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Peer Review

According to the American Nurses Association, peer review is the process by which professionals from common practice areas systematically assess, monitor, make judgments, and provide feedback to peers by comparing actual practice to established standards.110 Many health care organizations, such as The Joint Commission's hospital accreditation process and the American Nurses Credentialing Center's Magnet Recognition Program®, have peer review components in their standards. Peer review is often used for individual performance improvement and improving patient outcomes, but also as a mechanism for identifying areas of weakness or strength, recognizing trends, and strengthening accountability and performance. Some are formal, others informal. One of the keys to the success of this is that it is truly peer review, not manager to staff, but rather staff members responsible for the same clinical care reviewing one another. This is a nursing responsibility, and if a program manager is not a nurse, they should not be part of the peer review process, with the exception of maintaining records. While peer review may be protected under state and federal laws that encourage health care providers to have quality improvement, many programs destroy any documents used during peer review that itemize problems identified in a specific case and only keep a summary of how well the nurse performed. 

When peer review is instituted in a SANE program, the manager will want to consider the rationale behind the peer review. Is the peer review being instituted to achieve Magnet® status? If so, are there regulatory requirements? Has the process been defined, outlined, and described? Who will be responsible? One of the keys to success is ensuring the review occurs in a timely manner, soon after the episode of care. Another critical key is that peer review should not be construed as punitive, but more as a means of delivering mentoring.  

In order to build an organizational culture that supports peer review, the process should be ongoing, like QI, and built into the expectations outlined in job descriptions, policies and procedures, education, and quality improvement processes.

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