TERCAP (Taxonomy of Error, Root Cause Analysis Practice-Responsibility

KBN's Consumer Protection Branch, Investigation and Discipline Section, is a participating Member Board of the National Council of State Boards of Nursing (NCSBN) TERCAP project.  The TERCAP project was implemented in 1999 by NCSBN’s Board of Directors who appointed a task force to develop new knowledge about the causes of nursing practice breakdown.

In 2004, the following recommendation was made in the Third Institute of Medicine (IOM) Report on patient safety entitled, Keeping Patients Safe, Transforming the Work Environments of Nurses (2004):
Recommendation 7.2: The National Council of State Boards of Nursing [NCSBN], in consultation with patient safety experts and health care leaders, should undertake an initiative to design uniform processes across states for better distinguishing human errors from willful negligence and intentional misconduct, along with guidelines for their applicability by state boards of nursing and other state regulatory bodies (IOM, 2004, p. 15).

TERCAP was designed as an intake instrument for capturing data from nursing boards' discipline cases.  It creates an opportunity for consistent data collection and future analysis of compiled data by NCSBN and Member Boards.  The NCSBN Research Department will have access to the data submitted by participating Member Boards for the purpose of research through data analysis.  Only Member Boards participating in TERCAP will have access to the TERCAP reports, cases, and data until such time as there are a sufficient number of cases to prepare formal reports that will be published.

KBN's Consumer Protection Branch, Investigation and Discipline Section, may request additional information for the purpose of TERCAP.  

The goal of the TERCAP instrument is to get to the root cause of practice breakdown.  Member Boards will identify practice breakdown through TERCAP in the following categories:

Safe Medication Administration

• The nurse administers the right dose of the right medicine via the right route to the right patient at the right time for the right reason.

Documentation

• The nurse ensures complete, accurate, and timely documentation.

Attentiveness/Surveillance

• The nurse monitors what is happening with the patient and staff.
• The nurse observes the patient’s clinical condition; if the nurse has not observed the patient, then s/he cannot identify changes if they occurred and/or make knowledgeable discernments and decisions about the patient.

Clinical Reasoning

• The nurse interprets patient signs, symptoms, and responses to therapies.  The nurse evaluates the relevance of changes in patient signs and symptoms and ensures that patient care providers are notified and that patient care is adjusted appropriately.
• The nurse titrates drugs and other therapies according to their assessment of patient responses (e. g. assesses patient’s pain and adjusts pain medications).

Prevention

• The nurse follows usual and customary measures to prevent risks, hazards, or complications due to illness or hospitalization.  These include fall precautions, preventing hazards of immobility, contractures, stasis pneumonia, etc.

Intervention

• The nurse properly executes healthcare procedures aimed at specific therapeutic goals.
• Interventions are implemented in a timely manner. 
• The nurse performs the right intervention on the right patient.

Interpretation of Authorized Provider’s Orders

• The nurse interprets authorized providers orders.

Professional Responsibility/Patient Advocacy

• The nurse demonstrates professional responsibility and understands the nature of the nurse-patient relationship.
• Advocacy refers to the expectations that a nurse acts responsibly in protecting patient/family vulnerabilities and in advocating to see that patient needs/concerns are addressed.

The TERCAP Instrument [PDF Format - 269k] can be printed for use by any facility.  This instrument can also supplement the complaint form submitted to the KBN office.

The following questions are frequently asked about TERCAP:

Q:  What is “practice breakdown”?
A:  Practice breakdown is the disruption or absence of any of the aspects of good practice.

Q:  On what kinds of cases should TERCAP be used?
A:  Cases that involve some aspect of practice breakdown.

Q:  How can I get the TERCAP instrument?
A:  Click here [PDF Format - 269k]

Q:  When did the Kentucky Board of Nursing start utilizing the TERCAP instrument?
A:  July 1, 2007

Q:  Will you disclose my name and license number?
A:  No, the identity of the nurse is not revealed.

Harvard Health Policy Review/Vol. 7, No. 1, Spring 2006  

Relevant Articles:

• TERCAP: Creating A National Database On Nursing Errors
• Nursing And Patient Outcomes: How Can Employers Provide The Right Environment For Nurses To Deliver High Quality Care?