An Overview for Approved Providers
2013 Criteria for Approved
Provider Units
Maryland Nurses Association
An Overview for Approved Providers
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Educational Design Process
• New chapter
• Requirements for planning, implementing and
evaluating educational activities according to
accreditation criteria
• ANCC’s definition of content that is eligible to award
contact hours:
• Generalizable beyond employer setting
• Beyond basic for the professional registered nurse
• Evidence-based/based on best-available evidence
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Educational Design Process
• Assessment of learner needs
• Variety of methods – no “right way”
• Method must be appropriate for your target
audience
• Identify and validate a gap in knowledge, skills or
practice for target audience
• Evidence must be included in activity file
documentation
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Educational Design Process
• Nurse Planner (RN-BSN or higher) and one additional
RN planner for every activity
• Adherence to ANCC accreditation criteria
• Content expertise
• Target audience member requirement removed
• Other individuals:
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Faculty/presenters/authors
Content reviewer
Content experts
Target audience
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Educational Design Process
• Nurse Planner/Planning Committee
• Documentation of biographical data/qualifications
for role on committee
• Assessment of conflicts of interest
• Nurse Planner
• Other members of team/committee
• All individuals having the opportunity to influence
content must be evaluated for potential conflicts of
interest
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Other considerations:
• Determination of requirements for successful
completion
• Stay for entire activity?
• Evaluation form completed?
• Claim credit commensurate with participation?
• Financial or in-kind support accepted
• Method to ensure content integrity and prevention
of bias
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Educational Design Process
• Purpose of the activity
• Learner-focused
• Objectives
• Learner-oriented outcomes
• Content
• Based on most current available evidence
• Documentation should reflect quality of evidence
chosen
© 2012 American Nurses Credentialing Center
What do you mean by Behavioral terms?
• Cognitive
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Describe
Explain
Identify
List
Differentiate
Discuss
Compare
Contrast
Develop
Write
Prepare
Organize
Manage
• Affective
Choose
Describe
Identify
Justify
Complete
Differentiate
Explain
Select
 Psychomotor
Assemble
Design
Demonstrate Construct
Make
Classify
Create
Perform
An Overview for Approved Providers
• Educational Design Process
• Teaching/learning strategies
• Methods used to cover material in activity
• Learner feedback mechanism
• Successful completion
• Criteria for determining with rationale
• Participation verification
• Number of contact hours
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Educational Design Process
• Evaluation
• Short-term
• Long-term
• Requirement to define category of evaluation
removed
• Approval statement
• Certificate of completion
• Marketing materials
© 2012 American Nurses Credentialing Center
Definition of commercial interest
• A commercial interest is any entity either
producing, marketing, re-selling, or
distributing healthcare goods or services
used on or by patients or that is owned
or controlled by an entity that produces,
markets, re-sells, or distributes healthcare
goods or services consumed by or used
on patients
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Educational Design Process
•
What type of organization is providing support (where does the support come
from)?
• Commercial Support: financial or in-kind contribution given by
a commercial interest that is used to pay for all or part of an
educational activity
• Sponsorship: financial or in-kind contribution given by a noncommercial interest organization that is used to pay for all or part
of an educational activity
• Co-Providership: planning, developing, and implemented by 2
or more organizations or agencies
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Educational Design Process
• Money for exhibit space is not considered
commercial support or sponsorship
• When an Approved Provider accepts commercial
support or sponsorship for an educational activity, the
organization providing commercial support or
sponsorship may not co-provide the educational
activity
• Commercial support or sponsorship agreement
required
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Educational Design Process
• Content integrity of the educational activity
• Actual or potential conflicts of interest resolved
(individuals in a position to control/influence content of the activity)
• Content is based on best available evidence
• Independence from any organization providing
funding for the activity (commercial interest organization or
sponsor)
• Free from promotional activity
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Conflict of Interest
• Definition
• Relationships with commercial interest organizations
• Include spouse/significant other
• Past 12 months
• Evaluation
• No relationship
• Relationship present, not relevant to content, no resolution
required
• Relationship present, relevant to content, resolution required
• Resolution and Assessment
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Remove individual with relationship
Revise role for individual with relationship
Don’t award contact hours
Review content for bias before activity and monitor activity
Review content for bias before activity and evaluate participant
feedback
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Educational Design Process
• Disclosures
• Required:
• Requirements for successful completion including
purpose or objectives AND criteria used to determine
successful completion
• Presence or absence of conflicts of interest
• If applicable:
• Commercial support
• Sponsorship
• Non-endorsement of products (provider and Approver
Unit)
• Expiration date (enduring materials only)
• Off label use requirement removed
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Educational Design Process
• Recordkeeping
• See detailed list in manual
• Co-Providing
• Commercial interest organization may not coprovide an educational activity
• Non-commercial interest organization may either:
• Provide financial or in-kind support and not participate in
planning the activity (sponsorship) OR
• Co-provide the activity (co-provider) and money
exchanged between the provider and co-provider is
documented in a co-provider agreement
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Provider Approval
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Eligibility
Responsibilities
Application
Self Study and Activity Files
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Organizational Overview
Structural Capacity
Educational Design
Quality Outcomes
• Clarifications (if needed)
• Approval Decision
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Responsibilities
• Compliance with federal, state and local laws
• Attestation statement in application; removed from
self-study
• Primary Nurse Planner responsible for Provider Unit
compliance to accreditation criteria
• Nurse Planner on every activity awarding ANCC
contact hours
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Self-Study and Activity Files
• Submit by due date
• Submissions after due date will be accepted up to 30 days
with fee; not accepted after 30 days
• Self-study is narrative response with supporting
evidence/example for each criterion
• Evidence/examples may be chosen from
supplemental files submitted if desired, but not
required
• Activity files are chosen by applicant
• Representative of different types of activities
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Organizational Overview (OO)
• Replaces Executive Summary and Self-Assessment
• Provides context for understanding the organization
• Organized by:
• Structural Capacity
• Educational Design Process
• Quality Outcomes
© 2012 American Nurses Credentialing Center
Provider self study
Structural Capacity (SC)
Description and example demonstrate the Primary Nurse Planner’s commitment to learner needs
including how Approved Provider Unit processes are revised based on data.
If the Provider unit is part of a larger organization, description and example demonstrate how
the organization’s leadership is committed to supporting the goals of the Approved Provider Unit.
Description and example demonstrate how the Primary Nurse Planner ensures that all Nurse
Planners and key personnel of the Approved Provider Unit maintain adherence to the ANCC
accreditation criteria.
Description and example demonstrate how the Primary Nurse Planner is accountable for resolving
issues related to providing CNE.
Description and example demonstrate how the Primary Nurse Planner ensures that every Nurse
Planner maintains accreditation standards and guides the Planning Committee or team for an
individual educational activity.
Description and example demonstrate how the Nurse Peer Review Leader of the Accredited
Approver Unit is used as a resource by the Primary Nurse Planner and/or other Nurse Planner(s) in
the Approved Provider Unit.
Description and example demonstrate how the Primary Nurse Planner advocates for resources to
ensure that the Approved Provider Unit achieves its goals related to quality outcome measures.
Educational Design Process (EDP)
Description and example demonstrate the Nurse Planner’s methods of assessing the current learning needs
of the target audience.
Description and example demonstrate how the Nurse Planner uses data collected to develop an educational
activity that addresses the identified gap in knowledge, skills, and/or practices.
Description and example demonstrate the process used to select a planning team/committee for an
educational activity, including why an individual member was chosen.
Description and example demonstrate the process used to identify all actual and potential conflicts of
interest for all members of the Planning Committee, presenters, authors, and content reviewers.
Description and example demonstrate the process for resolution of an actual or potential conflict of interest
and the outcome achieved.
Description and example demonstrate the process utilized during the planning phase of the educational
activity to determine how participants will successfully complete the learning activity.
Description and example demonstrate how measurable educational objectives are developed that address
the change in nursing practice or nursing professional development.
Description and example demonstrate how the content of the educational activity is selected based on bestavailable current evidence (e.g., clinical guidelines, peer-reviewed journals, experts in the field, etc.)
Description and example demonstrate how content integrity is maintained for CNE activities, including
what precautions are taken to prevent bias and how those precautions are implemented.
If the organization accepts commercial support/sponsorship, In the presence of commercial
support/sponsorship, description and example demonstrate additional precautions taken to maintain content
integrity for CNE activities, including precautions taken to prevent bias and how those precautions were
implemented.
Description and example demonstrate how teaching methods were chosen that are appropriate to achieve
the purpose and objectives of the CNE activity.
Description and example demonstrate how summative evaluation data for an educational activity were used
to guide future activities.
Description and example demonstrate how evaluation data were collected to measure change in nursing
practice or nursing professional development.
Quality Outcomes (QO)
Description and example demonstrate the process utilized for evaluating
effectiveness of the Approved Provider Unit in delivering quality CNE.
Description and example demonstrate how the evaluation process for the Approved
Provider Unit resulted in the development or improvement of an identified quality
outcome measure.
Description and example demonstrate how the Approved Provider Unit selects
specific stakeholders to participate in the evaluation process.
Description and example demonstrate how input from stakeholders resulted in
development of or an improvement in quality outcome measures for the Approved
Provider Unit.
Description and example demonstrate how, over the past 12 months, the Approved
Provider Unit has enhanced nursing professional development.
An Overview for Approved Providers
Writing to the criteria:
• Narrative documentation with supporting
evidence/examples
• “Telling a story”
• “Description of the wonderful work done by your organization for
registered nurses”
• Examples may be chosen from supplemental activity
files but examples may also come from other activities or
work done within the organization
• “Describe” – tell the story
• “Demonstrate” – provide evidence to substantiate the
story
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Some tips for writing responses:
• Pause and reflect on the intent of the question
• Answer the question directly
• Do not add unnecessary extraneous information (do not “data
dump”)
• If an individual’s name is used in the narrative, indicate the
position/title of the individual to ensure the reader can follow the
response
• Give enough background/context for the reader to understand
the response
• Ask several colleagues to read the responses and tell you if they
make sense
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
Examples of responses to criteria (note:
examples range from poor to
strong)
Describe and, using an example, demonstrate each of the following:
EDP 4. The process used to identify all actual and potential conflicts of interest for all members of the
Planning Committee, presenters, authors, and content reviewers.
SAMPLE RESPONSE 1:
All planning committee members are also presenters of the educational activities provided by our
organization. As employees, they are required to complete a form when they are hired that is
evaluated for any potential conflict of interest. If they have a conflict of interest, they are not hired
in the organization. As a result, we do not have any identified actual or potential conflicts of
interest. Our employees fill out a form annually though. Our educational activities always score a
4 or better on the evaluation which indicates that there is no conflict of interest.
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
SAMPLE RESPONSE 2:
Actual and potential conflicts of interest are evaluated closely by our Primary Nurse
Planner. We have not had a conflict of interest identified yet because we very
thoroughly review every conflict of interest form for each educational activity.
One example of how we evaluate conflict of interest is by closely examining the content
chosen for educational activities. If the content chosen is based on the best available
evidence and there is no bias located in the content or the slides for the educational
activity, then we can be confident that we have evaluated the educational activity
before it is presented for potential conflict of interest. Then, we look at the evaluation
forms to determine if there is any bias that is reported. If anyone does indicate bias,
we look at the comments on the evaluation and follow up on each one that is
reported.
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
SAMPLE RESPONSE 3:
Although our organization has not identified an actual conflict of interest for a planning committee
member or presenter of an educational activity, we do have a process that we use within the
organization to ensure that we are thoroughly evaluating each person for an actual or potential
conflict of interest.
Our current process for evaluating conflict of interest is as follows:
At the start of the planning process for an educational activity, the Nurse Planner documents whether
she has any actual or potential conflicts of interest related to the content of the educational
activity. The Primary Nurse Planner is responsible for reviewing her conflict of interest form and
signing off that there is no conflict of interest. The form that is used by our organization can be
found under Tab B in the Appendix.
Once the PNP ensures that the NP has no actual or potential conflict of interest, the planning process
can continue.
The NP is responsible for reviewing all conflict of interest forms submitted by other planning committee
members, presenters, authors. We do not use content reviewers in this organization. The NP
signs off on each form to make sure that there is no actual or potential conflict of interest. Also,
the NP monitors for conflict of interest during the planning process.
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
The educational activity is presented. If possible, the Nurse Planner attends the educational activity
and monitors for any conflict of interest. Sometimes, other members of the planning committee
monitor the sessions.
The evaluation form for the educational activity includes a place to report any bias that is determined
in the activity and a comment section where the person can write in the bias that they identified.
The Nurse Planner and planning committee reviews each evaluation form after the educational
activity to make sure that there was no bias identified.
The planning committee discusses the educational activity and determines if there was any conflict of
interest found.
We do the same process for all of our educational activities and have not had any conflicts of interest
reported.
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
SAMPLE RESPONSE 4:
The process of evaluating for actual or potential conflicts of interest for members of the planning
committee, presenters, authors, and/or content reviewers is found in our organizational policy and
included in the Appendix under Tab F. The Nurse Planner for each educational activity is
responsible for ensuring that any actual or potential conflicts of interest are identified and resolved
in the planning phase of the activity. In addition, when the educational activity is presented, the
Nurse Planner or her designee monitors for any actual or potential conflicts of interest that may
arise. All activity evaluation forms (see example included in the Appendix under Tab G and in
each educational activity submitted as Attachments A, B and C) include an item where learners
can report any bias, conflict of interest, or any other concern that should be brought to the
attention of the planning committee.
An example of how the process of evaluating for an actual or potential conflict of interest is described
below:
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
Our organization was planning an educational activity on the treatment of asthma in the pediatric
patient. The Nurse Planner completed a conflict of interest form and declared that she had no
actual or potential conflict of interest related to the content of the educational activity. The Primary
Nurse Planner of our organization reviewed the form to ensure that there was no COI and signed
off on the form in the space for the reviewer. The Nurse Planner then asked everyone on the
planning committee to complete a COI form. Our COI form is found in the Appendix under Tab E.
The Nurse Planner reviewed each COI form and signed off in the space for the reviewer. No COI was
declared by any member of the planning committee. The planning committee then identified an
expert in the field of pediatric asthma from the local children’s hospital. The expert agreed to
present for the educational activity. When the expert completed the COI form, it was identified
that the expert declared relationships with three pharmaceutical companies. The Nurse Planner
reviewed the COI form and determined that one of the pharmaceutical companies made an
asthma medication for pediatric patients.
The Nurse Planner and planning committee met to discuss whether the expert had an actual or
potential conflict of interest. The Nurse Planner and planning committee determined that the
relationship declared by the expert was relevant to the content of the educational activity and that
resolution would be required to ensure that the activity was presented without bias to the learners.
The options for resolution were reviewed by the Nurse Planner and planning committee members
and they included:
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
1.
Removing the individual with conflicts of interest from participating in all parts of the educational
activity.
2.
Revising the role of the individual with conflicts of interest so that the relationship is no longer
relevant to the educational activity.
3.
Not awarding continuing education contact hours for a portion or all of the educational activity.
4.
Undertaking review of the educational activity by a content reviewer to evaluate for potential bias,
balance in presentation, evidence-based content or other indicator of integrity, and absence of
bias, AND monitoring the educational activity to evaluate for commercial bias in the presentation.
5.
Undertaking review of the educational activity by a content reviewer to evaluate for potential bias,
balance in presentation, evidence-based content or other indicator of integrity, and absence of
bias, AND reviewing participant feedback to evaluate for commercial bias in the activity.
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
Because the expert from the pediatric hospital was considered a leader in the field of pediatric asthma,
the Nurse Planner and planning committee felt that it was important that the target audience had
the benefit of hearing his presentation. At the same time, they knew that they had to implement a
process to resolve the COI. They chose to implement resolution process #4 as outlined above.
First, they spoke to the expert and provided him with a copy of the speaker guidelines developed by
the organization (see Appendix under Tab H). They asked the speaker to submit his slides 2
weeks prior to the presentation so that they could be reviewed by a content reviewer. Because
the Nurse Planner and planning committee members were not experts in the field of pediatric
asthma and therefore could not effectively review the content for potential bias, the Nurse Planner
and planning committee identified a content reviewer to review the slides. Before the content
reviewer reviewed the presentation, she submitted a COI form which was reviewed by the Nurse
Planner. No COI was declared by the content reviewer or identified by the Nurse Planner. The
content reviewer reviewed the presentation and the content was found to be evidence-based and
according to accepted clinical guidelines. In addition, all drug names referenced in the
presentation were generic. The content reviewer signed off on the presentation as acceptable.
During the presentation by the expert, the Nurse Planner remained in the audience to ensure that the
expert did not deviate from the presentation and introduce bias into the activity. No bias was
identified and the speaker was well-received. The Nurse Planner documented her findings for the
activity file.
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Narrative responses with evidence/examples are organized under
each new Criterion: Structural Capacity, Educational Design
Process, Quality Outcomes
• Each sub-criterion (source of evidence) is congruent with the key
elements from the 2009 manual, with a few new requirements (i.e.
quality outcomes related to nursing professional development).
• Several key elements from the 2009 manual have been moved to
responsibilities of applicant and approved providers and are
evaluated using evidence from the self-study and activity files (i.e.
calculation of contact hours, use of the approval statement).
• See Crosswalks provided for details
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Evaluation of written documentation:
• Threshold not met – organization is not ready to proceed
forward; approval denied; summary report provided to the
organization regarding strengths and deficiencies
• Additional documentation required - additional clarification is
required to demonstrate adherence to Approver Unit criteria and
determine whether threshold has been met
• Threshold met
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Clarifications
• Verify, clarify, amplify findings from self-study and
activity files
• Nurse Peer Reviewer Final Report
• Approver Unit makes approval decision
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Approval decisions:
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Approved with Distinction
Approved
Probation
Denial
*Organization may also be suspended or revoked
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
• Annual requirements:
• Annual demographic information form
• Annual Approved Provider Continuing Education
Summary form
• Additional documentation requested by the Approver
Unit (progress reports, response to complaints, or
similar)
• Random audits of organizations conducted by the
Approver Unit
© 2012 American Nurses Credentialing Center
An Overview for Approved Providers
Questions?
© 2012 American Nurses Credentialing Center