Nursing Peer Review – A reflection of the year past

The Nursing Peer Review Council celebrated its first year of activities. The team reviewed six cases from six different clinical departments. Nurses were evaluated using the Just Culture investigation process followed by the application of the Just Culture algorithm.

When coaching was indicated, the RN was presented with rationale for practice improvement based on standards of practice of specific nursing specialties, the North Carolina Board of Nursing scope and standards, the American Nurses Association Code of Ethics for Nurses, CVMC’s policies, and CVMC’s Professional Nursing Practice Model. The council was very grateful for the cooperation of all nursing staff involved in this process.

Meet your NPRC

Peer_review

Front Row (L to R): Cherie Trurney (ED), Rose Poole (Psychiatry Services), Leah Propst (Medical)
Back Row (L to R): Paula Stortz (Diagnostic Serv.), Mary Killian (PACU), Brandy Denton(CCU), and Amber Hice (Medical)
Not in the picture: Kim Pennell (Birthing Center) and Adina Andreu (Facilitator)

At the council’s end-of-year review it was identified that the basic structure of the council worked well to accomplish the original NPRC goal of “providing feedback for personal improvement or confirmation of personal achievement related to the effectiveness of the individual nurse’s professional, technical, and interpersonal skills in providing patient care.” Additionally, in several cases critical system issues were identified which were then corrected improving the quality of care for all patients.

The council did identify some process issues that will be addressed in a policy update including term lengths, the addition of alternate members, and allowing the appropriate time for the group to review cases during council meetings.

Council members all agreed that their participation in this process taught them a great deal about themselves seeing behaviors in their own practice that they observed in nurses that came before the council. Within this new context they viewed these behaviors in a new light recognizing how they themselves had “drifted*” in their care delivery. Unanimously council members believed that his process had strengthened their own nursing care processes and made them much more aware of patient safety and quality of care.

Peer Review cases can be referred according to the algorithm below.

NPRC_algorithm

*Just Culture defines “drift” as applying to our behavioral choices. Unlike human error, drift refers to all those choices we make that unknowingly create unjustifiable risk. An example is how we are all taught to drive with our hands on the wheel at 10 and 2 o’clock. As we become more comfortable driving we drift away from best practice and, believing we are safe, create additional risk, such as driving with only one hand on the steering wheel.