- • Nebraska Reports Individual Physicians - Not Adverse Events
NEBRASKA DOES NOT HAVE A MEDICAL ERROR REPORTING PROGRAM!
Nebraska has a mandatory reporting program to report individuals who are licensed, certified, or registered by the Nebraska Health and Human Services System (HHSS).1 The Department of Regulation and Licensure certifies and has licensure authority for health professionals (e.g., nurses, doctors, and psychologists) and other para-medical professionals, as well as licensure authority for healthcare facilities and services. In 1995, the Nebraska HHSS promulgated Title 172 NAC, Chapter 5 [PDF, ”Regulations Governing Mandatory Reporting by Health Care Professionals, Facilities, Peer and Professional Organizations, and Insurers.” These regulations, under the original authority of the Department of Health, Bureau of Examining Boards,2
“. . . govern the manner and method in which health care professionals, health care facilities, peer review organizations, professional associations and insurers shall report actions or conduct by persons who are licensed, certified, or registered by the Department which may violate laws or regulations governing their professions.”
The extent of the reporting is provided in the Summary of Mandatory Reporting Requirements [PDF]. This document describes the conditions for reporting (and self-reporting) of health professionals and lists 23 mandatory reporting requirements and circumstances imposed upon all "health care professionals, facilities, peer and professional organizations, and insurers."
Medical errors is one of many reasons why licensed individuals might be reported. In the context of these regulations, reporting of “gross Incompetence or a pattern of negligent conduct” by other licensed individuals or “adverse actions taken against licensed individuals” by health facilities, peer review organizations, or professional societies might represent categories for which medical errors may underlie the reporting of that licensed individual.
However, the reporting program regulations extend to licensee behavior, conduct, medical malpractice claims, criminal convictions, and issues that may not reflect negligence or medical error. Clearly medical error reporting is not the focus of these regulations.
A March 2003 NASHP publication that addressed the issue of adverse event definitions across multiple states compared state definitions against the 27 NQF 'Never' Events definitions.3 Nebraska was represented as having an Adverse Event Reporting program, and all 24 of the 27 NQF definitions for which Nebraska was alleged to have definitions were classified in the category "State includes this event but not explicitly."
However, based on Nebraska regulations and documents available from Nebraska, this NASHP position has likely been mis-stated. Nebraska has neither an adverse event reporting program nor definitions to support it. Nebraska has a Health Professional/Provider reporting program.
1 In 1996, the Legislature passed the Nebraska Partnership for Health and Human Services Act, LB 1044, which combined the Departments of Health, Social Services, Aging, and Public Institutions and the Office of Juvenile Services and reorganized them into the Nebraska Health and Human Services System, which is comprised of three agencies: 1) the Department of Finance and Support, 2) the Department of Regulation and Licensure, and 3) the Department of Services.
3 "Rosenthal J and Booth M, "Defining Reportable Adverse Events: A Guide for States Tracking Medical Errors," National Academy for State Health Policy, GNL50; March 2003. [PDF]
- • Medication Error Reporting
The State of Nebraska has hospital regulations that require that
“each hospital must establish and implement policies and procedures for reporting any errors in administration or provision of prescribed medications to the prescriber in a timely manner upon discovery and a written report of the error prepared.” [175 NAC 9-006.06B3].
However, these medication errors are not reported to any state agency. There is no dedicated medical error reporting program in Nebraska.
- • Non-public Patient Safety Initiatives
The Medication Error Reporting Project is a collaboration between the Nebraska Center for Rural Health Research, The Nebraska Medical Center, and participating Nebraska Critical Access Hospitals (CAH) hospitals that have 50 or fewer beds. The purpose of this collaboration is to provide a system of data collection, systems analysis, feedback and workshop opportunities regarding medication errors in small rural hospitals. The rural hospital medication error project website is available at the University of Nebraska Medical Center, and it provides some of the results and findings in that project. The participating hospitals provide reports of medication-related errors via Pharmacopeia's MedMarx™ program.
The Nebraska Hospital Association (NHA) maintains a Patient Safety website that provides links to Nebraska hospitals' voluntary efforts with patient safety initiatives. It is apparent that patient safety is a major theme and concern among both rural Critical Access Hospitals (CAH) and non-CAH hospitals.