specialty of emergency department nurse practitioner

8/11/2019 Specialty of Emergency Department Nurse Practitioner

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SPECIALTY OF EMERGENCY DEPARTMENT NURSE PRACTITIONER(Pediatric Hospital Facilities)Delineation o f Clinical Privil eges

Criteria for granting privil eges: Current national board certification in the appropriate advanced practice nursing specialty

AndCurrent unencumbered Tennessee license to practice as a Registered Nurse and as a Nurse Practitioner (APN) inthe state of Tennessee or in the state(s) of his/her practice.

AndEducation in the appropriate specialty at the masters or doctoral level

AndCurrent Drug Enforcement Agency (DEA) number

AndCurrent unencumbered Tennessee Nurse Practitioners (APN) Certificate with prescriptive authority

AndCurrent PALS certification

Appl icants w ill be requested to p rovide documentation of practice and current clin ical competence as defined on the attached competency grid. Applicants have

the burden of producing info rmation deemed adequate by the hospital for a proper evaluation of current clin ical competence, and other qualifications and for

resolving any doubts.

Current Clinical Competence - MHMH

In addition to the required education, experience and/or training specified on each DOP (Delineation of Privilege) form, documentation of current clinical competence is required.TJC (The Joint Commission) describes current clinical competence as having performed the privilege recently and performed it well.

Current clinical competence is assessed prior to granting privileges initially and reassessed when renewing privileges at reappointment.

This should not be confused with either FPPE (Focused Professional Practice Evaluation) or OPPE (Ongoing Professional Practice Evaluation). FPPE: an evaluation of clinical competence of all new privileges (as performed at Methodist Le Bonheur Healthcare) after they have been initially granted. This applies to all

new applicants as well as to current members applying for new/additional privileges.

OPPE: periodic (more frequent than annually) evaluation of professional practice.

Both FPPE and the current clinical competence assessment are privilege-specific. FPPE is conducted during the period after granting new/additional privileges.

Current Clinical Competence: Requirements for New Applicants

If applying directly from training, or based on the training received in a formal training program, submit case* logs from the program authenticated by the program directoralong with their recommendation attesting to the comparable training, experience and qualifications relative to the criteria for the clinical privileges requested.


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If applying after training completion, submit the following:

o Aggregate data from primary practice facility for the previous 12 month time period indentifying the top 10 diagnosis codes and the number of inpatients per code. Anycomplications/poor outcomes should be delineated and accompanied by an explanation.

o Procedure list from primary practice facility for the previous 12 month time period identifying the top 10 CPT/ICD9 codes and the number of procedures per code. Anycomplications/poor outcomes should be delineated and accompanied by an explanation.

o Case logs (see specifications below) for any special privileges requested which meet the specific number of procedures defined for current clinical competence.

Current Clinical Competence: Maintenance of Privileges fo r Current Practitioners

Practitioner should submit the following:

o Aggregate data from primary practice facility for the previous 12 month time period indentifying the top 10 diagnosis codes and the number of inpatients per code. Anycomplications/poor outcomes should be delineated and accompanied by an explanation.

o Procedure list from primary practice facility for the previous 12 month time period identifying the top 10 CPT/ICD9 codes and the number of procedures per code. Anycomplications/poor outcomes should be delineated and accompanied by an explanation.

o Case logs (see specifications below) for any special privileges requested which meet the specific number of procedures defined for current clinical competence.

Case Logs

All required case logs and/or procedure lists must contain the following information at a minimum: Date, patient identifier, CPT/ICD9 procedure code, diagnosis, complications,and disposition, and the facility name, name of the person authenticating the log, signature, date signed, and contact information. If the information requested is not available,please provide an explanation.

*A case is defined as an episode of care either cognitive or procedural. For interpretive care, case is interpretation of one diagnostic study.


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Board approved: March, 2011

Specialty/Procedure Delineation of

Privilege Form

Education/Training

Documentation for Initial Granting

Initial Application

(Proof of current clinical

competence)

FPPE Validation of

competence after

appointment and/orgranting of a new or

additional privilege

(To be completed withinone year)

Maintenance Requirements (Note:

Satisfactory OPPE required for all

privileges)

MHMH Data will be obtained,

applicant should supply additionalcase logs from other facilities if

necessary to meet the minimumrequirement(s)

Nurse Practitioner PediatricEmergency Medicine Core

Current national board certification inthe appropriate advanced practicenursing specialty

AndCurrent, unencumbered Tennesseelicense to practice as a RegisteredNurse and as a Nurse Practitioner(APN) in the state of Tennessee or inthe state(s) of his/her practice.

AndEducation in the appropriate specialtythe masters or doctoral level

AndCurrent unencumbered TennesseeNurse Practitioners (APN) Certificatewith prescriptive authority

AndCurrent Drug Enforcement Agency(DEA) number

AndCurrent PALS certification

Case log documenting 10 outpatientencounters during the previous 12months at the practitioners primarypractice facility

First 5 cases OPPE will be utilized along with caselog supplied by practitioner indicatingany 10 inpatient encounters during theprevious 12 months

Scope of Service and Responsibilit y:

Scope of service is based upon education, clinical training, demonstrated skills and capacity to manage procedurally related complications. The Nurse Practitioner willcollaborate with the supervising physician in admitting, managing care, and discharging patients from the hospital.

The Nurse Practitioner shall be in compliance with all applicable state and hospital rules including, but not limited to, supervision, protocols, patient reviews, andprescriptions.

Clinical Supervision Requirements:

The supervision of the Nurse Practitioner will be compliant with all applicable state rules and regulations and specifically as outlined in Rules of Tennessee Board ofMedical Examiners Division of Health Related Boards Chapter 0880-6 and Rules of Tennessee Board of Nursing Chapter 1000-4.


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Core Nurse Practitioner Privilege:

The privileges shall be for all pediatric emergency patients from 0-18 years of age seen at the pediatric hospital facilities on an outpatient basis. Consistent with theintent of the state rules and regulations, privileges serve the purpose to maximize the collaborative practice of Nurse Practitioners and supervising physicians in amanner consistent with quality health care delivery. Therefore, written protocols developed jointly by the supervising physician and the Nurse Practitioner will guide the

ongoing medical management of patients and the following privileges.

1. Perform and document initial and subsequent history and physicals. Once every ten (10) business days the supervising physician shall make a personalreview of the historical and therapeutic data and shall so certify by signature.

2. Develop working assessments and order necessary diagnostic studies.3. Draw diagnostic conclusion.4. Plan and prescribe treatment according to approved protocols, e.g. comfort measures, restorative care, further testing, follow-up care, and patient

education/counseling.5. Record and document assessments, orders, diagnostic conclusions, and treatment plans on the medical record.6. The Nurse Practitioner may write prescriptions, and any prescription written and signed by the Nurse Practitioner under the supervision and control of a

supervising physician shall be deemed to be that of the Nurse Practitioner. Controlled substances may be prescribed consistent with state rules andregulations.

7. Collaborate with supervising physician and other health care providers to provide patient care.8. May prepare a discharge summary, including final diagnosis and procedures, and incorporate the physical findings, laboratory reports, and the patients

course in the hospital. In addition the summary will indicate the instructions given the patient in reference to diet, medication, physical activity, and follow-upcare. The discharging physician will certify the completed medical record.

Core Procedures:

a. Approved LeBonheur Emergency Department Treatment Protocolsb. Anesthesia topical/localc. Arterial Puncture for Laboratory specimend. Debridement of first and second degree burnse. Epistaxis , nasal packingf. Hernia Reduction umbilical and inguinalg. Interosseous placementh. Lumbar Puncturei. MIC/GT tube replacement

j. Nail removalk. Reduction of Rectal prolapsel. Splinting of Extremitiesm. Subungal hematoma evacuationn. Suprapubic tapo. Tooth reimplantation


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Process Protocol:

The Nurse Practitioner in collaboration with the supervising physicians identifies the following evidence-based resources, texts, and reference documents that areapplicable standards of care and provide the applicable process protocols for care management:

Pediatric Emergency Department Patient Care Protocols Griffiths 5 Minute Pediatric Consult; Schwartz

Textbook of Pediatric Emergency Medicine; Fleisher and Ludwig

Pediatric Primary Care for Nurse Practitioners; Burns, Dunn et al

Clinical Guidelines in Child Health; Uphold & Graham

The Harriet Lane Handbook of The Johns Hopkins Hospital published by Mosby

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Consultation:

The Nurse Practitioner will be managing Primary, Secondary, and Tertiary care conditions for the above described patient population. In general, communication witha physician will be sought for all of the following situations and any others deemed appropriate:

Whenever situations arise which go beyond the intent of the Protocols or the competence, scope of practice or experience of the Nurse Practitioner

Whenever patient conditions fail to respond to the management plan in an appropriate time.

Any rare or unstable patient conditions. Any patient conditions which do not fit the commonly accepted diagnostic patterns for a disease or disorder.

Any unexplained physical examination or historical finding.

At the request of the patient, the Nurse Practitioner or the physician.

All emergency situations after initial stabilizing care has been started.

Whenever a physician is consulted, a notation to that effect, including the physicians name, must be made in the medical record.


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Special Procedures:

The applicant must provide documentation of current clinical competence in performing the procedure consistent with the criteria set forth in medical staff policiesgoverning the exercise of specific privileges and the appended competency grid. Applicants have the burden of producing information deemed adequate by thehospital for a proper evaluation of current clinical competence, and other qualifications and for resolving any doubts.


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Nurse Practitioner Pediatric Emergency Department Clinical Privileges

Check below the particular privileges desired as Nurse Practition er for each facility:

Please check () applicable age categories for each pr ivilege requested.

Privilege DescriptionMHMH

Germantown, Le Bonheur Medical Center,

North, South & University

MECH MHFH

Age Li mit ationsNeonates

(0-28 days)

Infants(29 days2 Years)

Children &Adol escents(2-18 years)

Adul ts &Adolescents(13 & Above)

Adu lts(18 & Above)

All Ages

Nurse Practitioner PediatricEmergency Department Core

Special Privileges

Scope of Practice Inpatient Outpatient

Patient Types/Location Specialty Focus: condition(s), disease(s) for the patient population (e.g. pediatric

neurology, adult cardiology)Emergency Medicine, Pediatric Hospital Facilities

LimitationsClinical privileges are granted only to the extent services are available at each facility.

Core privileges may vary to the extent services are available at each facility.Lightly shaded areas represent privileges granted only to those practitioners holding a valid contract to provide those services.

Darkly shaded areas represent privileges not available to any practitioner due to the service not being offered by the facility.

Acknow ledg ement of p racti tioner

I have requested only those privileges for which by education, training, current experience and demonstrated performance I am qualified to perform and for which I wish to exercise at thefacilities indicated above, to the extent services are available at each facility, and I understand that:

(a) in exercising any clinical privileges granted, I am constrained by facility and medical staff policies and rules applicable generally and any applicable to the particular situation

(b) any restriction on the clinical privileges granted to me is waived in an emergency situation and in such situation my actions are governed by the applicable section of the medical staffbylaws or related documents

______________________________________________________ ______________________________Practitioner's Signature Date

______________________________________________________Printed Name


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Acknow ledg ement of s ponsor

I agree to abide by the clinical supervision responsibilities listed and the Nurse Practitioner will abide by the privileges outlined above and the appropriate facility Medical Staff Rules andRegulations.

____________________________________________ Date: ____________________Signature (No Stamps)Employing or Supervising Physician

_____________________________________________ ID #___________________Printed Name

specialty of emergency department nurse practitioner

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