The Online Newsletter for Children's Nurses
e-Edition, Issue 6
What to do When Approached by
Nursing Peer Review
Written By: (from left to right)
Co-Chairs, Nursing Peer Review Committee
Patricia Lindsey, MSN, RN, CNS, CPN
Jennifer Norgaard, MSN, RNC-NIC, CNS
A staff nurse comes to you regarding a patient care incident with which you were involved and states that they are part of the Nursing Peer Review Committee and have some questions for you about a case. What do you do? Why are they talking to you after you already spoke with your supervisor? Are they trying to point the finger at you or get you in trouble? Chances are that these questions will go through your mind if this happens to you. Relax and a take a deep breath…no one is trying to “trip you up.” Actually, the nurse is attempting to learn how to improve care. What’s more, you can help.
Nursing peer review at Children’s Hospital began over eight years ago as a venue for enhancing the professional practice of nursing through accountability and contribution to the delivery of quality patient care. While physician peer review has been a standard across the nation for many years, it is only recently that nursing peer review has been embraced as an avenue to empower nurses and enhance professional autonomy. Peer review has evolved into a well recognized component of nursing practice and is included in the American Nurses Credentialing Center Magnet standards for exemplary practice.1
Nursing peer review operates similarly to physician peer review. Following a quality of care issue an incident is examined by a committee of peers to search for areas of improvement. Nursing peer review is a non-punitive process designed to evaluate whether standards of care have been met and if not, what systems or processes may have contributed. The committee offers the opportunity to learn from mistakes and to improve patient care. The peer review process helps to delineate isolated occurrences from house-wide issues that are more likely to reoccur if changes are not made. Areas of change may include standards of care, policy, systems issues, or education. The committee identifies trends, challenges, and barriers to delivering excellent nursing care and recommends changes accordingly.
The Nursing Peer Review Committee is a staff driven committee with representation from throughout the organization including the Emergency Department, Craycroft, Explorer, Day Surgery, Apollo, Discovery, Rehab, PACU, PICU, NICU, Patient Care Support and Clinical Risk Management. A fundamental component of the nursing peer review process is the importance of utilizing a peer to contribute the most realistic evaluation of nursing practice. Peers can perform an evaluation of the case with a true understanding of the processes involved and how they are enacted clinically at the patient’s bedside. Utilizing peers allows nurses to be reviewed by persons that are knowledgeable of their job duties, scope of practice, and responsibilities.
Anyone can refer a case for peer review. Cases are referred through risk management via unusual occurrence reporting, physician peer review, parent/family concern or direct referral from staff. The types of cases which warrant peer review include adverse events and outcomes due to failure to recognize changes in status or failure to initiate emergency response. Cases may also be referred in which no clear standard exists resulting in an unanticipated outcome. The nursing peer review process is not intended to evaluate interpersonal conflicts, individual behavior, or lack of adherence to a specific policy or procedure where standards are clearly in place. These cases are handled by the appropriate department leadership.
Once a case has been identified as warranting review, a peer reviewer is assigned. This ensures that the case is reviewed by a nurse knowledgeable of the practices, documentation, and routines of the area from which the case originated. After collection and analysis of data from the medical record (and if necessary speaking to those involved in the case), the reviewer brings their findings to the committee. The committee agrees on recommendation for improvement in each case and makes recommendations in the following categories:
- Review with Provider
- Track and trend
- Educational offerings
- Policy Review/ Development
- Individual counseling/discussion
- Referral to appropriate committee for action
The recommendations are based on the following review criteria:
- Complication grading scale (the outcome)
- Standard of practice/care met
- Contributing factors (patient disease, systems, communication)
- Opportunity to improve documentation
- Opportunity to improve communication
Nursing peer review provides valuable insight into nursing practice and outcomes. It is designed to elevate nursing practice to a new level of collaboration, professionalism and quality. The process strives to enhance and improve the quality of care provided by nurses at Children’s Hospital. So relax, answer questions and share ideas with your peer review representative. They’re here to help you and your patients. You can help empower nursing.
1. Application Manual Magnet Recognition ProgramÒ, American Nurses Credentialing Center, Silver Spring, MD, 2008 Edition
In This Issue
Pediatric Early Warning Tools
Patient Safety Survey
Informatics: The Language of Nursing
Nursing Peer Review
NICU Outreach Education
What is “Just Culture”?