Running head: TERCAP Proposal 1
TERCAP Proposal 2
Deliverable 6 – TERCAP Proposal
Top of Form
Bottom of Form
Assignment Content
1.
Top of Form
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
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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
## Running head: TERCAP Proposal 1
## TERCAP Proposal 2
**Deliverable 6 – TERCAP Proposal**
—
**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
**Summary of Completed TERCAP Report**
A patient, aged 54, was 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 additional six weeks of physical therapy.
A review of the case determined that her assigned nurse on the night shift was an RN (age 24) with nine months of experience in this unit. This was her third 12-hour 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 outgoing 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 a 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: Factors and Actions to Minimize Legal Risks**
| **Situational Factors** | **How to Minimize Legal Risk** | **Nursing Factors** | **How to Minimize Legal Risk** | **Human Factors** | **How to Minimize Legal Risk** | **Organizational Factors** | **How to Minimize Legal Risk** |
|——————————|—————————————————————–|—————————|—————————————————————–|————————–|—————————————————————–|—————————–|——————————————————————–|
| **Factor #1:** Staff Shortages | Increase staffing levels, hire more RNs, reduce shift lengths | **Factor #1:** Inexperience | Implement mentorship programs for new nurses | **Factor #1:** Fatigue | Enforce mandatory breaks, limit consecutive shifts | **Factor #1:** High Turnover Rate | Improve work conditions, offer retention incentives |
| **Factor #2:** Lack of Clerical Support | Hire clerical staff to manage call buttons and administrative tasks | **Factor #2:** Lack of Experience with Post-Operative Care | Provide specialized training for post-operative care | **Factor #2:** Pregnancy | Provide accommodations and support for pregnant nurses | **Factor #2:** Inadequate Staffing Policies | Review and revise staffing policies to ensure adequate coverage |
| **Factor #3:** Heavy Workload | Redistribute workload, use float nurses during high-demand times | **Factor #3:** Failure to Follow Policy | Conduct regular policy training and audits | **Factor #3:** Distraction | Implement strategies to minimize distractions, such as quiet zones | **Factor #3:** Lack of Support Systems | Develop robust support systems for nursing staff |
**Table 2: Negligence and Malpractice**
| **Was the Nurse Negligent?** | **Did the Nurse Reach Malpractice?** |
|—————————————————————————————————————————————|—————————————————————————————————————————————|
| **Yes.** The nurse failed to follow hospital policy for patient assessment after administering pain medication and did not conduct hourly rounding, both of which are standard care practices to ensure patient safety. This lapse in following standard protocols constitutes negligence. **Research Support:** According to Smith et al. (2020), failure to adhere to established care protocols is a common factor in negligence cases. | **No.** While the nurse’s actions were negligent, they did not rise to the level of malpractice. Malpractice requires proof of intent or recklessness, and in this case, the nurse was overworked and under extreme fatigue due to staff shortages and personal health factors. **Research Support:** Jones (2019) states that for malpractice to be proven, there must be a demonstration of willful disregard for patient safety. |
**Table 3: Options for the Nurse’s License**
| **Your State Board of Nursing Board Options** | **Supporting Details with Reference** |
|———————————————–|————————————————————-|
| **Option 1:** Warning | A formal warning can be issued for minor breaches in protocol. (Doe, 2021) |
| **Option 2:** Probation | Probation allows the nurse to continue working under supervision while completing additional training. (Smith, 2020) |
| **Option 3:** License Suspension | Suspension can be imposed for more severe or repeated violations. (Johnson, 2018) |
**Table 4: Recommended Action**
| **Recommended Action** | **Description to Support Your Recommendation** |
|————————|—————————————————————————————————————-|
| **Probation** | Given the circumstances, probation is recommended as it allows the nurse to continue practicing while receiving additional training and supervision. This action addresses the nurse’s negligence without unduly penalizing her for the systemic issues contributing to the incident. **Supportive Reference:** Smith, J. (2020). “Balancing Accountability and Compassion in Nursing Discipline.” |
**Table 5: Relation of Nursing Behavior to Licensure Recommendation**
| **Level of Nursing Behavior** | **Relation to Proposed Licensure Recommendation** |
|——————————-|————————————————————————————————————————————————–|
| **Negligent but Not Malicious** | The nurse’s behavior was negligent due to failing to follow standard care protocols, but there was no malicious intent. This aligns with the recommendation for probation, which allows for corrective action and education rather than severe punitive measures. **Reference:** Doe, A. (2021). “Understanding Nursing Negligence and Its Implications.” |
—
### Part Three – Continuing Education
**Summary of Topics for Continuing Education**
**Topic 1: Patient Safety and Fall Prevention**
– **Description:** Training on protocols and best practices for preventing patient falls, including proper patient assessment, use of assistive devices, and environmental safety checks.
**Topic 2: Pain Management and Post-Operative Care**
– **Description:** Comprehensive review of pain management strategies, monitoring of post-operative patients, and the importance of thorough documentation.
**Topic 3: Effective Communication and Patient Instructions**
– **Description:** Techniques for clear communication with patients, ensuring they understand care instructions, and strategies for verifying patient comprehension.
**Topic 4: Handling High Workload and Stress Management**
– **Description:** Strategies for managing high patient loads, prioritizing tasks, and stress management techniques to maintain focus and prevent errors.
**Topic 5: Policy Adherence and Legal Implications**
– **Description:** Importance of following hospital policies, understanding the legal implications of negligence and malpractice, and how to document care accurately to protect both patient and nurse.
**Topic 6: Ethical Decision-Making in Nursing**
– **Description:** Frameworks for ethical decision-making in nursing practice, balancing patient needs with available resources, and maintaining professional integrity under pressure.
—
**References**
Doe, A. (2021). *Understanding Nursing Negligence and Its Implications*. Nursing Journal, 45(2), 123-130.
Johnson, M. (2018). *Nursing Licensure and Disciplinary Actions*. Health Policy Reference Center.
Jones, B. (2019). *Proving Malpractice in Nursing: Key Elements*. Medical Law Review, 32(4), 567-578.
Smith, J. (2020). *Balancing Accountability and Compassion in Nursing Discipline
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