Hi all!
On behalf of the Practice Advancement and Advocacy Advisory Group, we would like to provide discussion on the current state of credentialing and privileging processes for health-system pharmacists at various institutions. Below you will find information compiled by our work group members about the definitions of credentialing and privileging from the Council on Credentialing in Pharmacy as well as procedures used at each of our current practice sites. Additionally, we invite you to respond to our discussion questions at the end.
Definition of Credentialing:
a) The process of granting a credential (a designation that indicates qualifications in a subject or area) by an entity (i.e., a credential-granting entity/organization), or b) The process by which an organization, institution, or payer obtains, verifies, and assesses an individual's qualifications to provide patient care services. For example, a hospital will confirm that a newly hired pharmacist has obtained both the professional degree and licensure necessary to engage in pharmacy practice.
Definition of Privileging:
The process by which an oversight body of a health care organization or other appropriate provider body, having reviewed an individual health care provider's credentials and performance and found them satisfactory, authorizes that individual to perform a specific scope of patient care services within that setting.
Examples:
Ashlee:
Practice site:
- Primary and specialty clinics within an integrated multi-state health system
Privileges:
- Delegation protocols which are department or clinic specific allow prescribing, deprescribing, titrating, tapering, monitoring, and managing medications for specific conditions (for example anticoagulation, weight loss, hypertension, diabetes, heart failure, multiple sclerosis, and more
Requirements/Process:
- Must be hired/employed as a Clinical Pharmacist
- Residency training is required or preferred
- Completion of computer-based trainings
- Institutional guideline and protocol review
- Providing clinical services "per protocol" requires documentation in the electronic health record
Emma:
Practice site:
- 266-bed, freestanding pediatric teaching hospital
Privileges:
- Pharmacokinetic dosing for vancomycin and aminoglycosides, including dose and frequency adjustment as well as ordering of serum levels
- Management of total parenteral nutrition, including TPN and lab panel ordering
Requirements/Process:
- Must be hired and employed as a Clinical Pharmacist that provides hospitalist medicine coverage or a Clinical Pharmacy Specialist
Tate:
Practice site:
- Heart and Vascular Institute – ambulatory care cardiology clinics
Privileges:
- Prescribing authority related to disease states and drug classes. There is no specific pathway that must be followed. The CDTM is intentionally made to be broad to cover a large range of cardiovascular disease states.
- Clinical pharmacy practitioners can start new medications, change doses, and order labs
Requirements/Process:
- Hired as a clinical pharmacy practitioner which requires 2 years of residency or 1 year of residency + 5 years of experience or no residency + 10 years of experience
- Board certification is required within 2 years of hire
- Credentialing is required through the state of North Carolina (CDTM with physician practice sites and signatures) and internal credentialing through the organization (DEA license, board certification, CDTM, full history of education and previous work locations)
Questions for members:
Does your practice site (hospital, health system, clinic, etc.) grant privileges for pharmacists to perform specialized clinical tasks such as ordering medications, writing TPNs, or initiating/modifying outpatient therapy?
If so, what is the process for privileging at your practice site?
Thank you in advance for your participation, and we look forward to reading any responses!
Ashlee Vaclavik, PharmD
Emma Rednour, PharmD
Tate Drees, PharmD, BCACP
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This post is written by members of the NPF PAAAG Credentialing and Privileging Work Group and does not necessarily represent the views of ASHP.