title: Effect of morbidity and mortality peer review on nurse accountability and ventilator-associated pneumonia rates.
abstract: 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 (chi(2)= 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.
authors.affiliation: Critical Care, Scripps Mercy Hospital, San Diego, California, USA. nolan.scot@scrippshealth.org
authors.forename: Scot W
authors.initials: SW
authors.lastname: Nolan
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Burkard
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Clark
authors.forename: Judy E
authors.initials: JE
authors.lastname: Davidson
authors.forename: Donna L
authors.initials: DL
authors.lastname: Agan
mesh_terms: D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000458:organization & administration; D019091:Critical Pathways; D019983:Guideline Adherence / Q000706:statistics & numerical data; D017721:Hospital Costs; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016294:Models, Nursing; D009017:Morbidity; D024802:Nurse's Role / Q000523:psychology; D015403:Nursing Evaluation Research; D010043:Outcome and Process Assessment, Health Care; D018024:Peer Review, Health Care / Q000379:methods*; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D012941:Social Responsibility