Get Comprehensive Request For Safe Harbor Nursing Peer Review - Bon Texas

Filling out the Comprehensive Request for Safe Harbor Nursing Peer Review is an important step to ensure safe nursing practices. This guide provides clear, step-by-step instructions to help users effectively complete the form online and understand its components.

Follow the steps to successfully complete the Safe Harbor Request form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the date, time, and location at the top of the form. This provides essential context for your request.
3. In Section I, check the box if you have previously completed a Quick Request for Safe Harbor. If not, proceed to describe your request for Safe Harbor in the provided text box, making sure to specify the conduct or assignment that you believe places patients at risk.
4. Fill in your professional relationship to the supervisor or person making the assignment. It is important to clarify how you are connected to the request and your role.
5. Detail the requested conduct or assignment. If there is a written directive, attach it and describe how it may compromise patient safety.
6. Describe your practice setting, responsibilities, and available resources in Section I. This context helps the Peer Review Committee understand your situation better.
7. Elaborate on how the requested conduct violates your duty to maintain a safe environment. Specify any affected patients by their initials and medical record number if applicable.
8. List any supporting documents that are pertinent to your request, which may be submitted later if not available at the time of filling out the form.
9. If you believe modifications to the conduct could make it safe, outline those changes clearly in the provided space.
10. Indicate your decision regarding whether to sustain or withdraw the Safe Harbor request, based on the circumstances. This decision must be recorded.
11. In Section II, the supervisor must acknowledge receipt of the request and fill out their comments and actions in response to your submission.
12. After submission, ensure that you keep a copy of the completed form for your records. You may save changes, download, print, or share the form as needed.

Complete the Comprehensive Request for Safe Harbor Nursing Peer Review online to ensure your rights and maintain patient safety.