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Benefits of formalized nursing peer review

Nurse Leader Weekly, August 19, 2005

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Texas now requires its healthcare facilities to have formal nursing peer review (NPR) processes in place, giving increased prominence to NPR.

What exactly is NPR? It is similar to the medical staff peer review process, except it focuses on nursing care, explained Mary Shepler, RN, BSN, MA, director of critical care services at Exampla Lutheran Medical Center in Wheat Ridge, CO, during the recent HCPro audioconference, "Incident-based Peer Review in Nursing: Proven Strategies for an Effective Process." 

Shepler defines NPR as "the process by which registered nurses systematically assess, monitor, and make judgments about the care provided to patients."

Shepler chairs her facility's NPR committee and offers the following insight into the benefits of having an NPR committee:

• Accountability: "Nurses become more accountable of the quality of care provided by other nurses in accordance with the standards of the profession," says Shepler.
• Ongoing process improvement: System issues are often found during NPR, and, by identifying them in the committee format, organizations are forced to recognize them. This encourages changes and leads to increased patient safety and satisfaction.
• Continuous learning: Because of the cases reviewed during committee, clinical nurse specialists and educators are better able to define hospital educational and competency needs, as well as policies.
• Increased efficiency for medical staff peer review: Having a formalized NPR committee for issues affecting nursing frees up time within medical staff peer review.

How it works

Typically, when a case goes to peer review, it is reviewed prior to the committee meeting by the assigned clinical nurse specialist, Shepler explains. The clinical nurse specialist gives a summary of the case and his or her assessment of care issues.

During the committee's discussion of the case, questions for the staff member may arise, such as "Did you call the physician?" These questions often crop up because nurses tend to do a lot more than what they actually document

Following the committee meeting, a clinical summary about the case (including committee members' questions for the nurse) is sent to the nurse, says Shepler.

Once the nurse receives the clinical summary, he or she has two weeks to respond. This offers the nurse a chance to offer his or her feedback, and it makes better use of the reviewers' and the committee's time. During the first committee meeting, members compound a set of questions that they want answered by the clinical nurse specialist or the nurse, and by the second committee meeting, they have the answers and are able to make a final determination, Shepler says. 

Source: Adapted from Competency Management Advisor (August 2005), published by HCPro, Inc.

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