Case-Based Nursing Peer Review Using Just Culture Principles

Although more than twenty five years have passed since the American Nurses Association published the 1988 Peer Review Guidelines and defined nursing peer review as “the process by which practicing registered nurses systematically access, monitor, and make judgments about the quality of nursing care provided by peers as measured against professional standards of practice” nurses have not fully integrated this into practice. Our Professional Practice Council recognized the need to develop a formal nursing case review process to supplement peer review feedback occurring informally and annually as part of performance review. A core group was formed to search relevant literature, seek hospital risk management and legal counsel input and develop a policy to guide a nursing case review process. Just Culture principles were explored and used as the basis for the development of our non-punitive process. Informational sessions educated staff about the process and expectations of nursing case review committee participants. The Chief Nursing Officer appointed the committee taking into account staff interest and director recommendations.  The majority of the committee members are clinical nurses representing the various units of the hospital. Ad hoc members from specific nursing units and other disciplines are invited to the case review as needed. The importance of confidentiality is emphasized, with all staff participating in a case review signing a confidentiality agreement.  Case referrals are made by clinical nurses, nursing leadership. medical peer review, performance improvement and risk management. Cases determined to be appropriate are presented to the nursing case review committee by a Clinical Nurse Specialist or the Professional Practice Manager. Nurses involved in a case are invited to voluntarily participate in the process, if possible or may be individually interviewed prior to the case discussion. A case review template is used and action plans are determined at the conclusion of the review. As a result of participating in this process, nurses’ experience increased professional accountability by identifying the need to make practice changes. Since implementation two years ago cases reviewed have supported need for  the following process changes: method of  implementing of venous thromboembolism prevention measures, medical surgical sepsis screening, screening of surgical patients for opioid tolerance, Magnetic Resonance Imaging prescreen process and direct admission process. Some of the educational needs identified and addressed included the medication reconciliation process, deep tissue injury identification and bowel management regimens.