Creating a culture of accounatbility, safety, and empowerment through the use of real time peer review

Purpose:
Identify structures and processes to facilitate real time peer review in the acute care environment to achieve positive outcomes.

Significance:
It is essential that nurses are empowered to direct their care at the bedside and create a safe and healthy environment. The application of real-time peer review has lead to significant improvement in nurse sensitive indicators. These tools are transferrable to all organizations.

Strategy and Implementation:
The utilization of real-time peer review at RWJUH provides an exceptional tool for change. In order to create an environment of change, nurses need to participate and drive the initiative. The nurses implemented “Hot Topics”. This is a safety focused huddled structured to include clinical issues, nurse sensitive indicators, patient satisfaction, what's new on the unit, what's new in the hospital, and reward and recognition. These huddles are 5-10 minutes in duration and are led by the staff nurses on the unit. The staff are empowered to identify issues that have the potential to affect their care, and as a team identify interventions to achieve their goals in real time and has achieved positive outcomes. This essential communication is real-time, contextual, specific, and meaningful. Because of the transparency that is disseminated throughout the unit the staff is open and expected to hold themselves and their peers accountable to their high standards every day.

Evaluation:
Through the use of the “Hot Topics Huddle” this unit has been able achieve statistically significant improvements on a number of nurse sensitive indicators such as pressure ulcer, engagement, satisfaction, and decreasing falls by 2.76 falls per/1000 patient days over 3 years.

Implications for Practice:
The use of real time peer review has the potential to empower nurses to lead change, direct care, optimize outcomes, and create a culture and environment of safety and quality. The tools highlighted above are specific and actionable at all organizations and can be achived at any organization.