The Practitioner Remediation

and Enhancement Partnership

PREP 4 PATIENT SAFETY

Mark Speicher Board Member,

Citizen Advocacy Center

Presented at the 2004 CLEAR Annual Conference

September 30 – October 2 Kansas City, Missouri

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

PreP For Patient Safety

A Program of the Citizen Advocacy Center (CAC) Under Contract With

HRSA

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

PHILOSOPHY OF PREP 4 Patient Safety PROGRAM

PhilosophyTo create a new paradigm where hospitals and the Boards of Medicine and Nursing serve as safety advocates and provide a means whereby practitioners having deficits in knowledge, skills or abilities remain in the work setting and receive remediation to improve safe patient care and enhance public protection.

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

FOCUS OF PREP 4 Patient Safety

Identification of problems before versus after harm occurs

Non-punitive versus “blame and punish”

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

Voluntary participation of licensee

Privacy of participation—treated as non-public information

ESSENTIAL PROGRAM ELEMENTSESSENTIAL PROGRAM ELEMENTS

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

• Competency –• practitioners who

demonstrate a deficit in knowledge, skills, abilities or judgment believed to be amenable to remediation

DUAL TRACKS OF PREPDUAL TRACKS OF PREP 4 Patient Safety

• Errors –• minor violations

of the practice act isolated incidents not subject to serious board action

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

• Identified deficiency or incident must be associated with an individual, recognizing that the individual is part of a complex environment

• Identified individual must be eligible for continued practice privileges or employment with participating pilot hospital

CRITERIA FOR PARTICIPATIONCRITERIA FOR PARTICIPATION

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

CRITERIA FOR PARTICIPATION

• Cases must NOT involve suspected drug diversion, reckless conduct, deceitful behavior or sexual misconduct

• Cases involving serious patient harm or prior disciplinary action not “PREP” cases

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

• Policies/Procedures for Boards and Hospital

• Identification of problem/deficit• Consultation/determination of eligibility• Assessment• Remediation Plan• Contractual Agreement• Monitoring• Reporting

PROGRAM COMPONENTSPROGRAM COMPONENTS SUPPORTED BY CAC

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

PATHWAYS TO ENTER PREP 4 Patient Safety

1. Hospital Initiated2. Board Initiated

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

PARTICIPATING BOARDS

BOARDS OF MEDICINE

(1) California(2) Minnesota(3) Missouri(4) North Carolina(5) Oregon(6) Rhode Island

BOARDS OF NURSING

(1) Colorado(2) Maryland(3) Nebraska(4) North Carolina(5) Oregon(6) South Carolina(7) West Virginia (LPN)

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

POSITIVE RESPONSES TO PREP 4 Patient Safety

• Improved communication and trust between pilot hospitals and boards

• Enhanced collaboration• Recognition/resolution of systems problems as

by-product of internal review• Favorable reception from licensees for

proactive, non-punitive approach by licensing board.

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

Support to Members: Assessment and

Remediation• CAC (Through AIM and NCSBN)

conducts survey of all boards• Availability and Use of

Assessment and Remediation Programs

• Goals: Discover Utilization Rates and ID Current Programs

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

Report Includes State-of-the-Art Info

• Background on Assessment and Remediation

• Current Status of Assessment and Remediation (Surveys of Medical and Nursing Boards)

• State-of-the-Art: Assessment

• State-of-the-Art: Remediation

• Resource Summary• Future Directions

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

Findings

• Survey Responses from 19 of 53 Nursing Boards and 46 of 63 Medical Boards

• Shows Low Utilization of Assessments, More but Still Low Use of Remediation

• Lists 40+ Assessment or Remediation Resources

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

Likely Direction

• Use of Assessments Today– Problem ID is the

assessment– Nurses get small, ongoing,

formalized assessment using an employment model

– Physicians get larger, one-time assessments using a peer review model

– Part of a punitive process• Use of Assessments

Tomorrow– More Use of Assessments– Staged Assessments– Not Punitive– Part of Larger Continuing

Competence Where Everyone Is Assessed

• Use of Remediation Today– More widely used than

outside assessments– Little objective follow-

up– For Boards, often part

of a punitive process• Use of Remediation

Tomorrow– User-friendly (i.e.

distance learning)– Not part of punitive

process– Outcomes are tracked

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

Summary

MORE THAN 125 PARTICIPANTS TO DATE

• WHAT WE’VE LEARNED SO FAR

• WHAT WE STILL HAVE TO LEARN

• GOAL FOR 2005: MORE BOARDS, MORE PROFESSIONS!

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

More Information on PreP For Patient Safety

PREP 4 Patient Safety WEB SITE

www.4patientsafety.net

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

• Mark SpeicherOptiMed Resources Inc.15826 N. 9th Ave., Phoenix AZ 85023(602) 942-9530 Fax (602) 296-0423mark@medspectrum.comwww.medspectrum.com