Vanderbilt University Medical Center Advanced Practice Orientation - - PowerPoint PPT Presentation

Vanderbilt University Medical Center Advanced Practice Orientation

Agenda

• Advanced Practice at Vanderbilt – Overview
• Shared Governance, Professionalism and Collaboration
• Credentialing and Privileging
• Tennessee Guidelines for Practice
• Prescribing in Tennessee
• Vanderbilt University Medical Center Guidelines for Advanced Practice (Bylaws, policies, eStar)
• National Guidelines for Advanced Practice
• VUMC Advanced Practice – Professional Practice Evaluation
• Disclosure Training
• Risk Management Training
• Orientation Packet and Checklist
• Office of Advanced Practice Virtual Tour

Advanced Practice Overview

Welcome to VUMC Advanced Practice – Your Journey Begins Here!

History

Image goes here In the 1960s – the first NP, CNM, CRNA and PA programs were launched. In 2004, VUMC had 100 APRNs and PAs. Today, the U.S. has over 300,000 APRNs and 100,000 PAs. And VUMC has grown to over 1000!

• Nurse Practitioners >745
• Certified Registered Nurse Anesthetists >155
• Certified Nurse Midwives >50
• Clinical Nurse Specialists >20
• Physician Assistants >60

Magnet Designation

Image goes here

• “ . . person, place, object, or situation that exerts

attraction”

• Commitment, Quality, & Excellence In Nursing
• Awarded by American Nurses Credentialing

Center (ANCC)

• 9% of US hospitals designated
• In 2017, VUMC received its 3rd Magnet

Designation!

Magnet

Image goes here Professional Practice Model

• Evidence based practice
• Quality, safety, service
• Professionalism and Leadership
• Integrated Technology

Essential Components of the Magnet Model

• Transformational Leadership
• Structural Empowerment
• Exemplary Professional Practice
• New Knowledge, Innovations &

Improvements

• Outcomes

Shared Governance

“A commitment to others to have an

active voice and participation in

improving practice in collaboration leaders.” Shared Governance supports:

• Decentralized decision making
• Shared accountability
• Partnerships to deliver

VUMC Advanced Practice Committees:

• Advanced Practice Standards
• Advanced Practice Professional Development
• Advanced Practice Council
• Advanced Practice Leadership Board

Image goes here

Professionalism, Collaboration and Teamwork

It’s the Vanderbilt Team that Makes all the Difference!

Building Relationships

Image goes here Nursing

• CREDO Behaviors
• Service is the HIGHEST priority
• Communicate effectively
• Professional self‐conduct
• Committed to my colleagues
• Maintain self‐awareness

Physicians

• Promote trust & credibility
• Integrated into care
• Continuous presence
• Increase knowledge & expertise

Collaboration

Image goes here “. . joint & cooperative, integrates individual perspectives & expertise of team members”

(Resnick & Bonner, 2003, p. 344)

Collaboration…

• Enhances empowerment
• Increases job effectiveness and satisfaction
• Associated with improvements in patient
• utcomes, healthcare costs and decision‐

making.

APRN/PA Patient Care Center (PCC), Hospital or Area Name Title

CRNA/VPEC Brent Dunworth, DNP, CRNA Director/Chief CRNA MEDICINE Jane Case, DNP, FNP Director NEUROSCIENCES Briana Witherspoon, DNP, ACNP Director OBGYN ‐ DEPT Angela Wilson‐Liverman, MBA, CNM Director SURGERY Heather Jackson, PhDc, APRN Assistant Director TRANSPLANT Deonna Moore, PhD, ACNP Director VCH Acute and Critical Care Michelle Terrell, DNP, PNP, AC/PC Director VCH Acute and Outpatient Care Jill Kinch, MMHC, PNP, AC/PC Director VHVI Tiffany Street, DNP, ACNP Director VICC Kiersten LeBar, DNP, PNP, AC/PC Director School of Nursing Nurse Faculty Practices and Midwifery Lori Crews, MSN, FNP and Melissa Davis, DNP, CNM Director PSYCHIATRY Molly Butler, MSN, PMHNP Team Lead OCCUPATIONAL HEALTH Catherine Qian, MSN, FNP Clinical Manager ORTHOPAEDICS Mary Duvanich, RN Administrative Director Vanderbilt Health Oncall Jennifer Mitchell MSN ANP Director

Which does NOT describe a Magnet designated facility?

A. Committed to quality and excellence in nursing B. Awarded by Centers for Medicare/Medicaid (CMS) C. Only 9% of US hospitals have designation D. Awarded by American Nurses Credentialing Center (ANCC)

Which describes the culture of shared governance?

A. Advocacy of active voice B. Commitment to active participation C. Improving practice through collaboration D. All of the above

Which is not true about collaboration?

A. Includes perspectives & expertise of team members B. Enhances empowerment C. Decreases job satisfaction D. Is associated with improved patient outcomes

Credentialing and Privileging

“It is truly a privilege to care for patients within Vanderbilt Medical Center”

Core Privileges

Nu Nurse Practition titioner an and Ph Physician ician Ass Assistant Deline Delineatio tion of

• f Cor

Core Priv ivileg ileges (DO (DOP)  Obtain and document a health history;  Perform and document complete, system‐focused, or symptom‐specific physical examination;  Assess the need for and perform additional screening and diagnostic testing, based on initial assessment findings;  Prioritize data collection;  Perform daily rounds/clinic visits on assigned patient population;  Document daily progress notes, plan of care, evaluation and discharge summary;  Manage diagnostic tests through ordering and interpretation;  Formulate differential diagnoses by priority;  Prescribe appropriate pharmacologic and non‐pharmacologic treatment modalities.  Utilize evidence‐based, approved practice protocols in planning and implementing care;  Initiate appropriate referrals and consultations;  Provide specialty specific consultation services upon request and within specialty scope of practice;  Facilitate the patient’s transition between and within health care settings, such as admitting, transferring, and discharging patients.  Demonstrate competency specific to the patient population of care, as indicated in area specific competency training, assessment and validation process.

Certified Certified Re Regist stered Nu Nurse Anes esthet thetis ist:  Performance of pre‐anesthetic assessments including a pertinent medical history, physical examination, and review of medical records  Formulation of an anesthetic care plan in consultation with the assigned anesthesiologist  Induction and maintenance of anesthesia with all commonly used agents and monitoring devices; management of emergence from anesthesia; airway maintenance including bag/mask ventilation, laryngeal mask airways, and intubation of the trachea  Anticipating and identifying common complications during the perioperative period, initiating treatment as indicated, and communicating problems to the anesthesiologist supervising the specific case or other appropriate staff members  Anesthetic management of urgent and emergent conditions  All elements of CRNA scope of practice as recommended by the AANA Scope and Standards for Nurse Anesthesia Practice document Certified Certified Nu Nurse Mi Midwife:  Perform and document complete, system‐focused, or symptom‐specific physical examination;  Assess the need for and perform appropriate screening and diagnostic testing.  Formulate differential diagnoses by priority.  Manage diagnostic tests through ordering and interpretation.  Prioritize data collection.  Perform daily rounds/clinic visits on assigned patient population.  Document daily progress notes, plan of care, ongoing evaluation and discharge summary.  Prescribe appropriate pharmacologic and non‐pharmacologic treatment modalities.  Utilize evidence‐based, approved practice guidelines in planning and implementing care.  Initiate appropriate referrals and consultations.  Provide specialty specific consultation services upon request and within specialty scope of practice.  Facilitate the patient’s transition between and within health care settings, such as admitting, transferring, and discharging.  Core procedures as incorporated in ACNM Core Competencies for Basic Midwifery Practice, latest edition, are hereby incorporated by reference.

Core Privileges

• Basic delineation of privileges to practice as an advanced practitioner
• These are essential to the role, the main responsibilities for practice
• DOP available for NP, CNS, PA, CNM, CRNA
• All practitioners must apply for and be approved for core privileges

Process for approval

• Complete one packet (every single document!)
• 90‐120 days for verification and review
• File goes to Joint Practice for recommendation
• File goes to VUMC Credentials Committee for recommendation
• File goes to Medical Center Medical Board for recommendation
• File goes to Board of Directors for final approval

Credentialing and Privileging Tips

• Fill out the entire application, “One Packet”, and keep copies of everything. This packet can be

processed in 60 to 90 days from receipt of application by Vanderbilt Credentialing Services.

• Use references who have current knowledge of your training/competency within the last 2 years

(i.e. supervising physician, APRN leader, preceptor, faculty instructor)

• Provide complete information regarding all prior malpractice coverage. A certificate of insurance
• r face sheet from the carrier is preferred.
• Read and answer all disclosure questions carefully prior to signing.
• For gaps in employment >30 days, please provide a brief written explanation.
• The Notice & Formulary is now termed “Collaborative Request”. Please submit the original to the

State BON, keep a hard copy for your records and submit a copy with your one packet.

• You will receive a payor enrollment packet soon after you submit your One Packet. This packet will

look a lot like the One Packet but it is indeed different. This packet contains documents to sign up with each payor. One of the documents will require a notary. We have a notary right here in OAP for you, so please drop by anytime to sign these documents and notarize as applicable.

• After credentialing is completed, you will receive a VHAN Application. VHAN is our extended health

affiliate network. The application will be mostly complete and all you will need to do is sign.

Additional Privileges

Additional (non‐core) Privileges

• Non‐core, usually procedural
• Granted only after procedural competency demonstrated and application submitted
• Must be medical necessary and supported by volume
• Application required to request additional privileges
• Can only be requested with initial privileges and in January, July and October
• Advanced practice leader must request the application for you
• Application completed by practitioner, AP leader and supervising physician
• Must submit procedural log with application (MR#, date, procedure, supervisor)
• Each procedure requires initial number of supervising procedures and number of procedures to

maintain privileges every two years

• High risk procedures require separate application: colposcopy, moderate sedation, circumcision,

acupuncture, nitrous oxide administration

Credentialing and Privileging

• Process flow for credentialing and privileging

in orientation packet

• APRNs and PAs are termed “Professional Staff

with Privileges” in the Medical Staff Bylaws and are credentialed under the process defined in the Medical Staff Bylaws

• May apply as a billing or non billing provider
• Billing requires additional membership with

Vanderbilt Medical Group and is subject to VMG Bylaws

• Billing providers may or may require a faculty

appointment

• Billing providers are credentialed with all

VUMC insurances, or payers Image goes here

Provisional Status

Image goes here While waiting for credentialing and privileging approval must remain in “provisional status”. Provisional status providers are required to have:

• Completed educational requirements for role
• Obtained a board certification
• Applied for state licensure
• Applied for DEA/NPI
• Applied for credentialing and privileging

Provisional status providers must:

• Not represent as NP, CNM, CRNA, PA
• Work under direct supervision
• Not submit orders under own name
• Not write notes intended for billing
• Follow ANA, state, specialty organization and

practice specific guidelines

• Access/enter eStar/epic as a “non‐

credentialed provider”

Professional Liability Coverage

• Coverage through Vanderbilt Self‐Insured

Trust

• 5.5 million
• PSS reviews malpractice history
• Evidence of previous coverage
• Collaborative practice critical
• Claims such as failure to diagnose or failure

to consult/refer Image goes here

MUST Report CHANGEs to:

Board of Nursing via Health Related Boards According to the Nur Nurse Pr Practice Act Act, any nurse who knows of any health care provider's incompetent, unethical or illegal practice MUST report that information through proper channels. Pr Prov

• vider Suppo

Support Servic Services

Until privileges are approved, the APP must…

A. Have 100% of charts reviewed by supervising MD or APRN/PA preceptor B. Perform all procedures under supervision C. Not make independent clinical decisions or diagnoses, write billing notes or prescriptions D. All of the above

After receiving initial privileges, practitioners are eligible for reappointment every…

A. 1 year B. 2 years C. 3 years D. 4 years

If you hold a faculty appointment, how often are you up for reappointment?

A. 1 year B. 2 years C. 3 years D. 4 years

State of Tennessee Guidelines

Laws for maintaining APRN or PA license. VUMC privileges are immediately suspended with loss or expiration of license.

Tennessee Rules and Regulations for Advanced Practice

Physician Assistants

• Department of Health ‐ PA
• Board of Medical Examiners

Nurse Practitioners, Midwives, CNS

• Board of Nursing
• Board of Medical Examiners

CRNAs

• Board of Nursing
• Board of Medical Examiners

Image goes here

Tennessee Law

Tennessee Board of Nursing Advanced Practice Nurses and Certificate of Fitness to Prescribe http://publications.tnsosfiles.com/rules/1000/1000‐ 04.20150622.pdf Tennessee Board of Medical Examiners Rules and Regulations for Nurse Practitioner Prescription Writer http://publications.tnsosfiles.com/rules/0880/0880‐ 06.pdf Tennessee Rules and Regulations for Physician Assistants http://publications.tnsosfiles.com/rules/0880/0880‐ 03.20160621.pdf Image goes here

Review Rules and Regulations for Tennessee (copies in your orientation folder)

0880‐6‐.02 CLINICAL SUPERVISION REQUIREMENTS

It is the intent of these rules to maximize the collaborative practice of certified nurse practitioners and supervising

physicians in a manner consistent with quality

health care delivery.

• A supervising physician or a substitute supervising

physician must possess a current, unencumbered license to practice in the state of Tennessee.

• Supervision does not require the continuous and

constant presence of the supervising physician; however, the supervising physician must be available for consultation at all times or shall make arrangements for a substitute physician to be available.

• A supervising physician and/or substitute supervising

physician shall have experience and/or expertise in the same area of medicine as the certified nurse practitioner. Image goes here

0880‐6‐.02 CLINICAL SUPERVISION REQUIREMENTS

It is the intent of these rules to maximize the collaborative practice of advanced practice nurse with certificate of fitness to prescribe and supervising physicians in a manner consistent with quality health care delivery.

• 20% chart review monthly
• 100% chart review of controlled substances
• Protocols for practice, reviewed every 2 years
• Supervising physician must be readily available for

consultation; site visit at least every 30 days

• Collaborative agreement on file with state (previously

known as Notice and Formulary) Image goes here

Chart Review

20% chart review monthly

• State does not specify guidelines on chart review other than it must be completed
• VUMC practitioners complete chart review in alignment with area workflow
• Attestation not required for indicating chart review

100% chart review of controlled substances

• State requires this review within 10 days of prescription and the MD signature on chart within 30 days

Examples of eStar chart review include:

• Using mandatory attending’s admission and discharge notes and co‐signatures as chart review
• Stating “I have reviewed this patient’s chart and plan of care with Dr. XXXX” on your own notes
• Practitioner pulling eStar report of all notes written in the month. These notes indicate which chart were

reviewed and signed by an MD. These reports can be generated any time needed.

• Specific notes, needing close attention by MD can be sent to MD for review and attestation, using “co‐sign”

click box on note Chapter 0880‐6‐.02, Tennessee Board of Medical Examiners Rules and Regulations http://state.tn.us/sos/rules/0880/0880‐06.pdf Image goes here

Protocols

Protocols are mandated by the Tennessee Board of Medical Examiners and are defined as written guidelines for medical management.

• Shall be jointly developed and approved by the supervising physician and nurse practitioner;
• Shall outline and cover the applicable standard of care;
• Shall be reviewed and updated biennially;
• Shall be maintained at the practice site;
• Shall account for all protocol drugs by appropriate formulary;
• Shall be specific to the population seen;
• Shall be dated and signed; and
• Copies of protocols and formularies shall be maintained at the practice site and shall be made available upon

request for inspection by the respective boards. Chapter 0880‐6‐.02, Tennessee Board of Medical Examiners Rules and Regulations http://state.tn.us/sos/rules/0880/0880‐06.pdf Image goes here

Protocols

Protocol Warehouse https://int.vanderbilt.edu/vumc/CAPNAH/APSC/APRNprot

• colswarehouse/default.aspx
• Access provided by Office of Advanced Practice after

completion of Advanced Practice Orientation

• Practitioner is attached to service line’s protocols
• New protocols can be written using template. We

have a practice template, procedure template and reference text (or online reference) template

• Resources for writing protocols and EBM toolbox

available on OAP website Image goes here

Collaborative Agreement

Collaborative agreement with supervising physician required to be on file with the state

• Must be up to date with current collaborative

physician(s)

• New online process available through TN Department
• f Health website
• If

If onlin

• nline sit

site is is not not wo working, ma may still ill use use old

• ld paper

paper Noti Notice ce and and Fo Formulary

• Practitioner responsibility to send to state
• Practitioner responsibility to send to PSS
• Keep a copy on file at all times

Image goes here

https://nppes.cms.hhs.gov/NPPES/Welcome.do

DEA Registration

Required for all VUMC practitioners

• DEA holders must register in CSMD within 30 days
• Controlled substance prescriptions monitored closely

by state

• DEA must be current in order to eprescribe in eStar
• VUMC waiver in rare circumstances. Letter submitted

to credentialing committee by chair for waiver. https:///www.deadiversion.usdoj.gov/webforms/validateL

• gin.jsp

Image goes here

DEA Misappropriation

Collaborative agreement with supervising physician required to be on file with the state

• Immediately notify supervisor, administrative and

clinical directors

• Notify pharmacy program director
• Complete veritas report

Pharmacy program director will conduct investigation and notify the following:

• Risk management
• HR consultant for nursing
• Law enforcement/ VUPD
• Nursing administrative director for professional

practice

• Medical administration
• Board of Nursing
• Board of Medical Examiners
• DEA
• CSMD

Image goes here

CSMD

DEA holders must register with CSMD within 30 days if you provide care to TN patients >15 days per year.

• Must check CSMD before prescribing a new course of
• pioids and/or benzodiazepines and annually for
• ngoing treatment
• Requires supervising physician and supervising

physician’s drivers license when completing registration in CSMD

• A clinic delegate can be assigned to check CSMD
• Documentation of checking CSMD must be in chart
• Required to report evidence of diversion, doc

shopping to TN CSMD

• Exceptions to checking CSMD include: hospice

patient, single 3 day course, medical specialty patients with low abuse potential, direct administration in hospital or nursing home and licensed veterinarians for non‐humans Image goes here

Prescribing in Tennessee

Tennessee has major issues with opioid prescribing, overdose and death.

State of Tennessee Prescription Safety

• ePrescription Safety Act 2012
• Continuing education requirement of 2 contact hours every 2 years including chronic pain

guidelines and education on opioids, benzodiazepines, barbiturates, carisoprodol

• TN Bill 396 restricts controlled substance prescriptions to 30 day non‐refillable, written only if

schedule indicated on collaborative agreement (notice and formulary)

• All practitioners who hold DEA must register with Controlled Substance Monitoring Database

(CSMD)

• TN Together Act of 2018

Opioid Prescription Rates by County‐ TN, 2007

Opioid Prescription Rates by County‐ TN, 2011

Retrieved from: https://www.cdc.gov/drugoverdose/data/statedeaths.html

Tennessee

Tennessee

936 1,034 1,049 1,066 1.17 1.27 1.29 1.31 0.5 1 1.5 2 200 400 600 800 1000 1200 2013 2014 2015 2016 Percent of Live Births, % Number of Cases, n Year Cases Percent of Live Births

NAS Rate per 1,000 Live Births, 2016

OAP can help with CME!

Image goes here

Resources for Tennessee controlled substance prescribing mandated education:

• https://cme.mc.vanderbilt.edu/home
• Other CME resources available on OAP

website

What do you need if your license is audited?

1. Current national certification (NOT state license; example: from ANCC, AANP, NBCRNA) 2. ONE item from the Registered Nurse proof

• f competence list

https://www.tn.gov/content/dam/tn/health/ documents/ContinuedCompetenceRequire ments.pdf 3. TWO contact hours of continuing education designed specifically to address controlled substance prescribing practices including the Tennessee Chronic Pain Guidelines http://tn.gov/health/article/nursing‐coedu 4. Copy of current Collaborative Request/APRN Supervisory Request (formerly Notice and Formulary) if prescribing https://lars.tn.gov/datamart/mainMenu.do Image goes here

Prescribing Tips

Image goes here

• Prescribing guidelines vary by state
• Respect granted authority and DO NOT

provide for friends and family.

• Collab

Collaboratin ing ph physic icia ian/design signee sho should be be in indicated on

• n pr

prescrip escriptio tion

• Many health care clinics and hospitals have

transitioned to e‐Prescribing. Can reduce errors; however, NEVER rely solely on the computer software to do your vigilance for you!

The Rights of Prescription Writing

Image goes here

• Right patient
• Right drug
• Right dose (strength per unit dose)
• Right dosage schedule, dosing interval, times of day
• Right route of administration
• Right date
• Right number of refills
• Right duration of treatment
• Right to informed consent
• Right to refuse treatment
• Right to be knowledgeable

Universal Components

Image goes here

• Prescriber’s Printed Name and Address
• DEA #
• Patient Name
• Date
• Drug, Dose, Units, Route, Frequency
• Indication
• Quantity to Dispense (dispense as written or

substitute allowed)

• Refill information
• Signature

DEA # 123920392187

John Brown AGPCNP-BC Karen Jones MD

136 Wright Way Nashville, TN 37202 587-822-5536

Name: John A. Smith Address 123 Meadow Lane, Nashville, TN 37216 Date 08/23/2013

Rx (please print)

_____John Brown_____________

LABEL

REFILL

3

TIMES PRN NR

____________________________

Substitution allowed Dispense as written

Lisinopril 20mg #30 Sig: 1 tablet by mouth daily Indication: for blood pressure

Prescription pad essentials

Image goes here

• Information of collab

llaboratin ting MD MD and NPs: ‐ name ‐ address ‐ phone number

• If multiple physicians listed, id

identify fy collab llaboratin ting MD MD by by check checkmark ark or

• r

cir circling ling MD MD name name

Institutional Guidelines

Medical Staff, Nursing and Vanderbilt Medical Group Bylaws

Institutional Guidelines

VUMC Nursing Bylaws https://vanderbilt.policytech.com/dotNet/documents/?docid=10788 Vanderbilt Medical Group (VMG) Bylaws (billing providers) https://vanderbilt.policytech.com/dotNet/documents/?docid=12212 VUMC Medical Staff Bylaws https://vanderbilt.policytech.com/dotNet/documents/?docid=12352 VUMC Policies https://vanderbilt.policytech.com/ VU Faculty Manual https://vanderbilt.edu/faculty‐manual/

Clinician Documentation Policy

• 10‐20.13 Documentation Standards for Clinicians
• Complete, accurate EHR supports safe care
• Timeliness requirements
• Within 24 hours of admission or

consultation

• Prior to any operation or procedure
• Within 72 hours of discharge
• Daily for IP progress notes
• Within 4 business days for OP progress

notes

• Delinquent = incomplete > 14 days post IP

discharge or OP encounter.

• Incomplete > 28 days = automatic suspension of

privileges

• https://vanderbilt.policytech.com/dotNet/docum

ents/?docid=7716

Benefit Staff and Staff VMG Faculty

Health, Dental, Vision same same Short‐term disability Base provided by employer. Buy‐up coverage paid by employee. N/A; Salary continuation up to 6 months at chair/dean’s discretion; Long‐term disability same same Supplemental life same same AD&D same same Retirement (mandatory) After 1 year, 3% mandatory and employer match; Immediate 3% mandatory and match (*VMG members have 6.47% mandatory and 3% match); Retirement (voluntary) May contribute up to 2% with equivalent employer match; May contribute up to 2% with equivalent employer match; PTO Accrual based on exemption and years of service; N/A; Vacation/time away department dependent; Grandfathered sick time If hired prior to 1/1/2014, grandfathered sick

• bank. No accruals.

N/A Parental leave Concurrent with FMLA/TMLA; 2 weeks paid leave (can request flexPTO, grandfathered sick time and/or file for short‐term disability); Concurrent with FMLA/TMLA; 6 weeks paid (any additional paid leave as approved by chair/dean); Nonacademic and academic leave with and without pay Guidelines for each as outlined in faculty manual. All requests require chair/dean’s approval; Resignation notice Standard professional notice 120 days in writing

Benefit Staff Faculty Tuition assistance (hired before 9/1/12) Children – 70% Employee – 70% Spouse – 47% Children – 70% Employee – 47% Spouse – 47% Tuition assistance (hired after 9/1/12) Children – 55% Employee – 70% Spouse – 47% Children – 55% Employee – 47% Spouse – 47% Tuition assistance

• 1 course/semester = 3/yr

(1 semester – Fall, Spring, Summer)

• 3 credit hrs/4 hrs w/lab
• Eligible 3 months after hire
• Contingent upon evidence of

completion with a “C” or better

• Consult with Supervisor
• 1 course/semester = 3/yr

(1 semester – Fall, Spring, Summer)

• 3 credit hrs/4 hrs w/lab
• Consult with Department Chair or

Division Director

Compliance Modules

• If you are School of Medicine faculty, please go to this link and log in to your compliance training

profile: https://medschool.vanderbilt.edu/faculty/foto

• If you are VUMC medical staff, please go to the Learning Exchange at this link and click on “my

courses”: https://learningexchange.vumc.org/

• If you are School of Nursing faculty, please go to the Learning Exchange at this link and click on “my

courses”: https://learningexchange.vumc.org/ School of Nursing Faculty: Be sure to use your VUMC VUNet ID (vs. VU).

• If there are any problems with pulling up your modules, please email the learning exchange:

LearningExchange@vanderbilt.edu

• For 2018, you should be assigned the following modules:

2018Annual Compliance Curriculum: Fraud, Waste and Abuse and Topics 2018 Annual Compliance Requirements: Bloodborne Pathogens & Infection Prevention 2018 Annual Compliance General Requirements 2018 Annual Compliance: Safety Curriculum Culture of Service: Service Recovery

Vanderbilt Learning Exchange

Joint Commission

 National Patient Safety Goals  Vanderbilt Joint Commission Handbook Image goes here

2018 2018 TJ TJC Reco comme mmendation

• ns fo

for Im Improvement

Ti Titr tratio ion or

• rder

ders mus must:

• consistently contain all

required elements which include:

• Starting rate of infusion (e.g.,

dose/min);

• Incremental units the rate can be

increased/ decreased;

• Frequency for incremental doses/rate

change;

• Maximum rate of infusion; and
• Objective clinical endpoint (e.g.,

RASS)

• be administered as ordered
• be documented by the administering

nurse the medication

• carefully denote order parameters

for accuracy

• be carefully reviewed by clinician

when renewing titration orders * Titration orders may include a bolus dose, if appropriate.

Split/Shared Encounters

• Encounter between MD & NP
• Not applicable to medical students, nurses,

residents

• Not applicable to consultations, procedures or

critical care services

• Service must be medically necessary.
• Service must be within scope of practice/licensure
• f NP.
• NP service & MD service may occur jointly or at

independent times on same day calendar day.

• Both must complete a face to face encounter in
• rder to bill as a shared/split visit.
• Both NP & MD should document what each

personally performed.

• Total documentation by both NP & MD should

support the level of service reported. Image goes here

Incident To Billing

Medicare Incident To Criteria:

• MD must personally perform the initial service &

remain actively involved in the course of treatment

• MD must be present in the office suite and

perform a face to face encounter.

• MD is delegating work to the NP
• MD and NP must be in the same specialty.

Incident To applies to the office/clinic setting (not applicable in the inpatient setting) Cannot be used when:

• Seeing new patients
• Seeing established patients with new problems
• Physician not physically present in office suite
• Physician not performing face to face encounter

Image goes here

National Guidelines

Licensure, Accreditation, Education and Certification

APRN Consensus Model

Image goes here

• Uniform model of regulation for advanced practice
• Designed to align licensure, accreditation,

certification, education (LACE)

• Consensual title for advanced practice: APRN
• 4 roles, 6 populations: Across continuum, Adult‐

Gero Primary/Acute; Pediatric Primary/Acute; Neonatal, Psychiatric, Women’s health/gender related

• Enables practicing to full extent of education and

licensure

• Uniformity eases mobility among states, benefits

APRN and enhances patient care

• Credential is legal tag; demonstrates successful

acquisition of board certification.

• http://www.mc.vanderbilt.edu/documents/CAPNAH/files/APR

NConsensusModelFinal09.pdf

Professional Practice Evaluation

What is FPPE and OPPE?

Professional Practice Evaluation

Image goes here

Ongoing Professional Practice Evaluation (OPPE), MS.08.01.01

• To move from cyclical to continuous evaluation of a

practitioner's performance to identify practice trends that impact quality, patient safety and determine whether a practitioner is competent to maintain existing privileges or needs referral for a focused review.

Focused Professional Practice Evaluation (FPPE), MS.08.01.03

• To verify competency, when applying for new privileges

(ie. new hire) and whenever questions arise regarding the practitioner's professional performance.

Focused Professional Practice Evaluation (FPPE)

A period of focused review (JC standard MS.08.01.01).

• Time limited
• Assigned proctor, usually a peer

When a practitioner has the credentials to suggest competence, but additional information

• r a period of evaluation is needed to confirm competence in the organization’s setting.

Implemented for all newly requested privileges

• Practitioners new to the organization
• Existing practitioners applying for new privileges

When practice issues are identified that affect the provision of safe, high‐quality patient care

• Triggered from an ongoing evaluation or clinical practice trends
• Triggered by a single incident or sentinel event

How do we measure FPPE?

• Chart review, direct observation, simulation, peer review, 360 discussions

Ongoing Professional Practice Evaluation (OPPE)

To move away from the procedural, cyclical process in which practitioners are evaluated when privileges are initially granted and every 2 years thereafter.

• To continuously evaluate a practitioner’s performance
• To identify professional practice trends that impact on quality of care and patient safety.
• To decide whether a practitioner is competent to maintain existing privileges or needs

referral for FPPE Clearly defined quality review process to evaluate each practitioner’s practice.

• Type of data collected may be general but also must include data that is determined by

individual departments and be individual practice specific

• Can include both subjective and objective data
• Must occur more than once a year, usually every 6‐8 months

To practice a sample OPPE, please scan this code or go to this link: https://redcap.vand erbilt.edu/surveys/ ?s=N3XJ7N8WTR

VUMC Patient Experience Provider Star Ratings

• For Outpatient Providers

with >300 encounters per year

• Stars are indicated if

there are >3 comments

Which of the following is NOT true regarding Professional Practice Evaluation?

A. OPPE occurs every 6 months (April and October) B. FPPE verifies competence for a newly hired APRN/PA C. FPPE does not use direct observation as a means to evaluate competency D. FPPE is reactivated when questions arise regarding an established practitioner’s performance

Per VUMC policy, all of the following pertain to timely documentation, except:

A. Supports safe & accurate care B. Must be completed within 24 hours of admission or consultation C. Is not required prior to any operation or procedure D. If incomplete >28 days, results in automatic suspension of privileges

When comparing staff and faculty, which of the following is NOT a shared commonality?

A. Have an AP leader for support B. Required to give 4 months notice C. Undergo FPPE and OPPE D. Receive malpractice insurance via VUMC’s self‐insured trust

Which of the following is true regarding APP supervision?

A. Requires 10% chart review B. Requires physical presence at all times C. Requires collaborative creation of evidence‐based protocols D. Requires 50% review of all CS prescriptions

Professional Weeks

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Professional Organizations

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OAP website tour

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www.vanderbiltoap.com

Thank you

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