2013 Criteria for Approved Provider Units

1. An Overview for Approved Providers 2013 Criteria for Approved Provider Units Maryland Nurses Association

2. An Overview for Approved Providers

3. An Overview for Approved Providers • Educational Design Process • New chapter • Requirements for planning, implementing and evaluating educational activities according to accreditation criteria • ANCC’s definition of content that is eligible to award contact hours: • Generalizable beyond employer setting • Beyond basic for the professional registered nurse • Evidence-based/based on best-available evidence

4. An Overview for Approved Providers • Educational Design Process • Assessment of learner needs • Variety of methods – no “right way” • Method must be appropriate for your target audience • Identify and validate a gap in knowledge, skills or practice for target audience • Evidence must be included in activity file documentation

5. An Overview for Approved Providers • Educational Design Process • Nurse Planner (RN-BSN or higher) and one additional RN planner for every activity • Adherence to ANCC accreditation criteria • Content expertise • Target audience member requirement removed • Other individuals: • Faculty/presenters/authors • Content reviewer • Content experts • Target audience

6. An Overview for Approved Providers • Educational Design Process • Nurse Planner/Planning Committee • Documentation of biographical data/qualifications for role on committee • Assessment of conflicts of interest • Nurse Planner • Other members of team/committee • All individuals having the opportunity to influence content must be evaluated for potential conflicts of interest

11. An Overview for Approved Providers • Other considerations: • Determination of requirements for successful completion • Stay for entire activity? • Evaluation form completed? • Claim credit commensurate with participation? • Financial or in-kind support accepted • Method to ensure content integrity and prevention of bias

12. An Overview for Approved Providers • Educational Design Process • Purpose of the activity • Learner-focused • Objectives • Learner-oriented outcomes • Content • Based on most current available evidence • Documentation should reflect quality of evidence chosen

13. Cognitive Describe Explain Identify List Differentiate Discuss Compare Contrast Develop Write Prepare Organize Manage Affective Choose Complete Describe Differentiate Identify Explain Justify Select What do you mean by Behavioral terms? • Psychomotor Assemble Design Demonstrate Construct Make Classify Create Perform

16. An Overview for Approved Providers • Educational Design Process • Teaching/learning strategies • Methods used to cover material in activity • Learner feedback mechanism • Successful completion • Criteria for determining with rationale • Participation verification • Number of contact hours

17. An Overview for Approved Providers • Educational Design Process • Evaluation • Short-term • Long-term • Requirement to define category of evaluation removed • Approval statement • Certificate of completion • Marketing materials

18. Definition of commercial interest • A commercial interest is any entity either producing, marketing, re-selling, or distributing healthcare goods or services used on or by patients or that is owned or controlled by an entity that produces, markets, re-sells, or distributes healthcare goods or services consumed by or used on patients

19. An Overview for Approved Providers • Educational Design Process • What type of organization is providing support (where does the support come from)? • Commercial Support: financial or in-kind contribution given by a commercial interest that is used to pay for all or part of an educational activity • Sponsorship: financial or in-kind contribution given by a non-commercial interest organization that is used to pay for all or part of an educational activity • Co-Providership:planning, developing, and implemented by 2 or more organizations or agencies

20. An Overview for Approved Providers • Educational Design Process • Money for exhibit space is not considered commercial support or sponsorship • When an Approved Provider accepts commercial support or sponsorship for an educational activity, the organization providing commercial support or sponsorship may not co-provide the educational activity • Commercial support or sponsorship agreement required

21. An Overview for Approved Providers • Educational Design Process • Content integrity of the educational activity • Actual or potential conflicts of interest resolved (individuals in a position to control/influence content of the activity) • Content is based on best available evidence • Independence from any organization providing funding for the activity (commercial interest organization or sponsor) • Free from promotional activity

22. An Overview for Approved Providers • Conflict of Interest • Definition • Relationships with commercial interest organizations • Include spouse/significant other • Past 12 months • Evaluation • No relationship • Relationship present, not relevant to content, no resolution required • Relationship present, relevant to content, resolution required • Resolution and Assessment • Remove individual with relationship • Revise role for individual with relationship • Don’t award contact hours • Review content for bias before activity and monitor activity • Review content for bias before activity and evaluate participant feedback

23. An Overview for Approved Providers • Educational Design Process • Disclosures • Required: • Requirements for successful completion including purpose or objectives AND criteria used to determine successful completion • Presence or absence of conflicts of interest • If applicable: • Commercial support • Sponsorship • Non-endorsement of products (provider and Approver Unit) • Expiration date (enduring materials only) • Off label use requirement removed

24. An Overview for Approved Providers • Educational Design Process • Recordkeeping • See detailed list in manual • Co-Providing • Commercial interest organization may not co-provide an educational activity • Non-commercial interest organization may either: • Provide financial or in-kind support and not participate in planning the activity (sponsorship) OR • Co-provide the activity (co-provider) and money exchanged between the provider and co-provider is documented in a co-provider agreement

25. An Overview for Approved Providers • Provider Approval • Eligibility • Responsibilities • Application • Self Study and Activity Files • Organizational Overview • Structural Capacity • Educational Design • Quality Outcomes • Clarifications (if needed) • Approval Decision

26. An Overview for Approved Providers • Responsibilities • Compliance with federal, state and local laws • Attestation statement in application; removed from self-study • Primary Nurse Planner responsible for Provider Unit compliance to accreditation criteria • Nurse Planner on every activity awarding ANCC contact hours

27. An Overview for Approved Providers • Self-Study and Activity Files • Submit by due date • Submissions after due date will be accepted up to 30 days with fee; not accepted after 30 days • Self-study is narrative response with supporting evidence/example for each criterion • Evidence/examples may be chosen from supplemental files submitted if desired, but not required • Activity files are chosen by applicant • Representative of different types of activities

28. An Overview for Approved Providers • Organizational Overview (OO) • Replaces Executive Summary and Self-Assessment • Provides context for understanding the organization • Organized by: • Structural Capacity • Educational Design Process • Quality Outcomes

29. Provider self study

34. An Overview for Approved Providers Writing to the criteria: • Narrative documentation with supporting evidence/examples • “Telling a story” • “Description of the wonderful work done by your organization for registered nurses” • Examples may be chosen from supplemental activity files but examples may also come from other activities or work done within the organization • “Describe” – tell the story • “Demonstrate” – provide evidence to substantiate the story

35. An Overview for Approved Providers • Some tips for writing responses: • Pause and reflect on the intent of the question • Answer the question directly • Do not add unnecessary extraneous information (do not “data dump”) • If an individual’s name is used in the narrative, indicate the position/title of the individual to ensure the reader can follow the response • Give enough background/context for the reader to understand the response • Ask several colleagues to read the responses and tell you if they make sense

36. An Overview for Approved Providers Examples of responses to criteria (note: examples range from poor to strong) Describe and, using an example, demonstrate each of the following: EDP 4. The process used to identify all actual and potential conflicts of interest for all members of the Planning Committee, presenters, authors, and content reviewers. SAMPLE RESPONSE 1: All planning committee members are also presenters of the educational activities provided by our organization. As employees, they are required to complete a form when they are hired that is evaluated for any potential conflict of interest. If they have a conflict of interest, they are not hired in the organization. As a result, we do not have any identified actual or potential conflicts of interest. Our employees fill out a form annually though. Our educational activities always score a 4 or better on the evaluation which indicates that there is no conflict of interest.

37. An Overview for Approved Providers SAMPLE RESPONSE 2: Actual and potential conflicts of interest are evaluated closely by our Primary Nurse Planner. We have not had a conflict of interest identified yet because we very thoroughly review every conflict of interest form for each educational activity. One example of how we evaluate conflict of interest is by closely examining the content chosen for educational activities. If the content chosen is based on the best available evidence and there is no bias located in the content or the slides for the educational activity, then we can be confident that we have evaluated the educational activity before it is presented for potential conflict of interest. Then, we look at the evaluation forms to determine if there is any bias that is reported. If anyone does indicate bias, we look at the comments on the evaluation and follow up on each one that is reported.

38. An Overview for Approved Providers SAMPLE RESPONSE 3: Although our organization has not identified an actual conflict of interest for a planning committee member or presenter of an educational activity, we do have a process that we use within the organization to ensure that we are thoroughly evaluating each person for an actual or potential conflict of interest. Our current process for evaluating conflict of interest is as follows: At the start of the planning process for an educational activity, the Nurse Planner documents whether she has any actual or potential conflicts of interest related to the content of the educational activity. The Primary Nurse Planner is responsible for reviewing her conflict of interest form and signing off that there is no conflict of interest. The form that is used by our organization can be found under Tab B in the Appendix. Once the PNP ensures that the NP has no actual or potential conflict of interest, the planning process can continue. The NP is responsible for reviewing all conflict of interest forms submitted by other planning committee members, presenters, authors. We do not use content reviewers in this organization. The NP signs off on each form to make sure that there is no actual or potential conflict of interest. Also, the NP monitors for conflict of interest during the planning process.

39. An Overview for Approved Providers The educational activity is presented. If possible, the Nurse Planner attends the educational activity and monitors for any conflict of interest. Sometimes, other members of the planning committee monitor the sessions. The evaluation form for the educational activity includes a place to report any bias that is determined in the activity and a comment section where the person can write in the bias that they identified. The Nurse Planner and planning committee reviews each evaluation form after the educational activity to make sure that there was no bias identified. The planning committee discusses the educational activity and determines if there was any conflict of interest found. We do the same process for all of our educational activities and have not had any conflicts of interest reported.

40. An Overview for Approved Providers SAMPLE RESPONSE 4: The process of evaluating for actual or potential conflicts of interest for members of the planning committee, presenters, authors, and/or content reviewers is found in our organizational policy and included in the Appendix under Tab F. The Nurse Planner for each educational activity is responsible for ensuring that any actual or potential conflicts of interest are identified and resolved in the planning phase of the activity. In addition, when the educational activity is presented, the Nurse Planner or her designee monitors for any actual or potential conflicts of interest that may arise. All activity evaluation forms (see example included in the Appendix under Tab G and in each educational activity submitted as Attachments A, B and C) include an item where learners can report any bias, conflict of interest, or any other concern that should be brought to the attention of the planning committee. An example of how the process of evaluating for an actual or potential conflict of interest is described below:

41. An Overview for Approved Providers Our organization was planning an educational activity on the treatment of asthma in the pediatric patient. The Nurse Planner completed a conflict of interest form and declared that she had no actual or potential conflict of interest related to the content of the educational activity. The Primary Nurse Planner of our organization reviewed the form to ensure that there was no COI and signed off on the form in the space for the reviewer. The Nurse Planner then asked everyone on the planning committee to complete a COI form. Our COI form is found in the Appendix under Tab E. The Nurse Planner reviewed each COI form and signed off in the space for the reviewer. No COI was declared by any member of the planning committee. The planning committee then identified an expert in the field of pediatric asthma from the local children’s hospital. The expert agreed to present for the educational activity. When the expert completed the COI form, it was identified that the expert declared relationships with three pharmaceutical companies. The Nurse Planner reviewed the COI form and determined that one of the pharmaceutical companies made an asthma medication for pediatric patients. The Nurse Planner and planning committee met to discuss whether the expert had an actual or potential conflict of interest. The Nurse Planner and planning committee determined that the relationship declared by the expert was relevant to the content of the educational activity and that resolution would be required to ensure that the activity was presented without bias to the learners. The options for resolution were reviewed by the Nurse Planner and planning committee members and they included:

42. An Overview for Approved Providers • Removing the individual with conflicts of interest from participating in all parts of the educational activity. • Revising the role of the individual with conflicts of interest so that the relationship is no longer relevant to the educational activity. • Not awarding continuing education contact hours for a portion or all of the educational activity. • Undertaking review of the educational activity by a content reviewer to evaluate for potential bias, balance in presentation, evidence-based content or other indicator of integrity, and absence of bias, AND monitoring the educational activity to evaluate for commercial bias in the presentation. • Undertaking review of the educational activity by a content reviewer to evaluate for potential bias, balance in presentation, evidence-based content or other indicator of integrity, and absence of bias, AND reviewing participant feedback to evaluate for commercial bias in the activity.

43. An Overview for Approved Providers Because the expert from the pediatric hospital was considered a leader in the field of pediatric asthma, the Nurse Planner and planning committee felt that it was important that the target audience had the benefit of hearing his presentation. At the same time, they knew that they had to implement a process to resolve the COI. They chose to implement resolution process #4 as outlined above. First, they spoke to the expert and provided him with a copy of the speaker guidelines developed by the organization (see Appendix under Tab H). They asked the speaker to submit his slides 2 weeks prior to the presentation so that they could be reviewed by a content reviewer. Because the Nurse Planner and planning committee members were not experts in the field of pediatric asthma and therefore could not effectively review the content for potential bias, the Nurse Planner and planning committee identified a content reviewer to review the slides. Before the content reviewer reviewed the presentation, she submitted a COI form which was reviewed by the Nurse Planner. No COI was declared by the content reviewer or identified by the Nurse Planner. The content reviewer reviewed the presentation and the content was found to be evidence-based and according to accepted clinical guidelines. In addition, all drug names referenced in the presentation were generic. The content reviewer signed off on the presentation as acceptable. During the presentation by the expert, the Nurse Planner remained in the audience to ensure that the expert did not deviate from the presentation and introduce bias into the activity. No bias was identified and the speaker was well-received. The Nurse Planner documented her findings for the activity file.

44. An Overview for Approved Providers • Narrative responses with evidence/examples are organized under each new Criterion: Structural Capacity, Educational Design Process, Quality Outcomes • Each sub-criterion (source of evidence) is congruent with the key elements from the 2009 manual, with a few new requirements (i.e. quality outcomes related to nursing professional development). • Several key elements from the 2009 manual have been moved to responsibilities of applicant and approved providers and are evaluated using evidence from the self-study and activity files (i.e. calculation of contact hours, use of the approval statement). • See Crosswalks provided for details

45. An Overview for Approved Providers • Evaluation of written documentation: • Threshold not met – organization is not ready to proceed forward; approval denied; summary report provided to the organization regarding strengths and deficiencies • Additional documentation required - additional clarification is required to demonstrate adherence to Approver Unit criteria and determine whether threshold has been met • Threshold met

46. An Overview for Approved Providers • Clarifications • Verify, clarify, amplify findings from self-study and activity files • Nurse Peer Reviewer Final Report • Approver Unit makes approval decision

47. An Overview for Approved Providers • Approval decisions: • Approved with Distinction • Approved • Probation • Denial *Organization may also be suspended or revoked

48. An Overview for Approved Providers • Annual requirements: • Annual demographic information form • Annual Approved Provider Continuing Education Summary form • Additional documentation requested by the Approver Unit (progress reports, response to complaints, or similar) • Random audits of organizations conducted by the Approver Unit