Correctional Nursing Peer Review: Some Examples

cocheAlthough 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 fourth in a 4-part series of posts on correctional nursing peer review. Find other posts on this topic here.

Recently I queried correctional nurse leaders around the country about what they were doing regarding nursing peer review. Many responded that they were researching the process and just getting started. Here are examples of what some systems have developed thus far. They may help you determine what would be best for your purposes.

The Washington state prison system is using a form to document peer review of these practice factors:

  • MAR Completion
  • Completion of Assessments
  • Nurse Care Plan & documented follow-up
  • Documentation
  • Seeks Consultation Appropriately
  • Appropriate Application of Guidelines
  • Clinical Knowledge Base
  • Interest in Improving Skills
  • Patient-oriented Care
  • Professionalism
  • Professional Ethics
  • Patient Education
  • Observed Clinical Skills
  • Critical thinking skills
  • Delegates tasks appropriately

Armor Correctional Health Services, Inc. is using a system that follows the nursing process, reviewing documentation for these practice factors:

  • Legibility of notes
  • Each entry includes date, time, signature and printed name
  • Sufficient information to understand the condition
  • Appropriate assessment includes objective information about the condition
  • Appropriate format and documentation (ie: soap v. incidental note, abbreviations)
  • Ordering of medication (from the right vendor, right medication, right dose)
  • Documentation on the medication administration record
  • Completion of referrals as appropriate

The Ohio state prison system has had a nursing peer review program in place since 2007. They review nursing documentation for each nurse every 2 years. Ten charts are selected – 5 by the reviewer and 5 by the nurse being reviewed. Their policy specifically states that results of the nursing peer review are never used as grounds for disciplinary or punitive action. Instead, a remediation plan may be initiated, if appropriate.

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

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

Correctional Nursing Peer Review: Determining Discipline-Specific and Community Standards

Peer review whiteboardAlthough 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 second in a 4-part series of posts on correctional nursing peer review. Find other posts on this topic here.

There are four key components to the ANA definition of nursing peer review according to their published  Guidelines.

  • Practicing Registered Nurses
  • Assess, monitor, and make judgments about
  • Nursing care provided
  • Measured against professional standards of practice

Accepted professional standards of practice for correctional nurses, then, provide the basis for a nursing peer review program. The NCCHC standard C-02 focuses attention on the competence of the individual under review. The ANA places peer review centers on the complementary goals of quality and safety. Thus, a peer review process for correctional nurses that encompasses competent, quality, and safe care provision is recommended.  Three primary sources of community and discipline-specific standards for nursing peer review programs are outlined below.

ANA Correctional Nursing Scope and Standards of Practice

The American Nurses Association Correctional Nursing Scope and Standards of Practice (affiliate link) provide key professional nursing standards focused on the unique nature of the correctional nursing specialty. Therefore, they provide an excellent foundation for a nursing peer review program. The six Standards of Practice, in particular, provide competency statements appropriate for use in peer review. These standards follow the nursing process and include:

  • Assessment
  • Diagnosis
  • Outcomes Identification
  • Planning
  • Implementation: Coordination of care, health teaching and health promotion, consultation, prescriptive authority and treatment (Advanced Practice Nurses)
  • Evaluation

State Boards of Nursing – Nurse Practice Acts

Nursing practice is governed by state legislation. State boards of nursing then provide the guidance for the nursing profession through interpretation of the nurse practice act and by developing administrative rules or regulations that clarify practice act components. Although they vary among the states, nurse practice acts all contain the standards and scope of nursing practice under their jurisdiction. Here are some examples of practice standards common to most Nurse Practice Acts and follow the key elements of the nursing process

  • Nursing Assessment
  • Patient-centered Health Care Plans
  • Independent Nursing Judgments
  • Provision of Care (as ordered or prescribed by authorized health care providers)
  • Evaluation of Interventions
  • Patient Teaching
  • Delegation of Nursing Interventions
  • Patient Advocacy

Links to state nurse practice acts can be found on the National Council of State Boards of Nursing website along with a helpful article describing the standard factors of nurse practice acts.

Accreditation Standards that Address Nursing Clinical Practice

Many NCCHC accreditation standards address organizational structure and process but some address individual professional practice. Most come from Section E: Patient Care and Treatment. Those standards can be incorporated into a nursing peer review program. Here are a few examples of appropriate accreditation standards to consider:

  • Receiving Screening
  • Transfer Screening
  • Initial Health Assessment
  • Mental Health Screening and Evaluation
  • Nonemergency Health Care Requests and Services
  • Nursing Assessment Protocols
  • Discharge Planning
  • Infirmary Care
  • Intoxication and Withdrawal

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

Correctional Nursing Peer Review: What It Is and What It Isn’t

Frau mit Lupe vor dem GesichtAlthough 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 first in a 4-part series on correctional nursing peer review.

Peer review is a familiar program to providers (physician, nurse practitioner, physician assistant) as a means of evaluating the quality of care provision by individual practitioners. Nurses, however, can have difficulty applying this concept to their own clinical practice. The American Nurses Association’s (ANA) Nursing Peer Review Guidelines provides a definition and set of principles for the nursing peer review process that are applicable in the correctional setting.

What It Is

The original ANA definition of nursing peer review stands today as an appropriate description of the process:

“Peer review in nursing is 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”

Breaking down the components of this definition supplies key concepts for a nursing peer review program in corrections:

Practicing Registered Nurses

Peer review should be performed by nurses who are practicing in a similar context. Thus, it would not be appropriate to have critical care nurses evaluate the nursing care of correctional nurses or for emergency nurses to evaluate the care of neonatal nurses. Nurses practicing in a similar context understand the environment of care, the patient population, and the standard processes for accomplishing care that would not be familiar to a nurse from another context.

Assess, Monitor, Make Judgments

Peer review is an evaluative judgment about the actions of another staff member from the same profession. The primary objective is to determine the quality and safety of care provided by an individual staff member.

Nursing Care Provided

A major component of the definition of nursing peer review is that it is a judgment of actual care provided. This is often done as a chart review but could also be performed as direct observation. However, the evaluation is of actual nursing care provided rather than a nurse’s ability to provide care.

Measured against Professional Standards of Practice

Accepted professional standards of practice are used to determine the quality and safety of care in a peer review. These accepted standards should be known to all members of the peer review process. For correctional nurses, professional standards of practice can come from

  • ANA Correctional Nursing Scope and Standards of Practice
  • State Board of Nursing Practice Act
  • Accreditation Standards that Address Clinical Practice

What it Isn’t

There can be misconceptions about what constitutes nursing peer reviews. Based on the above defining qualities of a nursing peer review, these are not nursing peer review processes:

Annual Performance Evaluation

An annual performance evaluation is a judgment of an employee’s work as it relates to their hired status and job description. Although clinical practice is a part of a nurse’s job performance, it is often not the primary focus of the performance evaluation.

Nursing Competency Checklists

Competency checklists or skills reviews evaluate a nurse’s ability to perform various skills and functions. They do not evaluation actual nursing care provided.

Simulations Such as Man-Down or Disaster Drills

As with competency or skill evaluations, simulations such as man-down or disaster drills evaluate staff ability to perform in an emergency situation but do not evaluate actual nursing care in a real clinical situation.

Continuous Quality Improvement Projects

Continuous quality improvement projects look aggregately at clinical care provided while nursing peer review evaluates a specific clinician’s actual care provision.

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: © Bernd Leitner – Fotolia.com