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 RN's employment 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 Civil Statutes, Article 4525a, §6A(b) as "conduct that does not indicate the nurse's continuing to practice professional nursing poses a risk of harm to the client or other person." An RN 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 of poor practice by the RN;
   3. (3) the RN exhibits a conscientious approach to and accountability for his/her practice; and
   4. (4) the RN appears to have the knowledge and skill to practice safely.

3. (c) Other conditions which may be considered in determining that mandatory reporting is not required are:

   1. (1) the significance of the event in the particular practice setting;
   2. (2) the situation in which the event occurred; and
   3. (3) the presence of contributing or mitigating circumstances in the nursing care delivery system.

4. (d) A 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 employing facility's policy;
   2. (2) the nurse's manager shall maintain a record of each minor incident involving those RNs under his/her supervision;
   3. (3) the nurse's manager shall assure that the incident/variance report contains a complete description of the incident, patient record number, witnesses, RN involved and the action taken to correct or remediate the problem;
   4. (4) the nurse's manager shall report an RN to the Peer Review Committee if three minor incidents involving the RN are documented within a one-year 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.
5. (e) In employment settings where no Peer Review Committee is required to exist, the nurse's manager shall review minor incidents involving those RNs under his/her supervision and keep the same reports as required in subsection (c)(1),(2), and (3) of this section. A nurse's manager shall report any RN involved in three minor incidents within one year to the Board.
6. (f) Nothing in this rule is intended to prevent reporting of a potential violation directly to the Board.
7. (g) 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.