FPPE/OPPE: Monitoring practitioners' privileges
In the first three articles of this series, Vicki Searcy, president, consulting services at Morrisey Associates Inc. in Chicago, introduced the four basic components of clinical privileging. She examined establishing criteria for privileges as well as accepting applications for privileges and applying criteria.
1. Determining the scope of services that an organization will provide.
2. Determine the criteria (training, experience, behavior, skills) necessary in order to provide a specific service (or grouping of services) or procedures. Establish how exceptions will be handled.
3. Allow applicants to apply for privileges and determine if they meet criteria. Make a decision and communicate it.
4. Monitor the individuals who are granted privileges to ensure their competence and practice within the scope of privileges granted.
In monitoring individuals who are granted privileges, Vicki Searcy, president, consulting services at Morrisey Associates Inc. in Chicago, says there are two components. The first component is to obtain data that show that practitioners are practicing within the scope of the privileges granted.
Several processes must be established to do this, she says. Patient care staff:
- "must be aware of their responsibility to monitor that practitioners practice within the scope of their granted privileges;
- must have a mechanism to find out what privileges have been granted to each practitioner;
- must know what to do if they identify that a practitioner is and/or plans to practice outside the scope of granted privileges (for example, a surgery scheduler should know what action to take if a surgeon wants to schedule a case for a procedure that he/she has not been granted privileges to perform)."
There are multiple ways this could be checked during an accreditation survey, she says.
A surveyor could:
- review a patient record and ask to see the credentials file of the practitioner caring for the patient to confirm that the practitioner has the requisite privileges.
- review the surgery schedule and ask a scheduler how he or she is aware of what privileges each surgeon has been granted. "If the scheduler stumbles and is unaware of how privileges can be accessed (either through electronic 'look-up' or accessing a privilege book), an adverse finding is likely," Search says.
Monitoring also requires that the compentency for practitioners who have been given new privileges be validated. This includes practitioners who are new to the organization as well as existing practitioners who apply for and are granted new privileges. "This requirement is called focused professional practice evaluation [FPPE] by The Joint Commission," Searcy says.
During a Joint Commission survey, a surveyor might ask to see the credentials file of a practitioner who was granted privileges within a year of the survey. "The documentation in the credentials file should identify how the competency of the practitioner was confirmed after he/she was granted privileges," Searcy says. This can be done by: proctoring, retrospective chart review, monitoring clinical practice patterns, etc. "It would be necessary to show that the full scope of privileges was included in the monitoring. For example, an OB/GYN with comprehensive obstetrics and gynecologic privileges should have been monitored on both obstetrics and gynecologic privileges," she says. "A file that shows that the practitioners' 'first six cases' were reviewed (which might have consisted of three D&Cs and three normal vaginal deliveries) would not validate competency for the full range of privileges granted."
Monitoring for practitioners who have been on staff for a period of time is called ongoing professional practice evaluation, or OPPE, she says. "The data collected for OPPE monitoring should cover the full scope of privileges granted," she says. Reports must be created and evaluated at regular intervals; every six to eight months is recommended, she says.
"The entire focus of OPPE is to continuously assess data to assure ongoing competency in the privileges which have been granted," she says. In order to do a full assessment, an organization has to know which privileges have been granted, those that have been denied, which privileges have been exercised, those that have not, as well as outcomes data from the exercise of those privileges. "An organization should have in place mechanisms to conduct these reviews and take action when necessary in order to assure that patients are treated only by those practitioners whose competency can continuously be documented," Searcy says.
In the first three articles of this series, Vicki Searcy, president, consulting services at Morrisey Associates Inc. in Chicago, introduced the four basic components of clinical privileging. She examined establishing criteria for privileges as well as accepting applications for privileges and applying criteria.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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