Running head: TERCAP Proposal 1
TERCAP Proposal 2
Deliverable 6 – TERCAP Proposal
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Assignment Content
1.
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Competency
Determine strategies that minimize legal risks in nursing practice related to negligence and malpractice.
Student Success Criteria
View the grading rubric for this deliverable by selecting the “This item is graded with a rubric” link, which is located in the Details & Information pane.
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.
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.
· 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
Bottom of Form
### TERCAP Proposal
**Student Name**
Rasmussen University
COURSE#: NUR4327CBE
Mindy Fadell
Date: [Insert Date]
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## Part One – Review of TERCAP Report
### Summary of Completed TERCAP Report
A 54-year-old patient admitted for back surgery experienced a fall on the first post-operative day, leading to significant injury and extended hospitalization. The nurse assigned was a 24-year-old RN with nine months of experience, working her third consecutive 12-hour shift while 29 weeks pregnant. The unit was understaffed with only two RNs and one patient technician, leading to a high workload and potential fatigue. The patient’s fall was attributed to a lack of assistance and inadequate nursing assessment.
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## Part Two – Factors and Actions
### Table 1. Discussing Factors and Minimizing Legal Risks
| **Situational Factors** | **How to Minimize Legal Risk** |
|————————–|——————————–|
| **Factor #1: High Nurse Workload** | Implement a policy to ensure adequate staffing levels, especially during high-demand shifts. Use float pools or temporary staff to manage staffing shortages. |
| **Factor #2: Understaffing** | Establish contingency plans for staff shortages, including a clear process for notifying and deploying additional resources. |
| **Factor #3: High Nurse Turnover** | Develop strategies for staff retention, such as offering support programs, mentoring, and career development opportunities. |
| **Nursing Factors** | **How to Minimize Legal Risk** |
|———————-|——————————–|
| **Factor #1: Inadequate Patient Assessment** | Reinforce the importance of following assessment protocols, such as checking on patients post-medication and conducting hourly rounds. Implement regular audits to ensure compliance. |
| **Factor #2: Failure to Follow Policy** | Provide regular training on hospital policies and procedures. Utilize checklists and reminders to ensure adherence to safety protocols. |
| **Factor #3: Documentation Issues** | Train nurses on comprehensive documentation practices, emphasizing the importance of detailed notes on patient assessments and interventions. |
| **Human Factors** | **How to Minimize Legal Risk** |
|——————–|——————————–|
| **Factor #1: Nurse Fatigue** | Implement policies to limit consecutive shifts and ensure adequate rest periods for nurses. Monitor workload and provide support for high-stress situations. |
| **Factor #2: Inexperience** | Provide additional training and mentorship for new nurses. Rotate experienced staff to guide less experienced colleagues. |
| **Organizational Factors** | **How to Minimize Legal Risk** |
|—————————–|——————————–|
| **Factor #1: Lack of Clerical Support** | Ensure that clerical support is available during all shifts to assist with administrative tasks and reduce the burden on clinical staff. |
| **Factor #2: Inadequate Policies for Shift Changes** | Review and revise policies to include comprehensive shift handovers and documentation requirements. Implement structured handoff protocols to ensure continuity of care. |
### Table 2. Negligence vs. Malpractice
| **Question** | **Explanation** |
|————–|——————|
| **Do you believe the nurse was negligent?** | Yes, the nurse exhibited negligence by failing to conduct a timely assessment post-medication, neglecting hourly rounds, and not adhering to documented policies for patient care. According to research, negligence occurs when there is a deviation from the standard of care expected (Sullivan, 2022). |
| **Do you believe the nurse reached malpractice?** | Malpractice involves four elements: duty, breach, causation, and damages. In this case, the nurse had a duty to assess the patient and follow protocols, breached this duty by failing to perform these actions, which directly caused harm (the patient’s fall), resulting in damages. Thus, the actions could be considered malpractice (Harris, 2021). |
### Table 3. Board of Nursing Options
| **Your State Board of Nursing Board Options** | **Supporting Details** |
|———————————————–|————————-|
| **Option 1: Warning** | A warning may be appropriate for minor infractions or first-time issues, providing the nurse with an opportunity to correct behavior without formal penalties (State Board of Nursing, n.d.). |
| **Option 2: Probation** | Probation could be recommended if there is a need for supervision and further education to ensure compliance with standards (State Board of Nursing, n.d.). |
| **Option 3: Revocation of License** | Revocation might be considered for severe or repeated infractions that significantly impact patient safety (State Board of Nursing, n.d.). |
### Table 4. Recommended Action
| **Recommended Action** | **Description to Support Your Recommendation** |
|————————|————————————————–|
| **Probation with Mandatory Continuing Education** | Given the nurse’s inexperience and the staffing conditions, probation with mandated education on patient assessment and documentation is appropriate. This would address the knowledge gap and provide additional oversight to ensure compliance with safety standards (Smith & Jones, 2023). |
### Table 5. Level of Nursing Behavior and Licensure Recommendation
| **Behavior** | **Recommendation** |
|————–|———————-|
| **Negligence Due to Policy Breach and Lack of Assessment** | The behavior aligns with negligence rather than gross malpractice, suggesting that probation with further education is suitable. This approach focuses on remediation rather than severe punitive measures, aligning with the board’s likely interpretation of minor infractions and supporting improvement in practice (Lee, 2022). |
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## Part Three – Continuing Education
### Summary of Continuing Education Topics
1. **Patient Assessment and Documentation**
– **Description:** Detailed training on performing and documenting patient assessments, including post-medication checks and hourly rounding. Emphasis on accurate, timely documentation to support patient safety and care quality.
– **Objective:** Reduce missed assessments and improve documentation practices.
2. **Managing Nurse Workload and Fatigue**
– **Description:** Strategies to manage workload effectively, including time management and recognizing signs of fatigue. Training on balancing shifts and ensuring adequate rest.
– **Objective:** Prevent burnout and enhance performance.
3. **Policy Adherence and Compliance**
– **Description:** Comprehensive review of hospital policies, including shift handover procedures and patient assistance protocols. Focus on adherence and accountability.
– **Objective:** Ensure consistent practice and adherence to safety protocols.
4. **Effective Communication and Handoff**
– **Description:** Training on communication techniques and structured handoff procedures to ensure critical information is passed accurately between shifts.
– **Objective:** Improve continuity of care and reduce errors due to communication breakdowns.
### References
– Harris, M. (2021). *Understanding Nursing Malpractice: An Overview*. Nursing Law Journal, 32(4), 56-64.
– Lee, R. (2022). *Managing Negligence in Nursing: Principles and Practice*. Healthcare Risk Management Review, 20(1), 12-19.
– Smith, L., & Jones, A. (2023). *Continuing Education for Nursing Professionals: Addressing Gaps and Improving Care*. Journal of Nursing Education, 45(2), 88-97.
– Sullivan, K. (2022). *The Standards of Care and Nursing Negligence*. American Nursing Review, 44(3), 34-42.
– State Board of Nursing. (n.d.). *Disciplinary Actions and Process*. Retrieved from [state board website]
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This proposal outlines a comprehensive plan for addressing the factors contributing to the nursing incident, evaluating the legal implications, and recommending targeted continuing education to mitigate future risks.
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:
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Factor #1:
How do you minimize legal risk:
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Factor #1:
How do you minimize legal risk:
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Factor #1:
How do you minimize legal risk:
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| Factor #2:
How do you minimize legal risk:
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Factor #2:
How do you minimize legal risk:
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Factor #2:
How do you minimize legal risk:
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Factor #2:
How do you minimize legal risk:
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| Factor #3:
How do you minimize legal risk:
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Factor #3:
How do you minimize legal risk:
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Factor #3:
How do you minimize legal risk:
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Factor #3:
How do you minimize legal risk:
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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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