Cultures of Safety Bill
Senate version: SB 993 by Senator Jane Nelson
House version: HB 2158 by Representative Jim McReynolds
The legislation's purpose is to shift the regulation of nursing from an individual-blame oriented model toward a model that focuses more on addressing system inadequacies and remediation of the individual. It shifts how incidents involving errors by nurses are handled. The current law perspective reflects that errors are primarily caused by "bad" individuals and when an error occurs, the individual who made the error needs to be identified and punished. The legislation reflects the perspective recommended by the Institute of Medicine that errors are primarily the result of system inadequacies that either made the error likely to occur or failed to provide the safeguards needed to prevent the error from occurring.
The bill accomplishes this shift in two ways: first, by modifying the mandatory reporting provisions of the Nursing Practice Act to help ensure that the nurses reported to the BNE are those nurses whose continued practice poses a risk of harm to patients, and secondly by encouraging greater sharing of information among the various committees that review patient care incidents.
This bill is the result of a task force appointed by of the Texas Nurses Association to look at the implications of two reports of the Institute of Medicine (its 2000 report To Err Is Human and its 2003 report Keeping Patients Safe: Transforming the Work Environment of Nurses) that focused on how the health care system can promote safer patient care by creating "cultures of safety." This legislation reflects recommendations of the task force.
Current Status of Legislation: Culture of Safety Bills
SB 993 by Nelson had a hearing in the Senate Health & Human Services Committee on 3/20/07 and has been reported favorably from committee with a recommendation that it be set on the Local/Uncontested Calendar in the Senate. The next step is to be scheduled for vote by the full Senate and the fact that it went to the Local/Uncontested Calendar means it will almost certainly be passed by the Senate.
HB 2158 by McReynolds had a hearing in the House Public Health Committee on 3/21/07 and, as is this committee's practice, the bill was left pending rather than being voted on at that time. The next step is to be voted out of committee. Since SB 993 is close to being passed by the Senate, SB 993 will likely be substituted for the House bill at some point in the process.