A patient, aged 54, admitted for back surgery secondary to compressed vertebrae and intense pain
The Board of Nursing in your state has decided to utilize a tool developed by the National Council of State Boards of Nursing called the Taxonomy of Error, Root Cause Analysis Practice- Responsibility (TERCAP). Your nurse manager has provided you with a summary of the completed TERCAP report by your Board of Nursing’s Disciplinary Action Committee. She has asked you to review this summary and to develop a proposal of suggestions for continuing education topics on ways to minimize legal risks for your hospital’s practicing nurses. The nurse educators will develop an education series based upon your recommendations.
Instructions
Prepare a proposal based on the summary of the TERCAP with recommendations and suggestions on minimizing legal risks that:
Part One – Review summary of completed TERCAP report below.
A patient, aged 54, admitted for back surgery secondary to compressed vertebrae and intense pain. The difficulty with pain management has caused the patient some depression and insomnia over the last month. During her first post-operative day, the patient fell attempting to go from the bed to the bathroom without assistance. Her injury was serious and involved significant harm requiring two additional days of hospitalization and an addition six weeks of physical therapy.
A review of the case determined that her assigned nurse on night shift was an RN (age 24) with nine months of experience in this unit. This was her third 12 hours shift in a row, and she was 29 weeks pregnant. There were 28 beds occupied with only two RNs and one patient technician, due to one vacancy and a call-in for illness. This community facility has experienced a turnover rate of 12% in the last year (community average of 4.5%), and has a high number of new graduates working on medical surgical units, particularly on the 7 pm- 7 am shift.
A review of the chart showed that the patient had been advised by the out-going nurse, who admitted her to the unit post-operatively, that she needed to ask for assistance with toileting for at least the next 24 hours due to the extensive back surgery and post-anesthesia response and pain medication. The RN coming on shift had received bedside shift report at 7 pm and noted the patient sleeping, so the issue of patient assistance was not repeated. She checked on her again at 8 pm and administered the requested prn medication (morphine) for pain. She was busy with other patients and did not see the patient again until the patient fell at 9:51 pm.
The patient reported that she did not recall having been instructed to ask for assistance, as she was very groggy from the anesthesia. She stated that she had pushed the nurse call button for assistance and “no one came.” There was no clerical support at the nursing station and the three staff members had been very busy with patients, so this statement could not be substantiated.
The risk manager found that the RN had not followed nursing policy for patient assessment 20 minutes after receiving pain medication, and had not done the recommended hourly rounding on the patient to assess for the need for elimination, pain, and patient comfort. The note in the chart indicated only that the patient requested pain medication, but did not provide specific nursing assessment details or comment that the patient had received the same dosage of morphine two hours earlier.
Part Two – Factors and Actions
· Discusses the factors that contributed to event and how these factors could be addressed to minimize legal risks.
· Situational factors
· Nursing factors
· Human factors
· Organizational factors
· Explains whether the nurse was negligent or did her actions reach the level of malpractice and support your reasoning with research.
· Determines what options the nursing board had regarding this nurse’s license to practice nursing.
· Describes your reasoning for what action would you recommend (warning, probation, revocation of license) if you were on the disciplinary committee of your Board of Nursing.
· Explains how the level of nursing behavior relates to your proposed recommendation on licensure.
Part Three – Continuing Education
· Summarizes a list of topics to be provided to the education department based on the summary of the TERCAP report.
· Provides stated ideas with professional language and attribution for credible sources with correct APA citation, spelling, and grammar in the proposal.
Resources
Library Databases
· Health Policy Reference Center
Websites and Resources
· Make sure to refer to your own state’s Board of Nursing guidelines for practice and reporting requirements. Board of Nursing’s actions regarding nursing complaints and their decisions are publicly available on their website.
· The Importance of Engaging with TERCAP: Taxonomy of Error Root Cause Analysis and Practice-Responsibility
· A Method to Determine Factors Associated with Nursing Practice Breakdown
· Taxonomy of Error, Root Cause Analysis and Practice-Responsibility
· Taxonomy of Error Root Cause Analysis Educators Can Utilize Practice Breakdown Categories
Guides & FAQs
· APA Guide
· Credible Sources FAQ
· Nursing Guide
· Rasmussen’s Answers/FAQs
Bottom of Form
TERCAP Proposal Template
Student Name
Rasmussen University
COURSE#: NUR4327CBE
Mindy Fadell
Date:
*Remember not to copy or paste from references or use student websites with examples of their work for the creation of this Deliverable
Part 1: Informational Page
Scenario
The Board of Nursing in your state has decided to utilize a tool developed by the National Council of State Boards of Nursing called the Taxonomy of Error, Root Cause Analysis Practice- Responsibility (TERCAP). Your nurse manager has provided you with a summary of the completed TERCAP report by your Board of Nursing’s Disciplinary Action Committee. She has asked you to review this summary and to develop a proposal of suggestions for continuing education topics on ways to minimize legal risks for your hospital’s practicing nurses. The nurse educators will develop an education series based upon your recommendations.
Summary of completed TERCAP report
A patient, aged 54, admitted for back surgery secondary to compressed vertebrae and intense pain. The difficulty with pain management has caused the patient some depression and insomnia over the last month. During her first post-operative day, the patient fell attempting to go from the bed to the bathroom without assistance. Her injury was serious and involved significant harm requiring two additional days of hospitalization and an addition six weeks of physical therapy.
A review of the case determined that her assigned nurse on night shift was an RN (age 24) with nine months of experience in this unit. This was her third 12 hours shift in a row, and she was 29 weeks pregnant. There were 28 beds occupied with only two RNs and one patient technician, due to one vacancy and a call-in for illness. This community facility has experienced a turnover rate of 12% in the last year (community average of 4.5%), and has a high number of new graduates working on medical surgical units, particularly on the 7 pm- 7 am shift.
A review of the chart showed that the patient had been advised by the out-going nurse, who admitted her to the unit post-operatively, that she needed to ask for assistance with toileting for at least the next 24 hours due to the extensive back surgery and post-anesthesia response and pain medication. The RN coming on shift had received bedside shift report at 7 pm and noted the patient sleeping, so the issue of patient assistance was not repeated. She checked on her again at 8 pm and administered the requested prn medication (morphine) for pain. She was busy with other patients and did not see the patient again until the patient fell at 9:51 pm.
The patient reported that she did not recall having been instructed to ask for assistance, as she was very groggy from the anesthesia. She stated that she had pushed the nurse call button for assistance and “no one came.” There was no clerical support at the nursing station and the three staff members had been very busy with patients, so this statement could not be substantiated.
The risk manager found that the RN had not followed nursing policy for patient assessment 20 minutes after receiving pain medication, and had not done the recommended hourly rounding on the patient to assess for the need for elimination, pain, and patient comfort. The note in the chart indicated only that the patient requested pain medication, but did not provide specific nursing assessment details or comment that the patient had received the same dosage of morphine two hours earlier.
Part Two – Factors and Actions
Table 1. Discusses the factors that contributed to event and how these factors could be addressed to minimize legal risks in the below table. Be sure to include Reference support.
Situational factors
Nursing factors
Human factors
Organizational factors
Factor #1:
How do you minimize legal risk:
Factor #1:
How do you minimize legal risk:
Factor #1:
How do you minimize legal risk:
Factor #1:
How do you minimize legal risk:
Factor #2:
How do you minimize legal risk:
Factor #2:
How do you minimize legal risk:
Factor #2:
How do you minimize legal risk:
Factor #2:
How do you minimize legal risk:
Factor #3:
How do you minimize legal risk:
Factor #3:
How do you minimize legal risk:
Factor #3:
How do you minimize legal risk:
Factor #3:
How do you minimize legal risk:
Table 2. Explain whether the nurse was negligent or did her actions reach the level of malpractice and support your reasoning with research.
Do you believe the nurse was negligent?
Do you believe the nurse reached malpractice? Remember the 4 elements of malpractice from Deliverable 5, how do they fit here?
Place your answer here and remember to support your reasoning with research
Place your answer here and remember to support your reasoning with research
Table 3. Determines what options your state nursing board had regarding this nurse’s license to practice nursing. Look up your state Board of Nursing to get this information
Your State Board of Nursing Board Options
Supporting details with reference
Option 1:
Option 2:
Option 3:
Table 4. Look at your state’s nursing board. Describe your reasoning for what action would you recommend (warning, probation, revocation of license) if you were on the disciplinary committee of your State’s Board of Nursing. For example, If you live in Florida, you would look on the Florida Board of Nursing for Information.
Recommended Action
Description to support your recommendation
Do not forget your supportive reference.
Table 5. Explains how the level of nursing behavior relates to your proposed recommendation on licensure.
Tip: You want to base your recommendations based on nursing boards interpretation of findings. For example, if you find that the nurse in the scenario was negligent, this should be supported by behaviors within the scenario and align with the nursing boards interpretation of negligence. Again, be sure to support your recommendations with references from the literature (start your search by looking at articles of negligence).
Part Three – Continuing Education
Please provide a summary (including a description of what is covered in it) of a list of topics to be provided to the education department based on the summary of the TERCAP report. How can you help the bedside nurse so the nurse will not make that mistake again.
References
Your reference list and in-text citations should be in APA format. Please refer to APA Rasmussen Guide, for examples. Here is the link: https://guides.rasmussen.edu/apa/references
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