1. (a) The Board believes protection of the public is not enhanced by the reporting of every minor incident that may be a violation of the Texas Nursing Practice Act. This is particularly true when there are mechanisms in place in the nurse's practice setting to take corrective action, remediate deficits and detect patterns of behavior. This rule is intended to clarify both what constitutes a minor incident and when a minor incident need not be reported to the board.

2. (b) A "minor incident" is defined by Texas Occupations Code §301.419(a) as "conduct that does not indicate that the continuing practice of nursing by an affected nurse poses a risk of harm to a client or other person." A nurse involved in an incident which is determined to be minor need not be reported to the Board or the Peer Review Committee if all of the following factors exist:

   1. (1) the potential risk of physical, emotional or financial harm to the client due to the incident is very low;
   2. (2) the incident is a singular event with no pattern indicating the nurse's continuing practice would pose a risk of harm to clients or others;
   3. (3) the nurse exhibits a conscientious approach to and accountability for his/her practice; and
   4. (4) the nurse appears to have the knowledge and skill to practice safely.

3. (c) Other factors which may be considered in determining whether a minor incident should be reported to the Board are:

   1. (1) the significance of the nurse's conduct in the particular practice setting; and
   2. (2) the presence of contributing or mitigating circumstances, including systems issues, in relation to the nurse's conduct.

4. (d) A single minor incident need not be reported to the Board or the Peer Review Committee. When a decision is made that the incident is minor, the following steps are required:

   1. (1) an incident/variance report shall be completed according to the facility's policy;
   2. (2) a record shall be maintained of each minor incident;
   3. (3) the incident/variance report shall contain a complete description of the incident, patient record number, witnesses, nurse involved, and the action taken to correct or remedy the problem;
   4. (4) In practice settings where a Peer Review Committee exists, the nurse manager or supervisor shall report a nurse to the Peer Review Committee if three minor incidents involving the nurse are documented within a one-year (any 12 consecutive month) time period; and

   5. (5) the Peer Review Committee shall review the three minor incidents and make a determination as to whether a report to the Board is warranted in accordance with Texas Occupations Code Annotated §301.403 (NPA). The committee need not report to the Board when they determine that:

      1. (A) The nurse's actions in the three incidents considered together continue to meet the criteria of subsection (b)(1) - (4) of this section, relating to criteria for "minor incidents; and
      2. (B) the committee determines remediation and monitoring of the nurse's knowledge and/or skills can be accomplished without referral to the Board.
   6. (6) If additional practice related errors are committed by the nurse after peer review is conducted, the information on the first three errors shall be given new consideration in combination with subsequent incidents occurring after this initial review process.
   7. (7) In practice settings where no Peer Review Committee exists, the nurse manager or supervisor shall review minor incidents involving those nurses under his/her supervision and keep the same reports as required in paragraphs (1) - (3) of this subsection. A nurse manager or supervisor shall report any nurse involved in three minor incidents within one year to the Board.
5. (e) Nothing in this rule is intended to prevent reporting of a potential violation directly to the Board.
6. (f) Failure to classify an event appropriately in order to avoid reporting may result in violation of the mandatory reporting statute.

Source Note:The provisions of this §217.16 adopted to be effective September 1, 1999, 24 TexReg 4001; amended to be effective February 19, 2003, 28 TexReg 1378; amended to be effective July 5, 2004, 29 TexReg 6296.