Help needed : peer evaluation in nurses' professional development

Daytonite, BSN, RN · Oct 28, 2006

hi, amandine!

peer review is something that has been going on in the u.s. with physicians for some time. i'm not surprised to hear that it may be something that may be done by nurses in some parts of the world as well. here in the u.s. medicare mandates peer review of physicians, by law, as part of their quality assurance activities. peer review is basically the evaluation of a person's professional performance by others in the same profession. peer review is a process where a person's performance is measured against the quality of the care they provided. quality assurance is the measuring of the quality of service being provided with remedial, or corrective, action being taken where needed to assure that a desired standard of quality is being maintained. peer review is focused more toward an individual person. quality assurance is focused more the bigger picture. you can substitute the word "excellence" for "quality" if you like.

the peer review forms i have seen ask very specific questions as to whether or not specific standards of care were met by the healthcare person being reviewed in performing care of the patient in question. if they were, that is fine. if they were not, what happens is a senior physician usually contacts the doctor whose care is in question and asks what their reasoning was for doing, or not doing, what they did for that particular patient. they will talk to him/her privately about what happened. a written report, however, goes into the physician's file that is kept locked in the medical staff office since this is considered confidential information here in the u.s.

i was on a quality assurance committee in several places i worked. what we did was identify problems with nursing care. nosacomial infections are an example. we did a big study of hand washing when it was found that there was an outbreak of mrsa in one of the icus. we developed a questionnaire that included the hospital policy about hand washing between patient contacts. then, some of us took turns observing the staff. we tabulated the results and then did a big teaching project [the corrective action] with all the nursing staff on that unit and ancillary departments as well since we found that laboratory and respiratory staff had just as much a problem washing their hands between patient contact as well. a few months later we re-tested using the original questionnaire again to see if our remedial action had any effect. this is quality assurance activity that involved a larger focus of activity.

in some places peer review is used strictly as a way to improve the quality of care being given to patients. in other places it can also be used as a learning tool for newer professionals to help them improve their practice. still, in some cases, it is used as documentation of a professional's continued poor practice and proof of incompetence. in any case, when you are the person whose case files are being reviewed, it can be emotionally difficult since we all want to do our best and it hurts to hear that we may have not given the best care that we could have.

hope that helps you out.

Amandine · Oct 29, 2006

Thanks so much for your help. It made things much clearer!