Effect of Morbidity and Mortality Peer Review on Nurse Accountability and Ventilator-Associated Pneumonia Rates

Objective: This program was designed to evaluate the effect of morbidity and mortality peer review conferences (MMPRCs) for ventilator-associated pneumonia (VAP) on nurse accountability and compliance with evidence-based VAP prevention practices. Background: Ventilator-associated pneumonia is associ...

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Bibliographic Details
Published in:The Journal of nursing administration 2010-09, Vol.40 (9), p.374-383
Main Authors: Nolan, Scot W., Burkard, Joseph F., Clark, Mary Jo, Davidson, Judy E., Agan, Donna L.
Format: Article
Language:English
Subjects:
Accountability
Attitude of Health Personnel
Chi-Square Distribution
Cost-Benefit Analysis
Critical Care - organization & administration
Critical Pathways
Guideline Adherence - statistics & numerical data
Hospital Costs
Hospital Mortality
Hospitals, Teaching
Humans
Length of Stay - statistics & numerical data
Models, Nursing
Morbidity
Mortality
Nurse's Role - psychology
Nursing
Nursing administration
Nursing Evaluation Research
Outcome and Process Assessment (Health Care)
Peer review
Peer Review, Health Care - methods
Pneumonia
Pneumonia, Ventilator-Associated - epidemiology
Pneumonia, Ventilator-Associated - prevention & control
Practice Guidelines as Topic
Program Evaluation
Social Responsibility
Ventilators
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Summary:Objective: This program was designed to evaluate the effect of morbidity and mortality peer review conferences (MMPRCs) for ventilator-associated pneumonia (VAP) on nurse accountability and compliance with evidence-based VAP prevention practices. Background: Ventilator-associated pneumonia is associated with longer average length of stay (ALOS), greater cost, and increased morbidity and mortality. Traditionally, passive or punitive methods have been used to reduce undesirable outcomes. The MMPRC is not a conventional nursing intervention. Methods: Each MMPRC included case history, relevant hospital course, diagnostic comorbidities, and compliance with VAP prevention strategies. The preventability of each VAP was determined by RN peers. Ventilator days, VAP bundle compliance, VAP incidence, ICU ALOS, cost, and satisfaction data were collected. Results: Nurse accountability improved significantly (χ2 = 24.041, P < .001), and VAP incidence was reduced. Data demonstrated satisfaction with the MMPRC. Number of ventilator days and ALOS did not change significantly, although VAP bundle compliance improved from 90.1% to 95.2%. Conclusions: The nonpunitive MMPRC process was cost-effective and should be considered for other nurse-sensitive indicators to increase nurse accountability and improve outcomes.
ISSN:0002-0443
1539-0721
DOI:10.1097/NNA.0b013e3181ee427b