CLINICAL PRIVILEGE WHITE PAPER

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1 Practice area 174 CLINICAL PRIVILEGE WHITE PAPER Background Respiratory therapist Respiratory therapists (RTs), also known as respiratory care practitioners, care for patients with breathing or other cardiopulmonary disorders. Under the direction of licensed physicians who have special expertise in respiratory care, RTs perform the tests that aid in the diagnosis and evaluation of respiratory problems and they administer therapeutic therapies. Their work includes monitoring patients and teaching them how to use prescribed respiratory treatment methods and equipment. They also routinely visit surgical patients to teach them exercises to reduce respiratory complications after surgery. RTs work primarily in hospitals, but they also work in home care, long-term care, subacute care, and hospice settings. They treat all patients of all ages, ranging from premature infants whose lungs are not fully developed to elderly people whose lungs are diseased. They provide temporary relief to patients with chronic asthma or emphysema, as well as emergency care to patients who are victims of a heart attack, stroke, drowning, or shock. Training for RTs is offered at the postsecondary level by colleges and universities, medical schools, vocational-technical institutes, and the Armed Forces. An associate degree has become the general requirement for entry into this field. Most programs award an associate or bachelor s degree and prepare graduates for jobs as advanced RTs. Other programs award associate degrees or certificates and lead to jobs as entrylevel RTs. The National Board for Respiratory Care (NBRC) is the certifying board that evaluates the professional competence of RTs. The NBRC offers the following voluntary certification and registration credentials to graduates of accredited programs in respiratory therapy: Certified respiratory therapist (CRT) Registered respiratory therapist (RRT) Certified pulmonary function technologist Registered pulmonary function technologist Neonatal/pediatric respiratory care specialist Credentials are awarded for a term of five years, and the NBRC requires RTs who were credentialed on or after July 1, 2002, to participate in a continuing competency program (CCP). There are three options for compliance with the CCP: A supplement to Briefings on Credentialing 781/ /04 1

2 Complete 30 hours of specified continuing education over the five-year period Retake the respective examination(s) for the credential being renewed and achieve a passing score Pass an NBRC examination if not previously completed Most states require some form of RT licensing. Student RTs should check on licensure requirements with the board of respiratory care examiners for the state in which they plan to work. Positions of societies and academies AARC The American Association for Respiratory Care (AARC) is the only professional society for RTs in hospitals and with home care companies, managers of respiratory and cardiopulmonary services, and educators who provide respiratory care training. To be eligible to be an active member of the AARC, applicants must satisfy one of the following requirements: Be legally credentialed as a respiratory care professional if employed in a state that mandates such Be a graduate of an accredited educational program in respiratory care Hold a credential issued by the NBRC In regard to the educational requirements, the AARC states that RTs must complete either a two-year associate s degree or a four-year baccalaureate degree. Upon graduation they are eligible to take a national examination that leads to the CRT credential. Subsequently they may take two more examinations that lead to the RRT credential. Positions of other interested parties NBRC The NBRC grants the CRT credential for entry-level RTs and the RRT credential for advanced RTs. CRT credential Applicants for the NBRC entry-level CRT examination must be 18 years of age or older and satisfy one of the following admission requirements: Have a minimum of an associate degree from a respiratory therapy education program supported by the Committee on Accreditation for Respiratory Care (CoARC), or its predecessor the Joint Review Committee for Respiratory Therapy Education (JRCRTE), or accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP). 2 A supplement to Briefings on Credentialing 781/ /04

3 Until December 31, 2005, have a certificate of completion/ graduation from a respiratory therapy education program supported by the CoARC or JRCRTE, or accredited by the CAAHEP. This applies only to individuals enrolled in an education program before January 1, Any one enrolled in a program beginning January 1, 2002, must have at least an associate degree from an accredited respiratory therapy education program. For Canadian RRTs, present a completed application form and a notarized copy of their Canadian registry certificate. RRT credential Applicants for the NBRC advanced RRT examination must be 18 years of age or older and satisfy one of the following admission requirements: Be a CRT who has earned a minimum of an associate degree from an advanced-level respiratory therapist educational program supported by the CoARC or JRCRTE, or accredited by the CAAHEP Until December 31, 2005, be a CRT having a certificate of completion/graduation from an advanced-level respiratory therapist educational program supported by the CoARC or JRCRTE, or accredited by the CAAHEP. To qualify for this admission route, the applicant must have enrolled in the education program prior to January 1, Be a CRT credentialed by the NBRC who has four years of full-time clinical experience in respiratory care under licensed medical supervision following certification and prior to applying for the registry examination. In addition, the applicant must also have at least 62 semester hours of college credit from a college or university accredited by its regional association or its equivalent, which included courses in anatomy and physiology, chemistry, microbiology, physics, and mathematics. Be a CRT with a baccalaureate degree in an area other than respiratory therapy but that included college-level courses in anatomy and physiology, chemistry, microbiology, physics, and mathematics. In addition, the applicant must have two years of full-time clinical experience in respiratory therapy under licensed medical supervision following certification and prior to applying for the registry examination. Be a Canadian RRT who has obtained the registry credential awarded by the Canadian Society of Respiratory Therapists. These individuals are required to pass only the clinical simulation examination (CSE) portion of the registry examina- A supplement to Briefings on Credentialing 781/ /04 3

4 tion to earn the NBRC s RRT credential. RRT applicants must pass the written registry examination for advanced RTs and the CSE, which currently consists of 11 patient management problems. JCAHO The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has no formal position on the delineation of privileges for RTs. However, in regard to qualifications for RTs, hospitals must comply with the following human resources (HR) and leadership (LD) standards from the 2004 Comprehensive Accreditation Manual for Hospitals: LD.3.70 The leaders define the required qualifications and competence of those staff who provide care, treatment, and services and recommend a sufficient number of qualified and competent staff to provide care, treatment, and services HR.1.10 The organization provides an adequate number and mix of staff consistent with the organization s staffing plan HR.1.20 The organization has a process to ensure that a person s qualifications are consistent with his or her job responsibilities HR.2.10 Orientation provides initial job training and information HR.2.20 Staff members, licensed independent practitioners, students, and volunteers can describe or demonstrate their roles and responsibilities, based on specific job duties or responsibilities, relative to safety HR.2.30 Ongoing education, including in-services, training, and other activities, maintains and improves competence HR.3.10 Competence to perform job responsibilities is assessed, demonstrated, and maintained HR.3.20 The organization periodically conducts performance evaluations CRC draft criteria When a hospital receives a request from an RT to become a member of the hospital staff, it should not be the first time the hospital considers whether this type of practitioner should be granted privileges. The policy covering RTs should be drafted in advance by the board and should resolve any liability, peer review, and reimbursement issues. In addition, the board should review federal laws, state laws, and state and local licensing requirements. The advice of the 4 A supplement to Briefings on Credentialing 781/ /04

5 medical staff should be considered as well as the needs of the community and the hospital s mission and strategic plan. Criteria should be in place covering qualifications, scope of practice, and physician supervisory requirements. The following draft criteria are intended to serve solely as a starting point for the development of an institution s policy regarding this practice area. Minimum threshold criteria for requesting core privileges in respiratory therapy References Basic education and minimum formal training: Applicants must have successfully completed an accredited program in respiratory care and be certified as an entry level CRT. RRT certification is recommended, and applicants must be licensed in those states that require licensure. Required previous experience: Applicants must be able to demonstrate that they have provided respiratory care for at least 50 patients in the past 12 months. A letter of reference must come from the director of the applicant s respiratory therapy training program. Alternatively, a letter of reference regarding competence should come from the RT s supervisor at the institution where the applicant most recently practiced. Core privileges in respiratory therapy Core privileges in respiratory therapy include but are not limited to the following: Select, assemble, and check equipment used in the respiratory treatment Collect, review, and maintain a patient s medical history and records Administer pulmonary function tests for assessment of lung function Draw blood and analyze oxygen, carbon dioxide, and ph levels Operate and maintain various types of highly sophisticated equipment to administer oxygen or to assist with breathing Use mechanical ventilation for treating patients who cannot breathe adequately on their own Monitor patient response to therapy Teach patients and their families to use respiratory care equipment Assist physicians in performing respiratory care procedures in a clinical laboratory, procedure room, or operating room A supplement to Briefings on Credentialing 781/ /04 5

6 Reappointment Reappointment should be based on unbiased, objective results of care according to the organization s existing quality assurance mechanisms. Applicants must be able to demonstrate that they have maintained competence by showing evidence that they have provided respiratory care for at least 50 patients annually over the reappointment cycle. In addition, continuing education related to respiratory therapy should be required. For more information For more information regarding this practice area, contact: American Association for Respiratory Care 9425 North MacArthur Boulevard, Suite 100 Irving, TX Telephone: 972/ Fax: 972/ Web site: Commission on Accreditation of Allied Health Education Programs 35 East Wacker Drive, Suite 1970 Chicago, IL Telephone: 312/ Fax: 312/ Web site: Joint Commission on Accreditation of Healthcare Organizations One Renaissance Boulevard Oakbrook Terrace, IL Telephone: 630/ Fax: 630/ Web site: National Board for Respiratory Care 8310 Nieman Road Lenexa, KS Telephone: 913/ Fax: 913/ We site: 6 A supplement to Briefings on Credentialing 781/ /04

7 Privilege request form Respiratory therapist To be eligible to request clinical privileges as an RT, an applicant must meet the following minimum threshold criteria: Basic education and minimum formal training: Applicants must have successfully completed an accredited program in respiratory care and be certified as an entry level CRT. RRT certification is recommended, and applicants must be licensed in those states that require licensure. Required previous experience: Applicants must be able to demonstrate that they have provided respiratory care for at least 50 patients in the past 12 months. References: A letter of reference must come from the director of the applicant s respiratory therapy training program. Alternatively, a letter of reference regarding competence should come from the RT s supervisor at the institution where the applicant most recently practiced. Core privileges: Core privileges in respiratory therapy include but are not limited to the following: - Select, assemble, and check equipment used in the respiratory treatment - Collect, review, and maintain a patient's medical history and records - Administer pulmonary function tests for assessment of lung function - Draw blood and analyze oxygen, carbon dioxide, and ph levels - Operate and maintain various types of highly sophisticated equipment to administer oxygen or to assist with breathing - Use mechanical ventilation for treating patients who cannot breathe adequately on their own - Monitor patient response to therapy - Teach patients and their families to use respiratory care equipment - Assist physicians to perform respiratory care procedures in a clinical laboratory, procedure room, or operating room Reappointment: Reappointment should be based on unbiased, objective results of care according to the organization s existing quality assurance mechanisms. Applicants must be able to demonstrate that they have maintained competence by showing evidence that they have provided respiratory care for at least 50 patients annually over the reappointment cycle. In addition, continuing education related to respiratory therapy should be required. I understand that by making this request I am bound by the applicable bylaws or policies of the hospital, and hereby stipulate that I meet the minimum threshold criteria for this request. Applicant s signature: Typed or printed name: Date: A supplement to Briefings on Credentialing 781/ /04 7

8 Clinical Privilege White Papers Advisory Board James F. Callahan, DPA Executive vice president and CEO American Society of Addiction Medicine Chevy Chase, MD Sharon Fujikawa, PhD Clinical professor, Dept. of Neurology University of California, Irvine Medical Center Orange, CA John N. Kabalin, MD, FACS Urologist/Laser surgeon Scottsbluff Urology Associates Scottsbluff, NE Publisher/Vice President: Suzanne Perney Executive Editor: Dale Seamans John E. Krettek Jr., MD, PhD Neurological surgeon Vice president for medical affairs Missouri Baptist Medical Center St. Louis, MO Michael R. Milner, MMS, PA-C Senior physician assistant consultant Phoenix Indian Medical Center Phoenix, AZ Senior Managing Editor: Edwin B. Niemeyer Beverly Pybus Senior consultant The Greeley Company Marblehead, MA Richard Sheff, MD Chair and Executive Director The Greeley Company, a division of HCPro, Inc. Marblehead, MA The information contained in this document is general. It has been designed and is intended for use by hospitals and their credentials committees in developing their own local approaches and policies for various credentialing issues. This information, including the materials, opinions, and draft criteria set forth herein, should not be adopted for use without careful consideration, discussion, additional research by physicians and counsel in local settings, and adaptation to local needs. The Credentialing Resource Center does not provide legal or clinical advice; for such advice, the counsel of competent individuals in these fields must be obtained. Reproduction in any form outside the recipient s institution is forbidden without prior written permission. Copyright 2004 HCPro, Inc., Marblehead, MA A supplement to Briefings on Credentialing 781/ /04

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