The Texas Board of Nursing (BON) has proposed the repeal and replacement of the reporting requirements for minor incidents. The Nursing Practice Act defines a "minor incident" as "conduct by a nurse that does not indicate that 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 this chapter or board rule.'" §301.401(2).
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." 22 Tex. Admin. Code §217.16(a). When there are mechanisms in place to identify nursing errors and take corrective action to remediate deficits in a nurses training or skill, then reporting to the BON is not necessary.
Current Rules on Reporting Minor Incidents
Under the current statute on reporting minor incidents, factors to be considered in evaluating if conduct must be reported to the Board include:
- A nurse involved in a minor incident need not be reported to the Board unless the conduct indicates the nurse:
- Ignored a substantial risk that exposed a patient or other person to significant physical, emotional or financial harm or the potential for such harm;
- Lacked a conscientious approach to or accountability for his/her practice;
- Lacked the knowledge and competencies to make appropriate clinical judgments and such knowledge and competencies cannot be easily remediated; or
- Indicates the nurse has engaged in a pattern of multiple minor incidents that demonstrate the nurse's continued practice would pose a risk of harm to patients or others.
- Evaluation of Multiple Incidents.
- Other factors that may be considered in determining whether a minor incident should be reported to the Board are:
- The significance of the nurse's conduct in the particular practice setting; and
- The presence of contributing or mitigating circumstances, including systems issues or factors beyond the nurse's control, in relation to the nurse's conduct.
Proposed Changes to the Rules on Reporting Minor Incidents
The proposed new §217.16(c) would clarify that "minor incidents are encouraged not to be reported to the Board unless the practice breakdown or error is required to be reported." However, nothing in the new rule would prevent the reporting of a potential violation directly to the Board or nursing peer review committee.
The proposed rule changes also seek to clarify how conduct should be evaluated to determine if it qualifies as a minor incident under the rule. The new combination of factors to be considered would involve "the nurse’s conduct, factors beyond the nurse’s control, and the relationship between the two that influenced or impacted the nursing practice breakdown."
In amending the reporting rules regarding "minor incidents," the BON seeks to more clearly describe conduct that is subject to mandatory reporting and conduct that may qualify as a minor incident and does not need to be reported to the Board. The purpose is to prevent unnecessary reporting to the Board.
The BON is currently considering the foregoing proposed rule changes. The timeframe for public comments or request for a public hearing closed on April 2, 2018.
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