Nursing Peer Review

NPR Participation in Peer Review Confidentiality Agreement / May 1, 2014 1

Zeeland Community Hospital
Participation in Peer Review Confidentiality Agreement
Name: ______________________________________________ Date: ____________________
Select One:
_____ Nursing Peer Review Committee Member (voting)
_____ Nursing Peer Review Committee Member (non-voting)
_____ Guest
Agreement:
Attending the Spectrum Health Zeeland Community Hospital Nursing Peer Review Committee (NPRC)
requires that you understand the function of our Nursing Peer Review. The NPRC is charged with
monitoring and evaluating the quality and appropriateness of patient care provided by the nursing staff.
As attendees of the NPRC the following is understood:
Expected:
All members and guests will contact the chair if you have any questions.
All members will participate in peer review case discussion by:
Asking and answering questions
Offering opinions and insight
Seeking consensus
Voting on recommendation levels when consensus is not achieved.
All guests will provide opinions when asked to do so by members of the NPR council.
Restrictions:
All members and guests will refrain from discussing cases outside of a NPRC meeting other than
with the chair of the NPRC council.
All members and guests will resist temptation to have casual or cocktail conversations about a
case. Discussing a case with a third party to obtain his or her opinion can inadvertently disclose
confidential information.
All members and guests will avoid creating any personal documents outside the council meeting
time. Any notes taken during a meeting will be immediately placed in an appropriate confidential
document bin for shredding.
If confidentiality is breached at any time, members and guests may resign or be removed from the
NPR committee and be subject to disciplinary action.

I have read, understand and agree to the above confidentiality agreement.
SIGNATURE: _____________________________________DATE:_____________________________

Statement of Confidentiality: Records, data and knowledge including minutes collected for and by individuals and committees, or
committees assigned peer review functions are confidential, are not public records and are not available for court subpoena in
accordance with MCL 333.20174, 333.21513, 333.215215, 331.531, 331.532, 331.533.