Incident-Based Peer Review
Incident-Based Peer Review Peer review is a process established to evaluate individual standards and quality of care issues (Harrington & Smith, 2015, p. 1). According to the Texas Department of State Health Services (DSHS), all hospitals are required to implement a program of incident-based peer review and comply with the reporting requirements established by the Texas Board of Nursing (BON) (Bearden & Shelton, n.d.). According to Haag-Heitman & George (2011), “the primary purpose of peer review is to help ensure the quality of nursing care through safe deliverance of standards of care and newly discovered evidence-based practices (p. 48). Through the implementation of peer review, nurses should be able to demonstrate the credibility in …show more content…
(Texas Board of Nursing [BON], 2013).
Membership and voting guidelines are also established by the BON for the peer review committee. According to the BON, the committee must be comprised of at least three-fourths of the members being nurses. When a registered nurse (RN) is under review, then two-thirds of the committee must be RNs and only RNs vote. When the nurse being reviewed is a licensed vocational nurse (LVN), RNs and LVNs may vote (Bearden & Shelton, n.d.). The committee should also consist of a least one nurse who is familiar with the area of nursing practice in which the nurse being reviewed practices (BON, 2011). According to G. Matthews, Wise Regional Health Systems (WRHS) has an incident-based peer review committee as outlined by the BON (personal communication, October 19, 2015). The committee is an Ad Hoc committee with a chairman appointed by the Chief Nursing Officer (CNO). The CNO and the chairman appoint four other members to serve on the committee. Members of the committee do not have direct administrative authority over the nurse being reviewed. All peer review committee activities are considered confidential and may not be disclosed expect as outlined by the BON and the Texas Occupation Code (personal communication, October 19,
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