Learning Objective #1: Apply human factors taxonomy to errors made by nurses and categorize them according to the Eindhoven classification scale

Learning Objective #2: Discuss reckless behavior, a knowing violation and negligent conduct and discuss implications for disciplinary action by regulatory boards

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The Health Alliance Safety Partnership (HASP) is a pilot program that adapts the airline industry's highly successful Aviation Safety Action Partnership (ASAP) to healthcare. The purpose of the pilot is to improve the environment of patient and practitioner safety by increasing the understanding of both human performance and systems factors contributing to adverse medical events and/or occurrences involving nurse actions. HASP includes the joint review of incident reports by the Event Review Committee (ERC) comprised of six members. The three voting members are: a member of the Board of Nurse Examiners (BNE), a nursing officer (from a participating healthcare organization) and a chair of a Peer Review Committee of one of the participating organizations. The three non-voting members include: a nurse with advanced training in human factors and systems analysis, a group facilitator, and a secretary. The ERC will receive a HASP report and complete an investigation of the event, identify the human performance and system factors contributing to the event, make intervention recommendations that address all of the identified factors to prevent the event from reoccurring, and require a response to these recommendations/action plans from the nurse and/or the institution. Consistent with the mission of the BNE and the focus of recent Institute of Medicine (IOM) reports, HASP seeks to improve protection to the public by documenting the role of systems and human performance factors, and developing recommendations to address identified factors to prevent recurrence of the event. Further HASP will communicate its findings in de-identified aggregate form along with best practices to increase dissemination of safety practices. Nurses who particpate in this voluntary program and report their errors are afforded limited protecion from BNE action.