Nursing Peer Review: Raising the Bar on Quality & Safety/A Hospital's Innovative Process for Improving Patient Outcomes

Purpose:
The nursing peer review committee is comprised mostly of bedside nurses and is part of the shared governance model which was initiated at the opening of a new patient-family centered care teaching hospital. The goal was to develop a professional nursing culture of excellence and safety.

Significance:
Over 35 years ago, the ANA identified nursing peer review (NPR) as an essential part of professional nursing practice. Its structure assists with developing a culture of professional nursing excellence of open communication for promoting safe quality care in a non-punitive learning environment.

Strategy and Implementation:
The process was implemented through the collaboration of the nursing peer review committee. The Nursing Standards and Improvement Coordinator (NSIC) is the first person to receive referrals and assign a severity index score ranging from acceptable to major variation from standard of care. After collection and analysis of data the NSIC brings the findings to the NPR committee. The NPR committee then reviews the case, determines if the case warrants review, and those that require evaluation are reviewed by specific criteria. This includes: nursing process issues, nursing standard of care, analysis the incident, and human factors. The committee then establishes recommendations on a level bases: Level 0; no further action, Level 1 (First case for RN); individual education provided by nurse member of NPR, Level 2; (Second case-same RN) RN invited to NPR committee for discussion by Clinical Educator (member), and Level 3; (Third case-same RN) referral to manager.

Evaluation:
In October 2011, our first NDNQI RN Survey for perceived quality of care indicating above the bench mark for all departments in our hospital. Recommendations from our committee so far include Level 1, Level 2, and educational opportunities indentified and brought to our Learning Council.

Implications for Practice:
The ultimate goal is improve our patient outcomes. This is achieved by identifying opportunities for nursing practice changes in a non-punitive approach. The learning environment helps encourage nurse accountability and strengthen nurse professionalism.