The Power of Peer Review: Impacting Practice at the Bedside

Purpose:
To develop and implement a nursing peer review process based on best practices identified by the shared governance task force.

Significance:
Nursing peer review engages the bedside nurse to be empowered to make nursing practice changes based on the peer review findings. In order to increase participation and ownership at the unit level, it was necessary to develop a nursing peer review process.

Strategy and Implementation:
A referral form, process/decision tree, acknowledgement letter, case review and lessons learned forms were developed. Membership and team structure is based on similar practice environments. Staff nurse members, one per unit are selected by their nurse manager to serve a one to two year term rolling-off incrementally to avoid having 100% turnover. The committee is collaboratively led in partnership between a staff nurse and Advanced Practice Nurse, with as needed support from a nursing director. Ad hoc advisors are consulted by the committee as deemed appropriate. Referrals are triaged using the decision tree. Members are trained to conduct reviews and complete the initial case review form and timeline in preparation for the pre-scheduled monthly two-hour committee meeting. A standardized tool is used to track identified deviations from the standard of care, practice, and documentation issues. Lessons learned from the cases are conveyed at shared governance meetings.

Evaluation:
Since January 2010, 21 of the 36 referred cases were deemed appropriate for review. Top clinical practice issues identified were ineffective communication, documentation not substantiating clinical course/treatment, inappropriate interventions, policy non-compliance, and delayed documentation.

Implications for Practice:
Bedside nurses have expressed positive experiences in participating in the process and have been engaged in initiating changes in nursing policy and practice directly related to the outcomes from case reviews.