Correctional Nursing Peer Review: Making It Practical

Peer Review written in white chalkAlthough the concept of nursing peer review is over two decades old, it is just coming of age in the correctional nursing specialty as the newest version of the National Commission on Correctional Health Care Accreditation Standards has expanded the Clinical Performance Enhancement Program (Standard C-02) to include RNs and LPNs. This is the third in a 4-part series of posts on correctional nursing peer review. Find other posts on this topic here.

Building a nursing peer review program from the ground up can be a daunting task. Here are some practical ideas for how to have a successful nursing peer review process that is efficient and effective.

Create Links to Current Programs

Although nursing peer review is different from continuous quality improvement, nursing competency reviews, or performance evaluations, these programs can be linked to the nursing peer review process in several ways.

  • Trending in CQI studies can help in prioritizing which professional standards to review in any given time period. If studies are showing that withdrawal protocols are not being initiated as expected in a jail setting, assessment and decision-making on intake might be a priority professional standard for nursing peer review.
  • Likewise, if competency evaluation of new orientees shows deficits in differentiating dental urgencies and emergencies, this can become a peer review priority.
  • Because performance evaluations often involve compensation and employment behavior, it is best to have a clear separation between the performance evaluation and the nursing peer review process. However, if trends in clinical issues emerge during the performance evaluation process, these issues might help make determinations of which professional standards will be the focus of upcoming peer reviews.
  • Other clinical data can also inform a nursing peer review program. Information from risk management, medication errors, mortality reviews, and emergency room visit trending may indicate a particular focus for evaluating clinical performance.

Involve Everyone

Involving front-line nurses in the creation of the program and prioritization of the standards used for the review will encourage maximum participation. The challenge of peer review is maintaining a climate of professional development rather than one of evaluation and criticism. It may be tempting for a nurse manager to complete the nursing peer review on all nurse employees. A team effort, instead, can provide professional growth among the staff. Properly managed, nursing peer review can be a supportive and encouraging professional process. Poorly managed nursing peer review can seem punitive and discouraging.

Create Forms

Forms provide structure to any process, especially new ones. If a form is used for peer reviews there is more opportunity for consistency. In addition, a form can operate as a checklist to prompt a reviewer on  elements requiring attention. Staff are more likely to get involved if they have a written format to follow. NCCHC also recommends the use of a standard form in the discussion of the C-02 standard.

Spread Reviews Across the Calendar

Work out a program for peer review throughout the year rather than trying to do it all at once. Make it a monthly or quarterly activity; possibly attached to an existing quality improvement or meeting structure. The important point is to keep nursing peer review as an active and ongoing process rather than a periodic disconnected project.

Are you developing a Nursing Peer Review program in your setting? Share your experiences in the comments section of this post.

To read more about professional practice issues see Chapter 19 in the Essentials of Correctional Nursing. The text can be ordered directly from the publisher and if you use Promo Code AF1402 the price is discounted by $15 off and shipping is free.

Photo Credit: © lculig – Fotolia.com

5 thoughts on “Correctional Nursing Peer Review: Making It Practical

    • HPI MD 1738: This is 80 yo female with complaints of SOB, respiratory distress and cramps. She presented 2 weeks with similar presentation of SOB and pedal edema. She reported feeling dizzy and not eating. Patient had a triple bypass, and she also had dementia. She also presented with vertigo, dizziness and distress. Patients being evaluated for SOB.
      V/S Temp 98.2, P 107, R 18 B/P 166/112
      0906 Labs: wbc 10.5, neutrophils 83.0 %, lymphocytes 9.2%
      0902 CXR: There is reticular hazy infiltrate within the right mid to lung which appears new and is suggestive of pneumonia. There also a small right pleural effusion which is also new.
      H&P MD 1609: Patient ambulate with front wheel walker, currently requires nasal cannula. Patient is alert, and oriented. He is complaining of losing weight for the past 3 months, severe cachexia, with dyspnea on exertion, weakness and now has an upper respiratory tract infection.
      Patient was evaluated in the ED and thought to have pneumonia versus a PE. She denies chest pain, but having difficulty breathing. Patient is not on oxygen at home; patient’s daughter would like to have hospice evaluation. Patient is DNR/DNI
      Pulmonary Consult MD 0636: Patient is tachycardia, hypertensive. On examination, she is unable to give any detailed history. She is complaining of having chest discomfort. The patient has extensive mediastinal lymphadenopathy with a mass lesion, possibly endobronchial extension with peribronchial lesion of upper airway. Patient was started on IV antibiotics and will monitor her 02 sat, her prognosis is poor.
      0020 Patient was transferred to ICU
      10/11/2017
      Death Summary MD 1931: Patient continues to decline with poor oxygenation, it was discussed with the family. The patient’s family decided to place the patient on comfort care, comfort measures. We are planning for hospice care at home. The patient expired in the ICU.
      Cause of Death:
      Respiratory failure, Pneumonia,

      Like

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