cases. PREP was conceived in the first instance to identify and remediate knowledge and skill deficiencies that expose patients to potential harm as a result of sub-competent practice. These first cases put a particular twist on the matter, since the identified deficiency is a lack of knowledge about scope of practice. If this lack of knowledge is not corrected, practitioners may expose patients to harm by attempting to deliver services or perform tasks for which they have not been adequately trained. We especially like that part of the intervention that asks the involved nurse to write a paper demonstrating that the educational intervention has worked!"

E-MAIL MAILING LIST SERVICE (LISTSERV) BEGUN; MORE USEFUL THANDISCUSSION?

While we have had lots of traffic to our web site, and many new subscribers to this newsletter (which now has almost 90 subscribers!) we have had a dismal response to our discussion boards. In order to provide you with an easy way to send questions to other Pilot States and get quicker responses, we have started a "listserv," or an e-mail mailing list. If you sign up for this list (it's optional and separate from signing up for this newsletter), you will be able to automatically send an e-mail to all other subscribers (without knowing their e-mail addresses) and get replies back in your mailbox rather than having to check the web site as you would in a discussion. To sign up, visit the web site and use the sign-up box in the left-hand bar, or get there from the "Advisory" top menu selection. Give it a try, and see if it makes communicating easier! If you're interested in seeing the discussion group, go to the web site, and choose "discussion" from the top menu.

BASELINE SURVEY REMINDERS SENT

On June 1, 2001, a baseline survey on the current level of hospital reporting activity to Boards, and remediation programs used by Boards, was mailed by CAC to each participating Pilot State Board. Of the 13 states, a number were not able to complete it by the end of June. If you are a Pilot State and have not completed the survey, you should have gotten a reminder asking you to complete it in the next two weeks. If you have problems or questions, please contact mark@4patientsafety.net.

UPCOMING EVENTS

There will be a PREP meeting before each of the Administrators In Medicine (AIM) regional meetings this fall, so mark your calendars for October 10 in San Francisco, and October 17 in Washington, DC.

THANKS for reading our newsletter. If you have questions or comments about its content, e-mail mark@4patientsafety.net. Until our next issue, be well.