Treatment Protocols & Interventions Flashcards

A surgeon requests privileges for a procedure never before performed at the hospital. What should the organization do first?

Answer: Develop and approve criteria for the new privilege through the medical staff process

New procedures require medical staff–developed, governing body–approved criteria before any practitioner can be privileged for them.

Under Joint Commission standards, Focused Professional Practice Evaluation (FPPE) is required for which of the following?

Answer: All newly requested privileges, including new privileges for existing staff

TJC requires FPPE for all initially granted privileges, whether the practitioner is new or already on staff.

In concurrent proctoring, the proctor:

Answer: Observes the procedure in real time as it is performed

Concurrent proctoring means direct, real-time observation of the practitioner performing the procedure.

What best describes 'core privileges'?

Answer: A bundle of activities that any competently trained practitioner in a specialty is expected to perform

Core privileges group the baseline activities expected of a competent practitioner trained in that specialty.

Criteria-based privileging decisions should rest primarily on:

Answer: Education, training, experience, and demonstrated current competence

Privileges must be based on objective, evidence-based criteria tied to qualifications and current competence.

The Joint Commission expects the quality of care for patients receiving moderate or deep sedation to be:

Answer: Comparable throughout the organization regardless of location

Sedation privileging criteria and care standards must be consistent hospital-wide so patients receive the same level of care.

A dermatologist requests laser privileges. Which documentation is MOST appropriate to support the request?

Answer: Evidence of device-specific training and documented or proctored cases

Laser privileges typically require training specific to the device or wavelength plus evidence of hands-on cases.