CCLINICAL PRIVILEGESLINICAL PRIVILEGES

Kewenangan yang diberikan kepada dokter, Kewenangan yang diberikan kepada dokter, dokter gigi, perawat dan bidan oleh Hospital dokter gigi, perawat dan bidan oleh Hospital Governing Board atau Direktur RS untuk Governing Board atau Direktur RS untuk memberikan layanan kepada pasien di RS.memberikan layanan kepada pasien di RS.

Pemberian kewenangan tsb secara umum Pemberian kewenangan tsb secara umum dibatasi hanya pada tenaga kesehatan yang dibatasi hanya pada tenaga kesehatan yang memiliki lisensi, pengalaman dan kompeten-memiliki lisensi, pengalaman dan kompeten-sisi..

CCLINICAL PRIVILEGESLINICAL PRIVILEGES

Emergency privileges Emergency privileges perlu diberikan kpd perlu diberikan kpd setiap tenaga kesehatan ketika ada kondisi setiap tenaga kesehatan ketika ada kondisi emergensi emergensi di di RS, RS, tanpa tanpa dikaitkan dikaitkan dengan dengan tugas layanan reguler maupun statusnya.tugas layanan reguler maupun statusnya.

Temporary privileges Temporary privileges bisa diberikan kepada bisa diberikan kepada tenaga kesehatan untuk memberikan layanan tenaga kesehatan untuk memberikan layanan kesehatan dalam waktu terbatas atau kepada kesehatan dalam waktu terbatas atau kepada pasien spesifik.pasien spesifik.

PEMBERIAN PEMBERIAN

CLINICAL PRIVILEGESCLINICAL PRIVILEGES

Ada banyak metoda pemberian ClinicalAda banyak metoda pemberian Clinical Privilege Privilege..

Masing-masing metode punya kelebihan dan Masing-masing metode punya kelebihan dan kelemahan atau punya keuntungan dan kerugian.kelemahan atau punya keuntungan dan kerugian.

Terdapat 4 metode pemberian CP, yaitu:Terdapat 4 metode pemberian CP, yaitu: 1. 1. Laundry list method. Laundry list method. 2. 2. Categorical privilege delineation method. Categorical privilege delineation method. 3. 3. Core privilege delineation method. Core privilege delineation method. 4. 4. Combination approach.Combination approach.RS perlu mengkaji metode mana yg paling sesuai. RS perlu mengkaji metode mana yg paling sesuai.

LAUNDRY LIST METHODLAUNDRY LIST METHOD

1. 1. This method has been in use since the 1950sThis method has been in use since the 1950s..2.2. TTo address issues related to inconsistent education o address issues related to inconsistent education

and training of physicians. and training of physicians. 3.3. ItIt requires the facility to develop a list of all possible requires the facility to develop a list of all possible

procedures a provider may perform for a specific type procedures a provider may perform for a specific type of specialty. of specialty.

4.4. Advantages of this approach include the availability Advantages of this approach include the availability of a provider specific listing of approved procedures. of a provider specific listing of approved procedures.

5.5. This is especially helpful for the surgical specialties. This is especially helpful for the surgical specialties. 6.6. The disadvantages of using this type of system are in The disadvantages of using this type of system are in

the maintenance and updating of the procedure liststhe maintenance and updating of the procedure lists..

Check List Clinical Privilege

CATAGORICAL PRIVILEGESCATAGORICAL PRIVILEGES

1. 1. This method delineates clinical privileges This method delineates clinical privileges in specific categories or levels of in specific categories or levels of privileges. privileges.

2.2. The categories can be defined in many The categories can be defined in many ways, such as by training and experience, ways, such as by training and experience, patient types or diseases, major treatment patient types or diseases, major treatment areas and degree of complexity. areas and degree of complexity. 3. 3. This approach works well for medical This approach works well for medical ssecialties.ecialties.

CORE PRIVILEGESCORE PRIVILEGES

1. 1. The concept of core privileges requires theThe concept of core privileges requires the medical medical staff to identify those cognitive and procedural skills staff to identify those cognitive and procedural skills that are part of the core competency of a given that are part of the core competency of a given specialty. specialty.

2. 2. This allows any physician meeting theThis allows any physician meeting the require requirements for ments for education, training and experience to perform any and education, training and experience to perform any and all of the core privileges. all of the core privileges.

3. 3. Special procedure privileges may be obtained by Special procedure privileges may be obtained by documenting additional training, experience and documenting additional training, experience and com-com-

petency for specific procedures requested. petency for specific procedures requested. 4. 4. Lists of specific diagnostic and invasiveLists of specific diagnostic and invasive p procedure rocedure skills must be developed for each set of core privileges.skills must be developed for each set of core privileges.

COMBINATION APPROACHCOMBINATION APPROACH

Components of any of the above methods Components of any of the above methods can be combined to create a clinical privilege can be combined to create a clinical privilege ddelineation method appropriate to a specific elineation method appropriate to a specific facility.facility.

THE ULTIMATE RESULTTHE ULTIMATE RESULT

TheThe ultimateultimate resultresult ofof anyany methodmethod ofof clinical clinical priviprivilege delineation is to insure the clinical lege delineation is to insure the clinical competencycompetency of the medical staff. of the medical staff.

During the initial appointment process cliniDuring the initial appointment process clini--cal competency validation is accomplished cal competency validation is accomplished byby obtain obtaining references related to requested ing references related to requested clinicalclinical privilegesprivileges andand byby verifyingverifying education, education, training and experience. training and experience.

BAGAIMANA MENILAI KOMPETENSIBAGAIMANA MENILAI KOMPETENSI

1. 1. Board certificationBoard certification.. 2.2. Documentation of training and experienceDocumentation of training and experience.. 3.3. Physicians may gain this training through Physicians may gain this training through

supervised training programs. supervised training programs. 4.4. PPractitioner may also gain provisional ractitioner may also gain provisional

privileges allowing him or her to perform the privileges allowing him or her to perform the procedure under the supervision of another procedure under the supervision of another practitioner skilled in the procepractitioner skilled in the proce--dure dure (proctoring).(proctoring).

5. 5. Data from some new procedures have shown that Data from some new procedures have shown that the complication rate decreases significanthe complication rate decreases significant-t-ly and ly and competency increases significantly after a certain competency increases significantly after a certain number procedures arenumber procedures are perform performed.ed.

6. 6. Guidelines for competency in new procedures or Guidelines for competency in new procedures or treatment modalities must be developed ontreatment modalities must be developed on the the basis of a review of the literature and the technical basis of a review of the literature and the technical aspects of the procedure. Once the guidelines are aspects of the procedure. Once the guidelines are successfully met by the practitioner, full privileges successfully met by the practitioner, full privileges are granted.are granted.

7. 7. As new procedures and treatment modalities As new procedures and treatment modalities develop, guidelines for clinical privileges must also develop, guidelines for clinical privileges must also develop. develop.

CREDENTIALING ASPECTSCREDENTIALING ASPECTS

1. Kompetensi Akademik:1. Kompetensi Akademik:

a. kognitif; dana. kognitif; dan

b. Psikomotor.b. Psikomotor.

2. Kesehatan:2. Kesehatan:

a. kesehatan fisik; dana. kesehatan fisik; dan

b. kesehatan mental.b. kesehatan mental.

IMPAIRED PHYSICIANSIMPAIRED PHYSICIANS

The one is unable to practice medicine The one is unable to practice medicine with reasonable skill and safety to patiens with reasonable skill and safety to patiens because of a physical or mental illness, because of a physical or mental illness, including deterioration through the including deterioration through the aging aging process process or or motor skillmotor skill, or excessive use or , or excessive use or abuse or drugs.abuse or drugs.

Joint Commission Joint Commission Credentialing, Privileging, Competency, and Peer Credentialing, Privileging, Competency, and Peer ReviewReview, 200, 20033

IINITIAL CREDENTIALINGNITIAL CREDENTIALING

1.1. Licensure – what type of license is required for the Licensure – what type of license is required for the specific privilege, MD, DO, PA, NP?specific privilege, MD, DO, PA, NP?

2.2. Staff Category – should the specific privilege be Staff Category – should the specific privilege be restricted to a specific category of medical staff: restricted to a specific category of medical staff: active, consulting, courtesy?active, consulting, courtesy?

3.3. Training – what specific training is required to Training – what specific training is required to perform each privilege specified? This component perform each privilege specified? This component includes education, medical, dental, nursing, includes education, medical, dental, nursing, postgraduate – residency, fellowship and in what postgraduate – residency, fellowship and in what specialties? Also included in this area could be the specialties? Also included in this area could be the requirement of specific focused training and requirement of specific focused training and education related to the privilege such as a 10-hour education related to the privilege such as a 10-hour course in the use of lasers.course in the use of lasers.

4.4. Concurrent privileges. The standards must define Concurrent privileges. The standards must define any concurrent privileges that the provider must any concurrent privileges that the provider must possess such as surgical privileges for open cases possess such as surgical privileges for open cases in addition to laparoscopic procedures.in addition to laparoscopic procedures.

5.5. Board certification/recertification requirements. Board certification/recertification requirements. Board certification indicates that an individual has Board certification indicates that an individual has demonstrated an understanding of a basic body of demonstrated an understanding of a basic body of knowledge. If board certification is a requirement knowledge. If board certification is a requirement for a specific clinical privilege, then the criteria for a specific clinical privilege, then the criteria should also address the consequences of not should also address the consequences of not maintaining board certification.maintaining board certification.

6.6. Preceptorship – the standards should address Preceptorship – the standards should address whether or not a the specific clinical privilege may whether or not a the specific clinical privilege may be obtained by participating in a Preceptorship and be obtained by participating in a Preceptorship and the qualifications of the preceptorship including the qualifications of the preceptorship including training methods.training methods.

7.7. Continuing medical education requirements should Continuing medical education requirements should be outlined for each specific clinical privilege for be outlined for each specific clinical privilege for which there is a requirement for CME.which there is a requirement for CME.

8.8. Required number of cases – the specific minimum Required number of cases – the specific minimum number requirement indicating the level of number requirement indicating the level of experience required to obtain clinical privileges for experience required to obtain clinical privileges for the requested procedure.the requested procedure.

9.9. Reference letter - standards for privileges should Reference letter - standards for privileges should include a requirement for reference letters from include a requirement for reference letters from either the providers education program, or from the either the providers education program, or from the hospital Department Chair. The reference letter hospital Department Chair. The reference letter should assess the provider’s qualifications and should assess the provider’s qualifications and competency to perform the specific clinical competency to perform the specific clinical privileges requestedprivileges requested..

10.10. Proctoring/provisional requirements. For facilities Proctoring/provisional requirements. For facilities with an adequate number of members on the with an adequate number of members on the medical staff to provide direct observation of the medical staff to provide direct observation of the care provided, proctoring can provide good care provided, proctoring can provide good information on the level of skill and expertise of the information on the level of skill and expertise of the provider. provider. 10.10. Confirmation of a certain number of patients treated Confirmation of a certain number of patients treated with a specific condition within a specified period of with a specific condition within a specified period of months. months. 10.10. Information from other facilities. If the request for Information from other facilities. If the request for privileges is the initial request, information on privileges is the initial request, information on volume and competence must be obtained from the volume and competence must be obtained from the pervious practice site. The standards should pervious practice site. The standards should address what information must be obtained from address what information must be obtained from the previous facility.the previous facility.

RRECRECENTIALINGECRECENTIALINGCCollect data on at least the following areas:ollect data on at least the following areas:1. 1. Number of procedures performedNumber of procedures performed..2. 2. Number and types of diagnoses managedNumber and types of diagnoses managed..3. 3. Outcomes achieved (complication rates, mortality Outcomes achieved (complication rates, mortality rates, readmission rates)rates, readmission rates)..4. 4. Results of review of required functions such as Results of review of required functions such as blood use, medication use, operative and invasive blood use, medication use, operative and invasive procedure review, medical record completion procedure review, medical record completion including legibility and timeliness and the results of including legibility and timeliness and the results of performance improvement activitiesperformance improvement activities..5. 5. Risk management information such as patient Risk management information such as patient complaints, compliments, malpractice activitycomplaints, compliments, malpractice activity..6. 6. Utilization review data such as length of stay, and Utilization review data such as length of stay, and resource utilizationresource utilization..

CCONSIST OF THE CREDENTIALS ONSIST OF THE CREDENTIALS REVIEWREVIEW

1. 1. Ensure that all information in included in the Ensure that all information in included in the packet for the credential committee and packet for the credential committee and medical staff review.medical staff review.2. 2. Information in the packet includes quality Information in the packet includes quality and peer review data to support the and peer review data to support the requested clinical privileges.requested clinical privileges.3. 3. Additional information is included to address Additional information is included to address any “red flags” such as liability insurance any “red flags” such as liability insurance claims, discrepancies in information on the claims, discrepancies in information on the reappointment form.reappointment form.

MASA BERLAKUNYA CPMASA BERLAKUNYA CP

Clinical privilege tidaklah bersifat permanen Clinical privilege tidaklah bersifat permanen sehingga dapat:sehingga dapat:

a. dipersempit;a. dipersempit;b. diperluas, melalui permohonan yang b. diperluas, melalui permohonan yang

didukung oleh setifikat pendidikan ataudidukung oleh setifikat pendidikan atau pelatihan; ataupelatihan; atau c. dicabut berdasarkan alasan tertentu.c. dicabut berdasarkan alasan tertentu.