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-CRTj_MS08_OFPPE (2010)


Conducting Focused Professional Practice Evaluations How to Improve Compliance with MS.08.01.01 [REF: MDx, MD]  
Source, Sept 2010, Pg4, Vol 8, # 9
In this article, John Herringer, associate director, Standards Interpretation Group, The Joint Commission provides useful clarifications and recommendations relating to FPPE for initially requested privileges, FPPE triggers and related surveyor expectations.

  • Re: FPPE for initially requested privileges – EP1 does not require (and should not be confused with) a period of provisional appointment. This is a time-period approach that too often ends without a specific and evaluation of privilege competence that is the critical task. Dr. Herringer recommends a volume-approach in which a small, pre-defined number of charts (e.g., 5) are reviewed for each privilege (independent of how long that takes). If the results are acceptable FPPE ends, if not, pull another sample and re-assess on the aggregate or larger sample. This approach is also acceptable for low-frequency privileges in which it may take an extended time (e.g., a year) to review the pre-defined number of charts.
  • Re: FPPE triggers –Although triggers may be single incidents or clinical practice trends, most often, “Triggers are very obvious problems and should be predefined by the organization.” Triggers always require a period of performance monitoring. On the other hand, “Performance issues are normally uncovered during ongoing professional practice evaluation…may or may not require additional performance monitoring, depending on the circumstances. How performance issues will be addressed should be outlined in the organization’s FPPE policy.”
  • Re: Surveyor Expectations – Be prepared for surveyors to assess if the hospital has: FPPE triggers and a process for monitoring and evaluating performance, Criteria for conducting performance monitoring
    • A method for establishing a monitoring plan specific to the requested privilege
    • A method for determining the duration of performance monitoring
    • Circumstances under which monitoring by an external source is required
    • Taken appropriate action around performance issues or triggered reviews that might have occurred

Key/Additional Details:

  • Hospital rates of non-compliance with Standard MS.08.01.01, have increased slightly from 25% in 2009 to 27% in the first half of this year.
  • MS.08.01.01 has not been a Top 10 compliance concern reported in state hospital PSQ, but it continues to be a source of some confusion/uncertainty
  • EPs 2 through 9 are nothing more than what was historically peer review,” “It was renamed Focused Professional Practice Evaluation in 2004”
  • MS.08.01.01 was revised in January 2008 to include the requirement for a period of FPPE on all initially requested privileges (EP 1). “There are no exemptions for board certification, documented experience, or reputation”.
  • Note that FPPE is one of 7 “high risk or problem-prone processes” selected by TJC for more thorough tracer evaluation. (see Tracers below)

 

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5 Sure-Fire Methods: Monitoring and Evaluating Practitioner Performance [REF: MDx, C&P].
Source Jan 2010, Pg2, Vol 8, # 1
Although it was not a significant issue in our 2009 post survey questionnaires (PSQ), 16% of TJC hospitals failed to fully comply with MS.08.01.01 in the first half of 2009. Apparently the specific point of concern is EP#1 that requires a period of focused professional practice evaluation (FPPE) whenever privileges are initially requested. Since there is no longer a specific requirement for a provisional period, FPPE can be defined not only as a provisional period of time, but by a number of admissions or procedures related to the new privilege. Four more compliance strategies are suggested.

 



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