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Taxonomy of Error Root Cause Analysis of Practice Responsibility (TERCAP®)

A Method to Determine Factors Associated with Nursing Practice Breakdown

TERCAP® History, NCSBN TERCAP®

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.

Why use the TERCAP® data collection instrument?

  • Provides consistent and comprehensive data collection about nurses practice breakdown
  • Tracks elements of recurring practice breakdown themes
  • Assists in learning from the experiences of nurses who have had nursing practice errors

What might we learn?

  • Common types of errors that occur in nursing practice
  • When and where errors occur
  • Factors in the system that affect errors
  • Ways to develop and evaluate new approaches to patient safety

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