Nursing Incident Based Peer Review: A Innovative Process for Improving Patient Outcomes

Purpose:
To describe the structure and process that was developed in one organization to implement Nursing Incident Based Peer Review (IBPR) and integrate it into the shared governance structure to support improvements and innovations in nursing care delivery.

Significance:
The CNO and Shared Governance Executive Council felt that there was a need for a formal structure to review nursing care, and track associated outcomes within our organization. The IBPR process provides a mechanism for nurses to express their concerns using the nursing process as the foundation.

Strategy and Implementation:
A work group within the Quality Improvement Council was tasked with creating the nursing incident based peer review process (IBPR) and structure. A review of the literature revealed very little regarding the utilization of nursing IBPR, outside of certain states where it is required. Therefore, a medical peer review format was utilized that focused on the nursing process. The work group developed an educational program that was presented to nursing leadership, shared governance councils and nursing staff to kick off the IBPR process. Cases are reviewed by two members using review forms based on the nursing process. The IBPR committee membership has evolved to include quality managers, advanced practice nurses, bedside nursing staff and specialty clinical experts as needed for specific case review. The referral criterion is simple: if a nurse has a concern that an unexpected outcome occurred due to an alteration in the nursing process then the case is appropriate for referral.

Evaluation:
The Committee has reviewed over 30 cases. Initially, staff voiced concerns regarding the process, but as cases have been presented in various nursing forums, nurses have heard of the lessons learned and they have come to understand that this is an avenue for them to own their practice.

Implications for Practice:
Specific themes emerged from the cases reviewed that led to nursing process changes in clinical areas including IV therapy, mental health patient safety, pain management. Bi-annually, the IBPR committee presents the most recent cases reviewed and the practice implications learned from each case.