Background: Patient safety is a concern and a focus of healthcare today. According to the Institute of Medicine, at least 98,000 people die in the hospital each year as a results of communication errors that could have been prevented. The Center for Medicare and Medicaid (CMS) indicated that the rate of medical errors due to poor communication was increasing and the death toll from preventive medical injuries approached 200,000 per year in the United States. Foreground: The Joint Commission reported that the primary cause of over 70 percent of sentinel events was communication failure. The Department of Veterans Affairs (VA) National Center for Patient Safety in America identified communication failure in healthcare as the primary root cause of 75 percent of more than 7,000 root cause analyses of adverse events nd close calls. Therefore, effective communication skills, including peer-to-peer review and feedback with a nurse colleague, are an essential component of excellent quality of care and patient safety. Method: Identifying a peer review process on a daily basis reinforces the entire discipline of nursing: To take effective action and create meaningful structures and processes that are grounded in evidence-based practice while improving patient outcomes. Using the PICO method as represented by; P: Surgical staff nurses at a 450 bed hospital, I: Peer Review and peer feedback in-services, O: Improve peer-to-peer communication and feedback that can lead into improved quality patient care. EBP: The Larrabee Framework provided a pragmatic, theory-driven model for empowering clinicians in the process of evidence-based practice. Conclusion: RN-to-RN peer review feedback is a vital component of patient safety as it will a) evaluated the quality and quantity of nursing care as it is delivered by the individual or group of practitioners; b) determine the strengths and weaknesses of nursing care, accounting for local and institutional resources and contraints; c) provide evidence for use, and base recommendations for new or altered policies and procedures to improve nursing care; and d) identify where practice patterns need more knowledge and research.
