Nolan and colleagues explored the effect of morbidity and mortality peer review conferences (MMPRCs) on ventilator-associated pneumonia (VAP) rates and on accountability and compliance among nursing staff at a large teaching hospital. Before program implementation, there was a 90% rate of compliance with grouped procedures for reducing VAP-resulting from fluctuating staffing and acuity levels, simply forgetting, and shifting responsibility. After MMPRCs based on the Iowa Model of Evidence-Based Practice were implemented in the hospital, VAP cases were identified, and nurses involved in the care of those patients were invited to the MMPRCs and offered compensation. They were told that the MMPRCs wouldn't be used to identify people to blame but to determine process and system challenges. The MMPRCs included an overview of the case history, an examination of compliance with VAP procedures, a consideration of diagnostic comorbidities, and other pertinent information.

Six VAP cases were identified during a three-month period, resulting in 11 MMPRCs attended by 45 nurses. Nursing accountability was measured by the number of "I" versus "you" statements made during the conferences, with "I" statements indicating greater personal responsibility. There was a 48% reduction in the number of "you" statements made between the first three and the last four MMPRCs. Similarly, the number of "I" statements increased from 24 to 92, indicating a greater degree of accountability among nursing staff.

There were 1.68 cases of VAP per 1,000 ventilator days in the three months before initiation of the MMPRCs compared with 0.86 afterward; however, this decrease wasn't statistically significant. Compliance with grouped VAP prevention procedures also improved, from a rate of 90% to 95%.