Chapter 4723-18 Practice Intervention and Improvement Program (PIIP)

4723-18-01 Definitions.

As used in this chapter:

(A) "Certificate holder" means an individual holding either: .

(1) A current, valid certificate of authority issued by the board to practice as a certified nurse-midwife, certified nurse practitioner, certified registered nurse anesthetist, or clinical nurse specialist; or

(2) A current, valid certificate issued by the board to provide dialysis care as a dialysis technician.

(B) "Educational provider" means the following:

(1) A provider or provider unit that has been approved by an Ohio board of nursing

(OBN) approver in accordance with Chapter 4723-14 of the Administrative Code;

(2) An educational institution that is both acceptable to the supervising member, and accredited by a nationally recognized accrediting body;

(3) A prelicensure nursing education program approved by the board in accordance with Chapter 4723-5 of the Administrative Code;

(4) A state board or agency that regulates health care providers when an educational offering approved or accepted by the board or agency contains content that has been prescribed by the supervising member for a participant in the practice intervention and improvement program; or.

(5) An employer of a licensee or certificate holder determined to be eligible for the practice intervention and improvement program pursuant to rules 4723-18-02 and 4723-18-03 of the Administrative Code, provided the employer meets the criteria specified in paragraph (C) of rule 4723-18-06 of the Administrative Code.

(C) "Employer" means any person for whom a licensee or certificate holder works, or may work in the future, or any institution that grants practice privileges enabling a licensee or certificate holder to practice at the institution, while participating in the practice intervention and improvement program.

(D) "Licensee" means any individual holding a current valid license issued by the board to practice nursing as a registered nurse or licensed practical nurse.

(E) "Participant" means a licensee or certificate holder undergoing a remedial process in the practice intervention and improvement program.

(F) "Participatory agreement" means a confidential, voluntary, written contract executed by a licensee or certificate holder and the practice intervention and improvement program (PIIP) which includes, but is not limited to, the following:

(1) Stipulation of the licensee's or certificate holder's identified practice deficiency;

(2) Consent of the licensee or certificate holder to participate in the remediation process required by the board;

(3) Consent by the licensee or certificate holder that allows the release to PIIP of all information pertaining to the licensee's or certificate holder's remediation process; and

(4) A provision whereby the failure of the remediation process will result in disciplinary action of the licensee or certificate holder by the board.

(G) "Practice intervention and improvement program" or "PIIP" means the program authorized by section 4723.282 of the Revised Code that allows the board to abstain from taking disciplinary action against a licensee or certificate holder, who has a practice deficiency that has been identified by the board through an investigation conducted under section 4723.28 of the Revised Code.

(H) "Practice deficiency" means a practice activity that does not meet acceptable standards of safe and effective nursing care as set forth in Chapter 4723-4 of the Administrative Code or rules 4723-8-02, 4723-9-08, and 4723-9-09 of the Administrative Code, or the acceptable standards of safe and effective dialysis care as set forth in rules 4723-23-12 and 4723-23-14 of the Administrative Code.

(I) "Remediation" means a prescribed educational intervention that is designed to correct an identified practice deficiency of a licensee or certificate holder. Remediation includes, but is not limited to, successful demonstration by the licensee or certificate holder that the learned knowledge and skills have been incorporated into the licensee's or certificate holder's practice.

(J) "Representative of the board" means an educational provider or workplace monitor, designated by the board to act on its behalf, who has entered into an agreement with PIIP to provide remediation or evaluation pursuant to section 4723.282 of the Revised Code and this chapter.

(K) "Supervising member" means the board member elected to serve as the supervising member for disciplinary matters in accordance with section 4723.02 of the Revised Code.

(L) "Workplace monitor" means the individual who observes and evaluates, for a specified time period, the practice of a participant in PIIP to determine whether the participant has incorporated applicable learned knowledge and skills into workplace practice.

Effective: 02/01/2009
R.C. 119.032 review dates: 10/16/2008 and 10/01/2013
Promulgated Under: 119.03
Statutory Authority: 4723.07, 4723.282
Rule Amplifies: 4723.282
Prior Effective Dates: 2/1/2001, 2/1/2003, 2/1/2004, 2/1/2007

4723-18-02 Process and criteria to use when identifying an individual's practice deficiency.

(A) The board shall investigate, in accordance with section 4723.28 of the Revised Code, evidence that appears to show that a licensee or certificate holder has failed to practice in accordance with acceptable standards of safe practice as set forth in Chapter 4723-4 of the Administrative Code, rules 4723-8-02, 4723-9-08, and 4723-9-09 of the Administrative Code, or rules 4723-23-12 and 4723-23-14 of the Administrative Code.

(B) The supervising member shall review the evidence obtained during the investigation to determine whether the licensee's or certificate holder's identified practice deficiency can be corrected through participation in the practice intervention and improvement program (PIIP) rather than through formal disciplinary action. Criteria to use when making this determination include, but are not limited to, the following:

(1) Whether the public will be adequately protected from unsafe practice if the licensee or certificate holder enters PIIP;

(2) Whether the licensee's or certificate holder's practice deficiency resulted in harm or other untoward outcome for the patient;

(3) The likelihood that the identified practice deficiency at issue is a deficiency that can be corrected through remediation;

(4) The extent of the licensee's or certificate holder's cooperation with the board during the investigation;

(5) Whether the licensee's or certificate holder's identified practice deficiency represented an intentional or willful commission or omission by the licensee or certificate holder;

(6) The frequency of the occurrence of the identified practice deficiency;

(7) The adverse impact of the identified practice deficiency on others;

(8) Whether the identified practice deficiency affected a particularly vulnerable patient;

(9) Whether the licensee or certificate holder is eligible for participation in PIIP in accordance with rule 4723-18-03 of the Administrative Code; and

(10) Whether the licensee or certificate holder has a mental or physical impairment that contributed to the practice deficiency.

(C) When the supervising member has reason to believe, after an investigation and review of evidence, that the licensee's or certificate holder's identified practice deficiency can be successfully corrected through participation in PIIP, the board may abstain from taking disciplinary action provided the licensee or certificate holder enters into an agreement with PIIP in accordance with rule 4723-18-04 of the Administrative Code, complies with the terms and conditions of PIIP, and successfully completes PIIP.

Effective: 02/01/2007
R.C. 119.032 review dates: 10/16/2008 and 10/01/2013
Promulgated Under: 119.03
Statutory Authority: 4723.07, 4723.282
Rule Amplifies: 4723.282
Prior Effective Dates: 2/1/01

4723-18-03 Eligibility requirements for participation in the practice intervention and improvement program (PIIP).

An individual may participate in the practice intervention and improvement program if the supervising member determines that the public will be adequately protected from unsafe practice if the licensee or certificate holder enters PIIP, and:

(A) The individual has not been the subject of formal disciplinary action by any regulatory board or entity located in Ohio or in another jurisdiction, unless the supervising member determines that the previous disciplinary action was for a violation which should not preclude participation in PIIP;

(B) The individual is not concurrently under investigation by the board for a violation of Chapter 4723. of the Revised Code or the rules of the board that does not constitute a practice deficiency;

(C) The supervising member determines that the nature of the individual's identified practice deficiency is such that it may be corrected through remediation;

(D) The individual holds a current valid license or certificate issued by the board;

(E) The individual is otherwise eligible to renew the license or certificate issued by the board; and

(F) If the board has compelled a licensee or certificate holder to submit to a mental or physical examination in accordance with division (G) of section 4723.28 of the Revised Code, the supervising member has determined that the licensee or certificate holder does not have any impairment identified through the examination that would significantly affect cognitive abilities or the ability of the licensee or certificate holder to incorporate learned knowledge and skills into the licensee's or certificate holder's practice.

4723-18-04 Provisions of the participatory agreement for the practice intervention and improvement program (PIIP).

(A) When a licensee or certificate holder has been determined by the supervising member to be eligible for the practice intervention and improvement program, in accordance with rules 4723-18-02 and 4723-18-03 of the Administrative Code, the licensee or certificate holder shall execute a participatory agreement with PIIP that includes, but is not limited to, provisions that:

(1) Set forth the identified practice deficiencies;

(2) Identify the specific remediation the participant must complete;

(3) Specify the time frame during which the participant must identify and select the educational provider that will provide the prescribed educational intervention and notify PIIP of the selection;

(4) Require the participant to pay all expenses the participant incurs as a result of the required remediation;

(5) Require the participant to provide the participatory agreement to a manager, or a person with equivalent or higher administrative responsibilities to a manager, of any and all employers or contracting entities for whom the participant provides nursing or dialysis care, and provide documentation to the board of the manager's receipt of the participatory agreement;

(6) Require a participant who is the holder of a certificate of authority issued under section 4723.41 of the Revised Code to provide a copy of the participatory agreement to the following, and submit documentation to the board of their receipt:

(a) The credentialing body of each institution at which the holder of a certificate of authority provides advanced practice nursing services or nursing care;

(b) Each collaborating physician with whom the holder of the certificate of authority works as a clinical nurse specialist, certified nurse practitioner, or certified nurse midwife;

(7) Require the participant to participate in workplace monitoring;

(8) Require the participant to cooperate with any entity, including, but not limited to, the educational provider and workplace monitor;

(9) Require the participant to cause any and all workplace monitors, selected in accordance with paragraph (B) of rule 4723-18-08 of the Administrative Code, and educational providers, selected in accordance with rule 4723-18-06 of the Administrative Code, to provide remediation and to send written progress reports regarding the participant's progress in remediation to PIIP at specified intervals;

(10) Require the participant to sign any and all waivers necessary to secure all reports required by PIIP;

(11) Require the participant to submit a written personal progress report containing the information required by PIIP to PIIP at specified intervals;

(12) Require the participant to meet in person with a PIIP representative at specified intervals;

(13) Require the participant to obey all federal, state, and local laws, including, but not limited to, all laws and rules regulating nursing practice or dialysis care in Ohio;

(14) Specify that the prescribed educational intervention may not be used to satisfy the continuing education requirements set forth in Chapter 4723. of the Revised Code and the rules of the board;

(15) Specify the terms and conditions the participant must meet to successfully complete the remediation, including, but not limited to, the time frames for successfully completing both the educational and workplace monitoring components of the remediation; and

(16) Set forth the grounds for termination from PIIP.

(B) A licensee or certificate holder determined by the supervising member to be eligible for PIIP who refuses to enter into the participatory agreement set forth in this rule within the time frame specified by PIIP may be subject to disciplinary action in accordance with section 4723.28 of the Revised Code.

4723-18-05 Grounds for termination from the practice intervention and improvement program (PIIP).

(A) A licensee or certificate holder determined by the supervising member to have a practice deficiency that may be remediated through participation in the practice intervention and improvement program may be terminated from PIIP for any of the following:

(1) Failure to comply with any term of the participatory agreement entered into by the participant;

(2) Receipt of evidence from the educational provider selected by the participant indicating that the participant has failed to progress through or to successfully complete the remediation in the manner and during the time frame prescribed by the supervising member;

(3) Receipt of evidence from the workplace monitor indicating that the participant has failed to incorporate learned knowledge and skills into practice or has continued to demonstrate the practice deficiency;

(4) Failure to complete the remediation; or

(5) Failure to maintain eligibility for PIIP.

(B) When a licensee or certificate holder is terminated from PIIP for one of the reasons specified in paragraph (A) of this rule, the board shall proceed with disciplinary action in accordance with section 4723.28 of the Revised Code. The board may consider an individual's termination from PIIP when determining the discipline to be imposed.

Effective: 02/01/2007
R.C. 119.032 review dates: 10/16/2008 and 10/01/2013
Promulgated Under: 119.03
Statutory Authority: 4723.07, 4723.282
Rule Amplifies: 4723.282
Prior Effective Dates: 2/1/01

4723-18-06 Requirements for educational providers.

(A) The practice intervention and improvement program shall utilize educational providers as defined in paragraph (B) of rule 4723-18-01 of the Administrative Code to provide the remedial educational intervention prescribed for a program participant.

(B) An educational provider that desires to offer a prescribed educational intervention for PIIP shall:

(1) Agree to meet the requirements set forth in paragraph (C) of this rule; and

(2) Agree, as a representative of the board, to maintain the confidentiality of all PIIP records in accordance with section 4723.282 of the Revised Code.

(C) The employer of a licensee or certificate holder determined to be eligible for the practice intervention and improvement program pursuant to rules 4723-18-02 and 4723-18-03 of the Administrative Code may serve as an educational provider if the employer:

(1) Employs or contracts with a registered nurse who holds a master's degree and has at least two years of experience in nursing education or adult education;

(2) Designs and executes a learning plan approved in advance by the board supervising member for disciplinary matters or the supervising member's designee that is tailored to meet the educational intervention prescribed for the PIIP candidate; and

(3) Agrees to maintain confidentiality of PIIP records in accordance with section 4723.282 of the Revised Code.

(D) When an educational provider is selected by a PIIP participant the provider shall:

(1) Maintain the confidentiality of the participant's participation in PIIP and of all records associated with the participant's specific prescribed educational intervention;

(2) Timely review the practice deficiency information provided by the participant that sets forth the specific prescribed educational intervention needed by the participant;

(3) Formulate and provide to the participant a learning plan for the participant that includes:

(a) Measurable objectives the participant must meet to successfully complete the prescribed educational intervention;

(b) The anticipated duration of the prescribed educational intervention; and

(4) Report to PIIP regarding the participant's progress in remediation at the intervals specified by PIIP;

(5) Notify PIIP in writing within five days of the occurrence of any of the following:

(a) Failure of the participant to satisfactorily progress through the prescribed educational intervention in the manner and during the time frame prescribed by the supervising member, or the participant's expulsion or termination from the intervention; or

(b) Failure of the participant to successfully complete the prescribed educational intervention.

When notification is provided in accordance with this paragraph, the educational provider shall provide to PIIP, within fourteen days after notification, evidence that documents the participant's failure to progress through or complete the prescribed educational intervention;

(6) Provide written verification to PIIP when the participant successfully completes the educational activity; and

(7) Provide a means acceptable to PIIP for the participant to complete the educational intervention if the provider ceases to provide the intervention.

(E) For purposes of providing the prescribed educational intervention directed by the supervising member, an educational provider selected by a PIIP participant shall be considered a representative of the board and, in accordance with section 4723.021 of the Revised Code, shall not be held liable in damages to any person as the result of any act, omission, proceeding, conduct, or decision related to official duties undertaken or performed pursuant to this chapter.

Effective: 02/01/2010
R.C. 119.032 review dates: 10/01/2012
Promulgated Under: 119.03
Statutory Authority: 4723.07, 4723.282
Rule Amplifies: 4723.282
Prior Effective Dates: 02/01/2001, 02/01/2002, 02/01/2007, 02/01/2009

4723-18-07 Standards and procedures for remediation.

(A) When the supervising member determines, in accordance with rules 4723-18-02 and 4723-18-03 of the Administrative Code, that a licensee's or certificate holder's identified practice deficiency may be remediated through participation in the practice intervention and improvement program, the licensee or certificate holder shall be notified in writing of the determination.

(B) In order to participate in PIIP, an eligible licensee or certificate holder shall enter into the participatory agreement set forth in rule 4723-18-04 of the Administrative Code.

(C) The participant shall select an educational provider and notify PIIP in writing of the provider selected within the time frame specified in the participatory agreement.

(D) The participant shall provide the selected educational provider with a copy of the participatory agreement and provide PIIP with documentation of the education provider's receipt of the agreement.

(E) In accordance with rule 4723-18-08 of the Administrative Code, PIIP shall establish workplace monitoring requirements that a participant must meet in order to demonstrate that the learned knowledge and skills have been incorporated into the participant's practice and shall notify the participant and the participant's workplace monitor in writing of these requirements.

(F) Upon receipt of evidence that the participant has failed to successfully complete the remediation, PIIP shall immediately notify the supervising member.

Effective: 02/01/2009
R.C. 119.032 review dates: 10/16/2008 and 10/01/2013
Promulgated Under: 119.03
Statutory Authority: 4723.07, 4723282
Rule Amplifies: 4723.282
Prior Effective Dates: 2/1/2001, 2/1/2007

4723-18-08 Standards and procedures for workplace monitoring.

(A) A licensee or certificate holder who is a participant in the practice intervention and improvement program shall be monitored by PIIP to determine whether the participant satisfactorily demonstrates that the learned knowledge and skills have been incorporated into the participant's practice.

(B)A participant, in collaboration with his or her employer, shall identify one or more individuals who meet the requirements of paragraph (E) of this rule who will act as a workplace monitor of the participant's nursing or dialysis care in accordance with the specifications set forth by PIIP.

(1) As directed by PIIP, observe specific aspects of the participant's practice at the intervals identified by PIIP;

(2) Evaluate specific aspects of the participant's practice and report to PIIP whether that practice, with respect to the identified practice deficiency, meets the standards of safe care as set forth in Chapter 4723-4, rules 4723-8-02, 4723-9-08 and 4723-9-09 of the Administrative Code, or rules 4723-23-12 and 4723-23-14 of the Administrative Code;

(3) Report to PIIP at the intervals required by PIIP regarding the participant's progress in remediation; and

(4) Maintain the confidentiality of the participant's participation in PIIP and of all records associated with the participant's remediation.

(D) A workplace monitor shall meet the following requirements:

(1) When monitoring a licensed nurse the workplace monitor shall be a registered nurse with a current, valid license;

(2) When monitoring a holder of a certificate of authority for an identified practice deficiency associated with the scope of practice set forth in section 4723.43 of the Revised Code, the workplace monitor shall be an advanced practice nurse with a current, valid certificate of authority issued under section 4723.41 of the Revised Code, or a holder of a current, valid certificate issued under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery, or podiatric medicine and surgery;

(3) When monitoring a dialysis technician, the workplace monitor shall be a registered nurse with a current, valid license or a holder of a current, valid certificate issued under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery.

(E) In addition to meeting the requirements of paragraph (E) of this rule, a workplace monitor shall:

(1) Have no disciplinary action imposed on the license or authorization in Ohio or in another jurisdiction;

(2) Be in a position that enables the monitor to directly observe the participant's clinical performance;

(3) Have a minimum of five years experience as a registered nurse, advanced practice nurse, or physician; and

(4) Cooperate with the participant and PIIP to meet the requirements set forth in the participatory agreement entered into by the participant and PIIP.

(F) When the individual to be monitored is a licensed practical nurse, the workplace monitor may direct a licensed practical nurse to observe specific tasks related to the identified practice deficiency and to report those observations to the monitor.

(G) When the individual to be monitored is a dialysis technician, the workplace monitor may direct an Ohio certified dialysis technician or licensed practical nurse to observe specific tasks related to the identified practice deficiency and to report those observations to the monitor.

(H) For purposes of providing the remediation directed by the supervising member, a workplace monitor shall be considered a representative of the board and, in accordance with section 4723.021 of the Revised Code, shall not be held liable in damages to any person as the result of any act, omission, proceeding, conduct, or decision related to official duties undertaken or performed pursuant to this chapter.

4723-18-09 Terms and conditions a participant must meet to successfully complete the practice intervention and improvement program (PIIP).

(A) A licensee or certificate holder eligible for the practice intervention and improvement program shall enter into a participatory agreement, as set forth in rule 4723-18-04 of the Administrative Code, and shall comply with all of the terms and conditions set forth in the agreement.

(B) A participant shall provide or cause to be provided all of the following to PIIP:

(1) Written verification from an educational provider acceptable to PIIP that the participant has successfully completed the educational intervention prescribed by the supervising member; and

(2) Written verification from a workplace monitor who meets the requirements set forth in rule 4723-18-08 of the Administrative Code that, at the time of verification with respect to the identified practice deficiency, the participant's practice meets the standards of safe care set forth in chapter 4723-4, rules 4723-8-02, 4723-9-08, and 4723-9-09 of the Administrative Code, or rules 4723-23-12 or 4723-23-14 of the Administrative Code.

(C) Upon receipt of the documents required by paragraph (B) of this rule, the supervising member shall review all information relevant to the participant's remediation to determine whether the participant's practice as a licensed nurse or dialysis technician meets the standards for safe care set forth in Chapter 4723-4, rules 4723-8-02, 4723-9-08 and 4723-9-09 of the Administrative Code, or rules 4723-23-12 and 4723-14 of the Administrative Code.

(D) When the supervising member determines that the licensee's or certificate holder's identified practice deficiency has been sufficiently corrected so as to meet the standards for safe care set forth in Chapter 4723-4, rules 4723-8-02, 4723-9-08 and 4723-9-09 of the Administrative Code, or rules 4723-23-12 and 4723-23-14 of the Administrative Code, the supervising member shall notify the participant in writing that remediation has been successfully completed and participation in PIIP is concluded.

(E) When making a decision regarding disciplinary action for violations of Chapter 4723. of the Revised Code or the rules of the board, the board shall be notified if the participant previously successfully completed PIIP, in accordance with the participatory agreement executed by the licensee or certificate holder.

(F) When sufficient remediation has not occurred the board shall proceed with disciplinary action in accordance with section 4723.28 of the Revised Code.

Effective: 02/01/2007
R.C. 119.032 review dates: 10/16/2008 and 10/01/2013
Promulgated Under: 119.03
Statutory Authority: 4723.07, 4723.282
Rule Amplifies: 4723.282
Prior Effective Dates: 2/1/01, 2/1/04

4723-18-10 Confidentiality of records for the practice intervention and improvement program (PIIP).

(A) Information obtained by the practice intervention and improvement program pursuant to an investigation conducted in accordance with sections 4723.28 and 4723.282 of the Revised Code shall be confidential pursuant to division (I) of section 4723.28 of the Revised Code.

(B) All records regarding an individual's participation in PIIP are confidential pursuant to division (D) of section 4723.282 of the Revised Code.

(C) All educational providers and workplace monitors selected to provide remediation by a participant in PIIP shall, as representatives of the board, maintain the confidentiality of all records regarding the participant's remediation.

(D) All PIIP records maintained by the board shall be kept in a secure storage area in accordance with the board's record retention schedule.

(E) Notwithstanding paragraphs (A) and (B) of this rule, PIIP shall make regular reports to the board setting forth in general terms, without specific participant identifiers, information regarding identified practice deficiencies, the types of educational interventions undertaken to correct the deficiencies, and any other statistical information requested by the board.

R.C. 119.032 review dates: 10/16/2008 and 10/01/2013

Promulgated Under: 119.03

Statutory Authority: 4723.07, 4723.282

Rule Amplifies: 4723.282

Prior Effective Dates: 2/1/01, 2/1/02, 2/1/04