Conducting meaningful APP professional practice evaluation
When conducting professional practice evaluation for APPs, peer reviewers should come from the same discipline whenever possible—PA to PA, NP to NP, CRNA to CRNA, and so forth. Of course, there may be times when it isn’t possible to get an evaluation from a peer in the same discipline. In such cases, you may have to rely on an NP evaluation of a PA, or vice versa. There may also be times when the only person with firsthand knowledge of the APP’s clinical abilities is a physician.
Given these possibilities, abide by the following guidelines when conducting professional practice evaluation for APPs:
- It is acceptable to use an evaluation from a practitioner with a higher level of training (e.g., an MD evaluation of a PA or NP). It is not acceptable to use an evaluation from a practitioner with a lower level of training (e.g., an RN evaluation of an NP).
- When considering an initial applicant, it is beneficial to have an evaluation from an APP’s most recent supervising physician. If you have a CRNA who is coming from a hospital setting where there are no anesthesiologists, you should ask for a surgeon as a reference. Surgeons who work with CRNAs should be able to evaluate their competency.
OPPE considerations
OPPE is conducted for APPs as well as for physicians. Data is not as readily available for APPs, so medical staff leaders and MSPs must get creative. Get your physicians involved. Ask them what indicators they consider valuable in evaluating their APPs.
If you ask several surgeons from different specialties which indicators they would like to track for their APPs, you might get a list like this:
- H&P—complete, appropriate
- Progress notes
- Surgical wound care
- Knowledge of operation
- Surgical skills—suturing, tying, cutting
- Operative/procedure notes
- Discharge summaries
These elements can be included in an evaluation form that the sponsoring physician, or other person involved in the care of the patients, would fill out each OPPE cycle.
If your medical staff uses chart review, some of the same indicators could be incorporated. Keep in mind, however, that “knowledge of operation” and “surgical skills” could not be evaluated through chart review. These measures are better assessed through direct observation. This same format can be used for APPs working in medical specialties, as well as for CRNAs.
FPPE considerations
When conducting FPPE for APPs, evaluation forms are a good tool to use because it is often difficult to identify APP cases for review. (Organizations are not required to conduct chart reviews as part of the FPPE process.) If an APP has a change in employment that includes a switch in specialty, the FPPE plan should include documentation of training with the new supervising physician.