Print Page | Sign In | Register
News: Education

Practice Tip of the Week: Do you know TERCAP?

Monday, June 5, 2017   (0 Comments)
Posted by: Nadia Tamez-Robledo
Share |

By Ellen Martin, PhD, RN, CPHQ

Director of Practice

Texas Nurses Association


The April Texas Board of Nursing meeting included the final report of the Texas Taxonomy of Error Root Cause Analysis of Practice Responsibility (TERCAP) Pilot. This four-year initiative was the result of legislation passed in 2011 that amended Texas Occupations Code Chapter 303, Sec. 303.012 allowing the Texas Board of Nursing to adopt a nursing practice error classification system for use by peer review committees.  The report offered recommendations: rule revision to provide clarity and guidance on minor incidents and resource development to guide nurse peer review committees in identifying systems factors beyond the nurses control.


This project has been over 18 years in the making.  In 1999, the National Council of State Boards of Nursing convened the Practice Breakdown Advisory Council to examine the individual and systems factors that contribute to nursing practice breakdown.  The nurse experts began working on an instrument that state Boards of Nursing could use as an intake tool for case analysis, classification of nursing errors, and to use in aggregate to track national trends in nursing errors. The TERCAP instrument includes nurse, patient, and system characteristics, as well as patient characteristics, system characteristics, and the root causes of nursing practice breakdown.  An overview of this developmental work was published by Benner, et. al (2006) and a map of the 26 states participating in TERCAP is available on the NCSBN TERCAP webpage


The TERCAP is organized into 8 categories of nursing practice:

  • Safe Medication Administration
  • Documentation
  • Attentiveness / Surveillance
  • Clinical Reasoning
  • Prevention
  •  Intervention
  •  Interpretation of Authorized Provider’s Orders
  • Professional Responsibility / Patient Advocacy


According to the Texas TERCAP pilot study report, 318 practice breakdowns reports were collected between September 1, 2012 and August 31, 2016.  The majority of reports came from hospitals over 350 beds and six hospitals contributed 49% of the reports. Statistical analysis indicated a greater risk of patient harm associated with the practice categories of Clinical Reasoning (p=0.001) and Intervention (p=0.002).    


This work has important policy implications. At the state level, the BON can use this data to inform rules and policy updates.  At the national level, trends and patterns of practice breakdown can be identified and addressed.  For example, the national pilot work indicated that patients with cognitive impairment were more susceptible to serious harm or death than patients without cognitive impairments. This could lead to systems changes such as increased nurse staffing for cognitively impaired patients. 


What kind of resources would be most helpful to you or your nurse peer review committee?  Drop a line to Practice Director Ellen Martin at

Texas Nurses Association

Texas Affiliate of ANA | 4807 Spicewood Springs Rd., Bldg 3, Austin TX

800.862.2022 | 512.452.0645 |