Read the following scenario and then answer the questions that followYou are on your hospital's Peer Review Committee (PRC). You are reviewing Nurse A's practice. She works on the pediatric unit. In the past, Nurse A has practiced safely without incidents. However, four months ago, Nurse A gave immunizations to five pediatric patients (3 months, 9 months, 2 years, 4 years, and 5 years of age). She used a vial of Hepatitis B vaccine that had been expired for 30 days but still was being stored in the unit refrigerator. She gave the five immunizations within a few minutes of each other, and she got the vial from the refrigerator only once (i.e., She did not take it out and replace it five times). She took responsibility for the errors when she was informed by her unit manager.

Should Nurse A be reported to the BON?

Apply the Minor Incident Rule to reach and support your decision

A. Criteria. First, review your learning about minor incidents - those which are NOT reportable to the BON. In the first column of the table, list the 4 criteria that are essential in determining if an incident is not "minor."

Criteria that determine an incident is NOT minor

Explanation of whether or not the facts

determine that the incident is NOT minor

There is a significant risk of harm.

The facts of the case support this criteria. As per the case, there is no risk of significant harm to the patients immunized with the expired vial. A vaccination works to prevent the occurrence of the disease (Kuenstler, 2014). Therefore and expired vaccine would not have any risk of harm to the patient.

The nurse lacks a conscientious approach or accountability...

Nurse A did not offer excuses and it is clear she was unaware the vaccine had expired before administering it to the patients.
Nurse lacks easily remediated knowledge and competencies for making appropriate clinical judgements (Texas Board of Nursing, 2016).

Nurse A has not had any other incidents and has always practised safely. The knowledge of nurse A can be remediated and Nurse A can be shown how to check the expiration date for drugs.

There is a pattern of multiple minor incidents

Based on the facts of the case, this was the first incident the nurse has faced. This clearly indicates that there is no need to eport the nurse as this was a minor case and the first time that the nurse had an incident.

B. Minor Incident? Apply the facts of the case to each criterion above. In the second column of the table, record your explanation as to whether the facts support or do not support each of the criteria.

C. Your Decision. Record whether, as a member of the Peer Review Committee (PRC), you would vote to report or not report Nurse A to the Board of Nursing. (Insert an X in the box that reflects your decision.)

Report

X

Not report

Part 2: Applying Rule 217.19 Incident-Based Peer Review

Read the following scenario and then reflect upon the actions it portrays.

Last module, the chairperson of your hospital's Peer Review Committee (PRC) passed you in the hallway and said, "I'm glad I ran into you. You're going to be peer-reviewed." The chairperson continued, saying, "Your manager found out that you called…