“Nurse Karen is caring for a newly admitted 67-year-old male patient with infectious endocarditis due to a bacterial infection of his prosthetic heart valve.

Part 1: Applying Rule 217.16

Let’s review what deems a Minor Incident (217.16 a) vs. a Reportable incident- (217.16 h)-

A minor incident is- 217.16(a)- nurses’ actions may be a violation of a board rule, but does not indicate the nurses continued practice poses a risk of harm to a patient or another person.

A reportable incident is- 217.16(h)- conduct that falls outside of the definition of a minor incident and must be reported to a PRC or BON.

Let’s come up with an easy way to remember what is a minor incident- in case you are ever in this situation, whether this happens to you or you are participating on a peer review committee evaluating a fellow nurse’s actions. Think about the word “harp.”

H- no significant Harm

A- nurse must take Accountability

R- easily Remediated

P- no Pattern of this behavior

However, these minor incidents still must be documented, tracked and remedied. The nurse must be reported to the nursing peer review committee if a nurse commits five (5) minor incidents within a 12-month period.

Look at this case study scenario below.

“Nurse Karen is caring for a newly admitted 67-year-old male patient with infectious endocarditis due to a bacterial infection of his prosthetic heart valve. After blood cultures come back positive for staphylococcus aureus, IV Vancomycin is ordered. He tells Nurse Karen and the doctor that the last time he got this medication, he experienced hives and hot, itchy skin but he was not allergic to it. The doctor ordered the medication to be infused slowly as to avoid Red Man Syndrome (500 mg IV bag at a rate of two hours as opposed to the standard one hour). Karen sets the IV pump incorrectly, and the infusion is given within a 30-minute period. She calls the doctor and immediately gives 50 mg diphenhydramine and ranitidine 50 mg via IV with orders. The patient experienced mild flushing, but the episode resolved within 20 minutes. Karen is a well-seasoned nurse with over 20 years of experience and no prior history of incidents. She took immediate responsibility for this error when meeting with the unit manager. Karen will now need another RN to witness and sign when she administers IV medication for the next 60 days. Karen agrees to this plan.” Using the Texas BON Rule 217.16, review (a) a Minor Incident vs. (h) a reportable incident. This information can be found at https://www.bon.texas.gov/rr_current/217-16.asp

Based on your assessment of the criteria, was this a Minor Incident or reportable event? Why or Why not? Please write four (4) professionally written sentences with examples from the Rule to support your thoughts for full credit. Minor or Reportable?

Why? Or Why not? Include examples from the Rule.

Part 2: Applying Rule 217.19 Incident-Based Peer Review

First, review your learning about incident-based peer review. The purpose of an IBPR is to determine whether a nurse should be reported to the Texas Board of Nursing (BON) for professional misconduct or licensure violations based on one or more such events.

Please use the link provided at https://www.bon.texas.gov/rr_current/217-19.asp

to review. Apply the information to this case study-

“Nurse Sam is charting at the nurse’s station where there are

-workers, physicians and a unit secretary gathered. Sam and the nurse manager have not been co seeing eye to eye lately (verbal altercations both in the halls and in the cafeteria recently). The nurse manager approaches Sam and loudly states, “I am glad you are here. Just to let you know, the Incident Based Peer Review Committee is meeting tomorrow, and we are investigating your recent questionable behavior. I know you have made many recent medication errors and safety violations noted by the Patient Safety Committee. I also heard you are dating that patient who was in Room 256B last month. I thought you would want to know this was happening, you could be in big trouble and probably fired. I don’t have anything official to give you, but you better find a lawyer, although I doubt you can with this short notice.”

How did this nurse manager violate the IBPR? Refer to the Rule listed below and discuss in the text box.

Rule 219.19 a (2) Bad Faith- knowingly or recklessly acting without the supported of reasonable or legal basis, misrepresenting the facts surrounding the facts under review, acting out of malice or personal animosity towards the nurse, acting from a conflict of interest, or knowingly or recklessly denying due process. How did this nurse manager violate the IBPR based on this rule? Please write four (4) professionally written sentences with examples from the Rule to support your thoughts for full credit.

Part 3: Multiple Choice Questions Answer the following multiple-choice questions according to the Module 3 readings and lectures. They are worth 5 points each, there is only 1 correct answer.

1). According to Clevette and colleagues, examples of unsafe, common disciplinary actions reviewed by boards of nursing include all of the following EXCEPT-

a). Destruction or alteration of patient records, including fraudulent charting and/or signatures and/or replacement of records with intent to mislead or deceive.

b). Physical patient abuse, such as when a nurse hits, strikes, or performs similar physical acts of aggression involving patient contact.

c). Practicing beyond the authorized scope, such as administering medications without a physician’s order.

d). Failure to implement safeguards to ensure patient confidentiality and integrity of patients protected health information, violating HIPPA.

). Failure to implement safeguards to ensure patient confidentiality and integrity of patients protected health information, violating HIPPA.

2). Rule 217.19 in Texas, Incident Based Nursing Peer Review and Whistleblower Protections provides to the nurse being peer reviewed EXCEPT-

a). Minimum protection

b). Minimum due process

c). Minimum legal representation

d). Minimum rights afforded to nurse

3). If a nurse does not agree to the discipline set due to a complaint made against this nurse, after reviewing the proposed agreed order, they can request a-

a). Informal conference

b). Formal conference

c). Informal hearing

d). Formal hearing4). Common nursing remedial education courses required if a nurse is being disciplined are-

a). medication refresher, ethics, geriatric care, nursing jurisprudence, care coordination.

b). ethics course, care coordination, documentation, medication refresher.

c). physical assessment refresher, critical thinking, documentation, medication refresher, geriatric care.

d). nursing jurisprudence, documentation, ethics, medication refresher, physical assessment refresher and critical thinking.

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