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

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

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

4. 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?

5. 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

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

7. 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

8. 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

9. 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

10. 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”

11. 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.

12. 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.

13. 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.

14. Other Professions that do Peer Review
Medicine
Accounting
Engineering
Publishing

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

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

17. 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

18. 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

19. 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

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

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

22. 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),
Diaz, L. (2008). Nursing Peer Review: Developing a Framework for Patient Safety Journal of Nursing Administration, 38 (11)
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.