The Practitioner Remediation and Enhancement Partnership PREP 4 PATIENT SAFETY Mark Speicher Board M

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The Practitioner Remediation and Enhancement
Partnership PREP 4 PATIENT SAFETYMark Speicher
Board Member, Citizen Advocacy Center

• Presented at the 2004 CLEAR Annual Conference
• September 30 October 2 Kansas City,
  Missouri

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PreP For Patient Safety

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

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PHILOSOPHY OF PREP 4 Patient Safety PROGRAM

• Philosophy
• To 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.

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• FOCUS OF PREP 4 Patient Safety

Identification of problems before versus after
harm occursNon-punitive versus blame and
punish
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ESSENTIAL PROGRAM ELEMENTS

• Voluntary participation of licensee
• Privacy of participationtreated as non-public
  information

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DUAL TRACKS OF PREP 4 Patient Safety

• Competency
• practitioners who demonstrate a deficit in
  knowledge, skills, abilities or judgment believed
  to be amenable to remediation

• Errors
• minor violations of the practice act isolated
  incidents not subject to serious board action

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CRITERIA FOR PARTICIPATION

• 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

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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

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PROGRAM COMPONENTS SUPPORTED BY CAC

• Policies/Procedures for Boards and Hospital
• Identification of problem/deficit
• Consultation/determination of eligibility
• Assessment
• Remediation Plan
• Contractual Agreement
• Monitoring
• Reporting

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PATHWAYS TO ENTER PREP 4 Patient Safety

• Hospital Initiated
• Board Initiated

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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)

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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.

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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

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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

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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

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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

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Summary

• MORE THAN 125 PARTICIPANTS TO DATE
• WHAT WEVE LEARNED SO FAR
• WHAT WE STILL HAVE TO LEARN
• GOAL FOR 2005 MORE BOARDS, MORE PROFESSIONS!

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More Information on PreP For Patient Safety

• PREP 4 Patient Safety
• WEB SITE
• www.4patientsafety.net

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• Mark Speicher
• OptiMed Resources Inc.
• 15826 N. 9th Ave., Phoenix AZ 85023
• [phone] Fax [phone]
• mark_at_medspectrum.com
• www.medspectrum.com