What are the core essentials of the PreP 4 Patient Safety model and what aspects are adaptable to accommodate the idiosyncrasies of the participating states?
The core essentials are:
>hospitals must agree to inform licensing boards of every intervention to upgrade skills and knowledge, and boards must likewise agree to inform hospitals when the board identifies practitioners with deficient skills or performance who hold privileges at their facility;
>licensing boards must agree to honor the confidentiality of participating practitioners so long as they are complying with terms of their intervention plans;
>licensing boards must agree to take over the monitoring function if a participating practitioner leaves the hospital for any reason.
The flexible elements are:
>pilots can be adapted to take into account existing statutes, structures, and political realities, so long that this does not compromise the essential elements;
>pilots can be adapted to incorporate existing licensing board programs, if any (examples might include board-initiated continuing competence, quality improvement or educational intervention programs, existing mandatory adverse action or incident reporting requirements);
>eligibility requirements (except that PreP 4 Patient Safety is not a substitute for disciplinary action);
>financing of interventions;
>all other aspects of the program that are not required as core essentials.
What is an "intervention to upgrade skills and knowledge?"
An intervention to upgrade skills and knowledge could take many forms, including requiring a practitioner to take a course or a mini-residency to upgrade specific skills; requiring a practitioner to perform certain tasks only under the supervision of another practitioner; requiring a practitioner to seek a second opinion before making diagnoses or providing services. The objective of the intervention is to upgrade the skills and knowledge of practitioners considered to be deficient, as a proactive, preventative action in the hope that this will prevent medical errors from occurring. These interventions are appropriate for licensed practitioners whose skills, knowledge and performance do not (yet) warrant that the board or the hospital would take an adverse action. Case studies illustrating situations that are appropriate for PreP 4 Patient Safety interventions to upgrade skills and knowledge, as well as illustrating the development and monitoring of such interventions, have been developed by different states and some are posted on this web site.
What are participating boards expected to do?
>Contact hospital(s) or the state hospital association, relevant state professional associations, educators and educational institutions, legislators and other interested parties to educate them about the project and initiate pilots;
>Convene a face-to-face meeting of interested parties and get buy-in to a pilot (CAC project personnel will attend, if desired);
>Agree on purposes, goals and parameters of the pilot in your state;
>Assign a staff member to manage and administer the pilot program and act as contact person and advisor to the hospitals and to CAC;
>For hospital-initiated interventions (see the "Pathways" document for more information), negotiate memoranda of understanding (MOUs) with participating hospitals specifying roles and responsibilities of licensing board(s), hospitals and other participants, and stating the terms in writing (e.g., eligibility to participate; nature of remedial interventions; qualified remedial education providers; process for monitoring interventions; post-intervention evaluations, etc.);
>For hospital-initiated interventions, establish a procedure for receiving information from participating hospitals regarding practitioners with deficiencies in skills or knowledge that warrant an intervention;
>For board-initiated interventions, establish a procedure for informing hospitals about practitioner skill and knowledge deficiencies about which the board has learned from another source, such as consumer complaints or reports from colleagues;
>For board-initiated interventions, negotiate individual monitoring agreements with hospitals;
>Participate with cooperating hospitals in the design of educational interventions on a generic and, as needed, on a case-by-case basis
>Establish a procedure for staying informed of the progress of interventions monitored by the participating hospital(s);
>Establish a procedure for taking over the monitoring of practitioner(s) who leave the hospital that imposed the intervention before it has been successfully completed.
What are participating hospitals expected to do?
>Inform and educate its medical staff leaders and governing board about the pilot program, the requirements of participation, and how the program changes current hospital practice;
>For hospital-initiated interventions (see the "Pathways" document for more information), negotiate MOUs with participating state health professional regulatory board(s);
>For hospital-initiated interventions, identify individual practitioners in need of intervention to upgrade their skills and knowledge;
>For board-initiated interventions, receive referrals from the regulatory board(s) about practitioners in need of upgrading;
>Develop individualized intervention plans to upgrade knowledge and skills, in collaboration with the appropriate licensing board as needed;
>Inform the appropriate board of the intervention plan, on a confidential basis;
>Monitor the execution of the intervention plan;
>Share progress reports with the appropriate licensing board(s);
>Notify the appropriate licensing board(s) of the successful completion of the intervention plan or, in the alternative, any failure to satisfactorily complete the intervention plan.
What does CAC do?
>We have prepared template documents and educational programs for use by boards and hospitals;
>We aid and assist participating boards and hospitals throughout the course of the pilot projects;
>We help you trouble-shoot as required;
>We consult with you, if requested, in developing intervention plans to upgrade practitioner skills and knowledge;
>We maintain a secure on-line directory of education providers and facilities, and a moderated discussion group to enable participating states to share experiences with and aid one another;
>Identify and pursue potential sources of funding to boards and hospitals to offset the costs of continued participation in this program;
>Prepare a report at the end of the project, including aggregate data and best practices.
Why should boards and hospitals participate in the PREP Pilot Project?
>The pilot is breaking new ground in line with the Institute of Medicine's ideas about reducing medical errors and improving patient safety;
>The pilot offers an opportunity for boards and hospitals to expand the scope of their cooperative efforts;
>The pilot tests an intervention model that offers patients protection from practitioners with deficient skills and knowledge while offering the practitioners an opportunity to upgrade their competence;
>The pilot seeks to tap the potential of educational rather than punitive approaches to quality improvement.
Will a state need special legislation to participate in this project?
States that have statutes that appear to prevent them from engaging in a pilot at present (e.g. open records laws that make it difficult for the board to assure confidentiality of reports,) may wish to alert interested legislators of their participation in the pilot and their proposed methods for assuring confidentiality during the pilot.
What will the costs be?
>The administrative costs for both the licensing board and the hospital will involve staff time and overhead. Hopefully, these can be kept at an acceptable level during the initial months of the pilots, but additional funding may well be needed to extend the program on a permanent basis. CAC will seek funding for participating states for continuation of the pilots after 2001;
>It is anticipated that the costs to licensees of participating in educational interventions will be borne by the individual practitioners, as they are currently in programs for chemically dependent health care practitioners and in current medical board post-licensure assessment programs. States in which the licensing authority or professional association wish to subsidize the costs of interventions for individual practitioners may want to incorporate that into the structure of their pilots.
What makes a practitioner eligible for participation in a remedial intervention?
>The practitioner is willing to agree to the terms of the remedial intervention;
>All other eligibility criteria will be determined on a state-by-state basis by the licensing board(s) and participating hospitals.
What makes a practitioner ineligible for participation in a remedial intervention?
>The practitioner has been discharged by the participating hospital or has had practice privileges taken away. (This does not preclude the participation of practitioners whose privileges are restricted or reduced while in assessment, or pending evaluation after completion of assessment, or those whose privileges are limited as a part of the educational intervention.)
What should I do if we are interested in participating in the PreP 4 Patient Safety Pilot Project?
>Contact CAC to indicate your interest;
>plan to attend one of the NCSBN or AIM Meetings where CAC is updating participants on the PreP 4 Patient Safety Project. Participants at these meetings will be invited to contribute to the refinement of concepts and practical considerations on which the individual states' pilots will be based, and on the content of model forms and documents CAC will develop for the use of state boards and hospitals, such as MOUs, a list of job functions for the board contact person, model policies and procedures for participating boards and hospitals to follow (or adapt) during the pilot; sample intervention plans, and other resources. |
