APP PRIVILEGES IN NEUROSURGERY - Stanford … · APP PRIVILEGES IN NEUROSURGERY ... 10 chart reviews each ... Develops effective solutions that can be generalized across differing

APP PRIVILEGES IN NEUROSURGERY

Required QualificationsEducation/Training Successful completion of a PA, NP or CNS program

Licensure (Initial andReappointment)

Current Licensure as a PA, RN or CNS in the state of CACurrent certification as a NP in the state of California

Certification (Initial andReappointment)

Current certification as a PA or NP by a nationally accredited organization

Additional Qualifications(Initial and Reappointment)

Current BLS from the American Heart Association

FPPE FPPE CRITERIA LISTED BELOW. FPPE WILL BE ASSIGNED BY THE SERVICE CHIEFDURING THE APPROVAL PROCESS10 chart reviews each - Administration of Moderate Sedation3 chart reviews for each privilege selected - Core and All other StandardizedProtocols/Standardized Procedures

Published: 8/13/2014 Page 1 of 8

S0003463

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Patient Population

Request Request all privileges listed below.Uncheck any privileges that you do not want to request.

SupervisingPhysician

ServiceChief/Designee

Patient PopulationInfantPediatricAdolescentAdultGeriatricSettingOutpatientInpatient

Provide care on LPCH patients in specific areas of SHC




Additional RequestFor LPCH APP who ONLY provide care of patients in the SHC EmergencyDepartment, ASC, Cath Lab, Cancer Center or Endo Unit

[applicant] [form name]


Core Privileges - PHYSICIAN ASSISTANT (PA)




General SupervisionEvaluates and treats patients with acute, chronic complaints and healthmaintenance concerns related to specialtyObtains complete histories and performs pertinent physical exams withassessment of normal and abnormal findings on new and return patientsPerforms or requests and evaluates diagnostic studies as indicated uponevaluation of the patientOrders and collects specimens for routine laboratory tests, screeningprocedures and therapeutic procedures, including blood and blood productsOrders physical therapy, occupational therapy, respiratory therapy, radiologyexaminations and nursing servicesPerforms designated procedures after demonstrated competency, accordingto written standardized procedures where applicableObtains informed consent, as indicatedInitiates arrangements for hospital admissions and discharges and completesappropriate paperwork

QualificationsRenewal Criteria Maintenance of all the above qualifications.

Minimum of 22 core cases required during the past two years.



Core Privileges - NURSE PRACTITIONER (NP)




General SupervisionEvaluates and treats patients with acute, chronic complaints and healthmaintenance concerns related to specialty, according to written standardizedproceduresObtains complete histories and performs pertinent physical exams withassessment of normal and abnormal findings on new and return patients,according to written standardized proceduresPerforms or requests and evaluates diagnostic studies as indicated uponevaluation of the patient, according to written standardized proceduresOrders and collects specimens for routine laboratory tests, screeningprocedures and therapeutic procedures, including blood and blood productsOrders physical therapy, occupational therapy, respiratory therapy, radiologyexaminations and nursing servicesPerforms designated procedures according to written standardizedprocedures where applicableObtains informed consent, as indicatedInitiates arrangements for hospital admissions and discharges and completesappropriate paperwork





Core Privileges - CLINICAL NURSE SPECIALIST (CNS)




General SupervisionProvides patient care to select patients or families as an expert clinician/rolemodelProvides specialized knowledge and skill to assist staff with management ofdifficult patient/family problemsManages specialty populations to improve and promote healthcare outcomesDevelops effective solutions that can be generalized across differing units,populations or specialties to improve health care outcomesFacilitates staff in developing innovative and/or cost effective programsFacilitates patient care transitions across the continuum of care





Standardized Protocols/Standardized Procedures

Description: (requires selection of a core professional role above)




(requires selection of a core professional role above)General SupervisionMEDICATIONS Administer, order, furnish or prescribe drugs and providetreatment within the APP's scope of practice, and consistent with the APP'sskill, training, competence, professional judgment and policies of SHC. seeStandardized Procedure: Administering, Ordering, Furnishing or Prescribing ofDrugs; Formulary ProtocolCONTROLLED MEDICATIONS OUTPATIENT PRESCRIPTION Administer,dispense and prescribe legend drugs in outpatient setting including narcoticsand provide treatment within the APP's scope of practice, and consistent withthe APP's skill, training, competence and professional judgmentADMINISTRATION OF MODERATE SEDATION [CRITERIA - In accordancewith SHC Moderate Sedation policy and completion of the SHC sedationexam every two years. Renewal Criteria - Minimum 6 cases required duringthe past two years]Personal SupervisionFIRST ASSISTANT [CRITERIA - Initial - Successful completion of anaccredited RNFA course -OR- Concurrent enrollment in an accredited RNFAcourse with the attending surgeon as primary preceptor with completion ofclinical practicum within 12 months of didactic course completion -OR-Completion of a First Assistant course with clinical practicum completion asevidenced by a certificate of completion -OR- Evidence from another hospitalor organization where privileges were granted to assist in the OR. PacemakerICD ILR Evaluation and Programming - Successful completion of specializedtraining in device evaluation and programming with a member of thearrhythmia team that is Heart Rhythm Society Certified Cardiac DeviceSpecialist. -AND- Three months of weekly clinic sessions which will includedidactic teaching session and supervised hands on sessions. Renewal -Minimum 20 cases required during the past 2 years]

Division




(Select division which corresponds to your Supervising Physician)NEUROSURGERYNEURO-FUNCTIONAL



Standardized Protocols/Standardized Procedures




(requires selection of a core professional role above)General SupervisionARGININE HCL GROWTH HORMONE RELEASING TESTDEEP BRAIN STIMULATION DEVICE: ADJUSTMENTDEEP BRAIN STIMULATION DEVICE: INITIAL PROGRAMMINGINTRAOPERATIVE RETRACTIONINTRAOPERATIVE TISSUE AND SPECIMEN HANDLINGINTRAOPERATIVE WOUND CLOSUREINTRATHECAL PUMP REFILLLUMBAR PUNCTUREMOTOR CORTEX STIMULATOR: PROGRAMMINGPUNCH BIOPSYSPINAL CORD STIMULATOR: PROGRAMMINGSTEREOTACTIC FIDUCIAL MARKER: PLACEMENTSTEREOTACTIC FIDUCIAL MARKER: PLACEMENT - ASSISTSTEREOTACTIC HEAD RING: PLACEMENTSTEREOTACTIC HEAD RING: PLACEMENT - ASSISTVENTRICULAR SHUNT PROGRAMMINGVENTRICULAR SHUNT / RESERVOIR TAPWOUND CLOSURE

QualificationsInitial Criteria Must Also Meet the Core Criteria for Standardized Protocols/Standardized Procedures

Renewal Criteria Each Standardizied Procedures requires minimum 6 cases during the past 2 years



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APP PRIVILEGES IN NEUROSURGERY - Stanford … · APP PRIVILEGES IN NEUROSURGERY ... 10 chart reviews each ... Develops effective solutions that can be generalized across differing