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Table 4. Respondents Indicating They Do Not Have a Privileging Process in Place (n = 30).
Survey questionsa
My state pharmacy practice will allow the development of a privileging process at my institution.
I feel my pharmacy staff will support the development of a privileging process.
My medical staff board will support the development of a privileging process.
I have the appropriate resources to implement a privileging process at my hospital/organization.

Median

Unknownb

4
4
4
3

3
3
9
1

Rated on a 5-point Likert scale: 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree.
Respondents had the ability to answer "at this time, I do not know."

same therapeutic class. Additional activities included the following: managing parenteral nutrition therapy, adjusting
anticoagulation doses, ordering preoperative antimicrobials
and stress ulcer prophylaxis, ordering ventilator associated
pneumonia prophylaxis, and prescribing for targeted diseases states.

Pathway 2
Thirty-one pharmacy directors indicated they did not have a
current privileging process in place. They were asked a
series of 7 questions, and respondents did not answer all
questions. Pharmacy directors were asked if they were considering establishing a process. In total, 70% of respondents
answered yes (21/30), 10% answered no (3/30), and 20%
indicated they were undecided (6/30). Directors were then
asked to indicate when they planned on establishing such a
process. The majority of respondents indicated they were
considering establishing a process within the next 2 years
(59%; 17/29). Of the 5 pharmacy directors who had previously attempted to establish a privileging process, 4 indicated they will consider reattempting in the next 0 to 2 years.
To gain an understanding for the perceived barriers associated with the establishment of a privileging process, pharmacy directors were asked to select barriers from a series of
choices. About 48% (14/29) of respondents indicated institutional or organization hurdles and 45% (13/29) identified
a lack of appropriate resources to be perceived barriers to
the implementation of a privileging process at their institution. Only 17% (5/29) believed the state/statute would be a
barrier to establishing a process and 24% (7/29) indicated
at this time they were unsure what barriers lie ahead.
Additionally, respondents were asked a series of 5-point
Likert scale questions (Table 4). Pharmacy directors agreed
or strongly agreed their state pharmacy practice would
allow for the development of a privileging process (63%;
19/30), and felt their pharmacy staff was supportive of the
development of a privileging process (63%; 19/30). Only
37% of respondents agreed or strongly agreed their medical
staff board would support the development of a privileging
process (11/30). Nine pharmacy directors indicated they
did not know whether the medical staff board would support the development of a privileging practice. One-third
(10/30) of respondents agreed they had the appropriate

resources to implement a privileging process at their institution, 20% disagreed (6/30), and 17% strongly disagreed
(5/30) they had appropriate resources.

Discussion
According to the national Practice Advancement Initiative
(PAI), formerly referred to as the Pharmacy Practice Model
Initiative (PPMI), as the health care landscape continues to
evolve, changes related to the practice and advancement of
pharmacy will be necessary for continued success of the
profession.4,5 The goal of PAI is "to significantly advance
patient health by developing and disseminating futuristic
practice recommendations that support pharmacists' roles
as direct patient care providers." The process of privileging is an important step in achieving this goal and developing optimal pharmacy practice models for hospitals and
health systems.6 In addition to furthering direct patient
care roles, a priority of the American College of Clinical
Pharmacy (ACCP) is to ensure pharmacists are competent
to engage in clinical practice and perform direct patient
care activities.7 One way to demonstrate competence is
through obtaining board certification and credentialing.8
ACCP believes
clinical pharmacists engaged in direct patient care should be
board certified and have established a valid collaborative drug
therapy management (CDTM) agreement or have been formally
granted clinical privileges by the medical staff or credentialing
system within the health care environment in which they
practice.7

The movement toward credentialing and privileging in
pharmacy is similar to other nonphysician disciplines such
as physician assistants and nurse practitioners. For example, acute care nurse practitioners (ACNPs) pursue specialized training and credentialing to care for complex and
critically ill patients.9 ACNPs must be credentialed and
privileged to perform functions within their institution of
employment. A recent survey of institutions in California
found while privileges related to conducting invasive procedures varied between institutions, the one commonality
was that medical staff offices oversaw the credentialing and
privileging process. Not only does privileging allow for

Hospital Pharmacy - December 2019

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