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Taxonomy of Error Root Cause Analysis of Practice-responsibility (TERCAP®)

A Method to Determine Factors Associated with Nursing Practice Breakdown

The TERCAP® (Taxonomy of Error, Root Cause Analysis and Practice-responsibility) is a national nursing adverse event database created by the National Council of State Boards of Nursing designed to collect nursing practice breakdown data from boards of nursing.

The TERCAP® intake instrument provides a multi-focal approach to investigating nursing practice breakdown by providing a template to categorize the type of nursing practice breakdown as well as identifying individual nurse, patient, healthcare team and system contributing factors surrounding the event.  The Texas Board of Nursing participates in this initiative to support a national report for analysis and trending to understand and prevent nursing error.

The “heart” of TERCAP® is composed of a taxonomy, or set of categories, that is based on notions of good nursing practice. These include:

Nursing Practice Breakdown Categories
Safe Medication Administration The nurse administers the right dose of the right medication 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 Nurses interpret patient signs, symptoms and responses to therapies. Nurses evaluate the relevance of changes in patient signs and symptoms and ensure that patient care providers are notified and that patient care is adjusted appropriately. Nurses titrate drugs and other therapies according to their assessment of patient responses.
Prevention The nurse follows usual and customary measures to prevent risks, errors, threats to patient safety and hazards or complications due to illness or hospitalization. Hazards of immobility include skin breakdown, contractures, etc.
Intervention The nurse properly executes healthcare procedures aimed at specific therapeutic goals. Interventions are implemented in a timely manner. Nurses perform the right intervention on the right patient.
Interpretation of Authorized Provider’s Orders The nurse interprets authorized provider orders.
Professional Responsibility / Patient Advocacy 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 nurse demonstrates professional responsibility and understands the nature of the nurse-patient relationship.

In 2011, the 82nd Legislature passed SB 193 allowing the Texas Board of Nursing (BON or Board) to adopt a standardized error classification system for utilization by nursing peer review committees.  Consequently, the BON implemented a pilot program that allowed nursing peer review committees to use a modified version of the TERCAP® intake instrument.

The Texas TERCAP Pilot Program was conducted from 2012 – 2016 and provided valuable information regarding hospital based nursing peer review committees’ evaluation of practice breakdown. 

Utilizing important findings from the pilot, the Board has developed the N-PREP (Nursing Peer Review Evaluation of Practice-breakdown) resource for utilization by Texas nursing peer review committees.

For a full report of the TERCAP Pilot Program and information regarding N-PREP, please refer to the resource section below.  

Additional Resources