Peer Review What, Why, When, Where & How? Priscilla P. Sterne, DNP, RNC Nursing Administration

Goals Increase knowledge about Peer Review Understand different forms of Peer Review Empower nurses to perform Peer Review

Objectives Understand Peer Review process Explain the fundamentals of Peer Review Define Peer Groups Promote Professionalism and Accountability Create Culture of Inquiry

Peer Review Outline What is it? Why do we do it? When do we do it? Where do we do it? How is it done?

What is Peer Review? Tool used for advancing nursing practice and promote patient safety Method of optimizing the quality of nursing care within a unit, in terms of structure, process, and outcomes Review of a nurse’s work within the health care setting Identifies documentation issues, nursing care issues, system issues and provides opportunity to improve systems

What is a Peer? A peer is someone of equal standing in terms of education level, professional experience and/or employment status

Peer Review is Not Can be misperceived by nurses as a practice that is meant to be judgmental Designed to punish mistakes, assign blame, or criticize

Why Do Peer Review? Reinforce the professional status of nursing by demonstrating self-regulation and transparency Empower staff nurses who exhibit best practices to identify and address gaps in quality care Identify system or communication issues in order to advance a culture of safety Professional development for all parties involved in review process

Why Do Peer Review? Grow professionally through collaboration and shared insights Empowerment of nurses Enhance professional autonomy Ensure competent nurses: Ongoing clinical education Annual Performance Review Peer Review Facilitates identification of system or practice issues or knowledge deficits Promotes transparency in nursing

ANA’s Code of Ethics ANA’s Peer Review Guidelines “Each nurse must participate with other nurses in the decision-making process for evaluating nursing care.”(ANA, 1988) Recognizes that effective peer review is indispensible for holding nursing practice to the highest standards Addresses boundaries of duty and loyalty for all nurses “The responsibility to preserve integrity and safety, maintain competence, and to continue personal and professional growth”

Fundamentals of Peer Review (American Nurses Association, 1988) Six Principles 1. A peer is someone of the same rank. The term “peer review” does not refer to an annual performance evaluation conducted by a manager. In true peer review, floor nurses review other floor nurses, advanced practice nurses review other APNs, and so forth. 2. Peer-review is practice-focused.
This means the process is concerned with patient outcomes. It’s a way to monitor the standards of care within a unit, as measured against professional standards and evidence-based nursing practice.

Fundamentals of Peer Review (American Nurses Association, 1988) 3. Feedback is timely, routine, and continuous.
When peer review happens in real-time – rather than as an annual evaluation – nurses can catch policy and process failures right away and correct them, before more harm occurs. 4. Peer review fosters a culture of continuous learning regarding patient safety and best practices.
Peer review is not a blame game. Its purpose is to gather evidence that can be used as the basis for policies and procedures that improve nursing care on an organizational basis.

Fundamentals of Peer Review (American Nurses Association, 1988) 5. Feedback is not anonymous.
In order for nurses to work together collaboratively, we need face-to-face, professional dialogue about nursing practice, rather than sharp criticisms or personal attacks. 6.  Feedback considers the developmental stage of each nurse.
Nursing skills develop along a continuum, from novice to expert. This brings into play another important consideration – the chance for experienced nurses to act as informal mentors to younger nurses, by sharing supportive insights or practical ways to apply critical thinking skills.

Other Professions that do Peer Review Medicine Accounting Engineering Publishing

When We Do Peer Review What Happens? Improve Patient Care Foster Teamwork Promote Collaboration Learn from Errors

Where is Peer Review Done? Chart Review/Audits Evaluations Committee

When is Peer Review Done? Professional Development Evaluation: Non-biased (or constructive) feedback that promotes professional development through positive communication Identify problems: Goal is to to proactively prevent problem from happening again and becoming a threat to patient safety Personnel Evaluation:  Measured against professional standards of practice for job role

How We Do Peer Review? Incident related (triggered by adverse event or poor outcome directly related to nursing care)-not to assign blame, but to determine if breakdown in systems or processes contributed to the problem Goal is to identify problems that might arise again and to proactively prevent them from becoming threats to patient safety

How We Do Peer Review? Evaluation is measured against professional standards of practice Non-biased feedback is given to the nurse that delivered the care in a way that promotes professional development through positive communication

How We Do Peer Review? Formal Annual Performance Review Preceptor/Mentor/Coach Review Application for Advancement RCA Event/Problem/Issue

How We Do Peer Review? Informal Working along side as a team Bedside Shift Report SBAR Collaborating with a staff member Questioning Attitude

References American Nurses Association (1988). Peer Review Guidelines. American Nurses Association (2003). Nursing’s Social Policy Statement (2nd Edition). Washington, DC: American Nurses Publishing. American Nurses Credentialing Center (2008). Application for Magnet (3rd Edition). Brooks, S.B., et al. (1995). Peer review: An approach to performance evaluations in a professional practice model. Critical Care Nursing Quarterly, 18(30), 36-47. Diaz, L. (2008). Nursing Peer Review: Developing a Framework for Patient Safety Journal of Nursing Administration, 38 (11) 475-479 Mantesso, Petrucka, & Bassendowski, (2008) Continuing professional competence: Peer feedback success from determination of nurse locus control. Journal of Continuing Education Nursing 39(5):200-5; quiz 206-7, 240. (Masso, M. (2004) Peer review of adverse events-a perspective on Macarthur. Austrian Health Review. 28(1):26-33.