1. Content Integrity in Continuing Nursing Education Session 1 – Addressing Conflict of Interest Provided by ONA and MNA Facilitator: Pam Dickerson, PhD, RN-BC, FAAN Director of Continuing Education, Montana Nurses Association 1

2. Disclosures Criteria for successful completion: Submit registration and payment, participate in the webinar, complete the evaluation Conflict of Interest: There is no conflict of interest for anyone in a position to control content for this activity. Provider Statement: The Ohio Nurses Association (OBN-001-91) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. Joint Providers: This session is provided collaboratively by the Ohio Nurses Association and the Montana Nurses Association. 2

3. What is content integrity? 1.Conflicts of interest are resolved 2.Content is presented independent of organizations providing commercial support 3.Content is based on best available evidence 4.Content is free from promotional activity 3

4. Conflict of Interest 3 key components: 1.Individual has the ability to control content of the educational activity 2.Individual has a financial relationship with a commercial interest 3.The products or services of the commercial interest are relevant to the topic of the educational activity 4

5. Why does this matter?  Financial relationship with a commercial interest creates the opportunity for the individual to “slant” the activity toward the products / services of that commercial interest  The individual has the ability to accrue financial gain from any additional business acquired by the commercial interest  These factors unfairly jeopardize the educational experience for the learner 5

6. What is a “commercial interest”?  “Any entity producing, marketing, reselling, or distributing healthcare goods or services consumed by or used on patients”.  Could also be entity owned or controlled by such an entity ANCC – see COI form 6

7. Who is “the individual”? Anyone with ability to control content of the educational activity, such as:  Nurse planner  Planning committee member, including content expert  Content reviewer  Speaker / author  Instructional designer 7

8. Assessing for Conflict of Interest (COI) First step: Be sure the nurse planner has no COI How:  Nurse planner completes COI form, acknowledging relationships with commercial interests  Someone else with knowledge of this process reviews the data, determines whether there is a conflict  If a conflict exists, nurse planner should not continue with this activity  If no COI, planning continues 8

9. Assessing for Conflict of Interest (COI) Next steps: 1.Everyone else with ability to control content completes COI form 2.Nurse planner evaluates evidence to determine presence/absence of COI 3.If questions, may consider additional information A.Employer B.Web search C.Questions to individual D.Other 9

10. Types of Financial Relationships 1.Employee: an employee of a commercial interest can NEVER be involved with an activity that pertains to his/her field of employment. 2.Non-employee: may be involved with an activity IF the conflict of interest is identified, resolved, and disclosed to the learner Types of non-employee relationships include:  Speakers’ bureau  Research funding  Consulting  Other 10

11. Other factors to consider  Applies to relationships currently in effect OR that have been in effect within the past 12 months  Applies to spouse or partner of person  Applies to holding shares of individual stocks – does NOT apply to mutual funds 11

12. Analyzing a COI Does the person have the ability to control content of the activity? Does he/she have a financial relationship with a commercial interest? Is it related to the content of this educational activity? If yes to ALL, must be resolved and disclosed to learners 12

13. Is this a COI? The nurse planner for an activity on women’s health is the author of an article that recently appeared in a peer-reviewed nursing journal on the topic of osteoporosis. 1.Yes 2.No 3.Unable to determine 13

14. Is this a COI? Tom Jones is invited to speak on the topic of heart disease in patients with diabetes. He shares that he is on the speakers’ bureau for Eli Lilly. Does he have a COI? 1.Yes 2.No 3.Unable to determine 14

15. Is this a COI? Ruth Wilson is on the agenda to present at a conference on precepting. She states that she does not have any financial relationships with commercial interests. However, she provides you with a bio sketch to be used in her introduction, which includes the fact that, for 5 years, she was a manager at Wyeth. Does she have a COI? 1.Yes 2.No 3.Unable to determine 15

16. Is this a COI? Sarah Jackson is on the planning committee for an activity on caring for patients with hip replacement surgery. She shares that she has received research funding from a company that makes artificial joints. Does she have a COI? 1.Yes 2.No 3.Unable to determine 16

17. Is this a COI? Alice Graham is suggested as a speaker for a conference on alternative therapies. You learn that she owns her own business, Herbals for Life. Your web search shows that her business sells herbal products. Does she have a COI? 1.Yes 2.No 3.Unable to determine 17

18. Resolving a COI Nurse planner makes decision:  Removing the person from the activity  Changing the role of the person  Offering the activity (or session) without contact hours  Nurse planner and/or planning committee talk with person, review content  Nurse planner engages independent content reviewer to provide objective input  In addition to pre-activity actions, personally attend activity to assure integrity  In addition to pre-activity actions, collect data from learners to assess for content integrity 18

19. How to resolve Tom Jones is invited to speak on the topic of heart disease in patients with diabetes. He shares that he is on the speakers’ bureau for Eli Lilly. What would you do?  Is he an employee?  Can the conflict be resolved?  What options would you consider? 19

20. How to resolve Alice Graham is suggested as a speaker for a conference on alternative therapies. You learn that she owns her own business, Herbals for Life. Your web search shows that her business sells herbal products. What would you do? 20

21. Scenario 1 You have a small provider unit and always use the same planners for every activity. Do you need to assess COI for each planner for every activity? 1.Yes 2.No 3.Unsure 21

22. Scenario 2 Your provider unit always uses planners and speakers from your own organization. The organization has a policy that employees may not have working relationships with any commercial interests. Do you still have to assess for COI? 1.Yes 2.No 3.Unsure 22

23. Scenario 3 Your hospital often requests that the provider unit use speakers from companies that provide its products. The purpose of this request is to ensure that staff appropriately use these products. What do you do? 1.Refuse to have the company employee present 2.Offer the education but don’t award contact hours 3.Have the speaker do a train-the-trainer session 23

24. Scenario 4 Your organization is implementing a new electronic medical record system. Every nurse in the facility needs to attend mandatory education on this activity, which will be presented by representatives of the EMR company. What would you do? Can you award contact hours for this activity? 24

25. Scenario 5 Your college of nursing provider unit has identified a need for education for faculty on test writing skills. A prospective speaker has been identified – she owns her own education consulting company. She also shares that her husband owns stock in a company that makes wound care products. What do you do? 25

26. Disclosure to the learners No COI: Examples: ◦There is no conflict of interest for any planner or presenter for this activity. ◦There is no conflict of interest for anyone with ability to control the content of this educational activity. ◦No conflict of interest has been identified for any planner for this activity or for the author of the study. 26

27. Disclosure to the learners Presence of COI: Example: There is no conflict of interest for any planner or presenter for this activity, except for Sharon Green, who is on the speakers’ bureau for Eli Lilly. With presence of COI – disclosure must include:  Name of individual  Type of relationship  Name of commercial interest 27

28. Questions? For additional information, please contact: Pam Dickerson pam@mtnurses.org Zandra Ohri zohri@ohnurses.org 28

29. References American Nurses Credentialing Center (2013) Primary Accreditation Application Manual for Providers and Approvers, version 3. Silver Spring, MD: Author. ONA Provider information: MNA Provider information: http://www.mtnurses.org/Main-Menu-Category/Continuing- Education/MNA-Approved-Providers/Activity-Documentation-Forms-2http://www.mtnurses.org/Main-Menu-Category/Continuing- Education/MNA-Approved-Providers/Activity-Documentation-Forms-2 29