Oregon Health & Science University

There is a significant evolution in the role of pharmacists in recent decades. The transformation has moved from traditional dispensing to offerings of a broadrange of responsibilities and patient care services. Numerous factors drive this transformation, including advancements in healthcare, the transition towards a patient-centered approach and the growing recognition of pharmacists’ expertise in medication management for complex and varied disease states. Additionally, the current national shortage of healthcare providers further emphasizes the need for expansion of pharmacists’ roles. Despite these advancements and increasing healthcare demands, the scope of practice of pharmacists remains limited due to operational, administrative, and legislative barriers in the context of credentialing and privileging (C&P).

Credentialing is a process to review and verify an individual’s qualifications conducted by healthcare institutions, while privileging grants those individuals the authority to provide patient care services within their scope of practice. In May 2022, Oregon Health & Science University (OHSU), in an effort to reduce the care gap and advance the practice of pharmacy, successfully implemented both inpatient and ambulatory pharmacist credentialing and privileging with the support of various stakeholders.

Upon completing the C&P process, pharmacists are granted the official title of clinical pharmacist practitioner, signifying their status and expanded scope of practice. The privileges for pharmacist practitioners incorporate the analytical, consultative, educational, and monitoring services they offer in compliance with state and federal laws. The purpose of these expanded privilegesis to qualify the achievement of positive therapeutic, safety, and economic outcomes from therapy. The privileges are categorized into different groups, including those applicable after the initial order(s) placed by a Licensed Independent Practitioner, inpatient privileges for admission and discharge, and ambulatory privileges. One notable privilege in ambulatory settings is the ability to prescribe pharmacological or nonpharmacological interventions for symptom management as applicable to the patient’s medications or health conditions. Clinical pharmacist practitioners have more autonomy, ultimately benefiting patient care and enhancing the efficiency of the entire healthcare team.

Despite the potential benefits of pharmacist C&P, the widespread adoption of such advanced programs in the pharmacy profession has been hindered by a range of challenges. Implementing the C&P process can be a time-consuming task, as it requires collaboration and support from numerous departments within the institution. It is essential to conduct a thorough review and make necessary process modifications to ensure alignment with the institution's policies and compliance with state laws and regulations. Limited resources and infrastructure could further impede pharmacist C&P. Generating enthusiasm among pharmacists to participate in the C&P process requires some finesse.The pandemic that has persisted over the past three years has already led to increased workloads due to staff shortages, resulting in higher rates of burnout. Consequently, motivating clinical pharmacists to engage in the C&P process may be perceived as adding further burden to their already demanding workload.

During theimplementation of this program,there wereadditional challenges identified in areas of duplication of documentation and communication.In response to feedback from the pharmacist practitioners, continuous evaluation and specific initiatives have been put in place to address these issues and streamline workflows of the healthcare team. It is important to note that the pharmacist C&P process is an ongoing endeavor, requiring continuous communication and collaboration among different stakeholders within the institution. The experience of OHSU underscores the importance of long-term commitment and collaboration in order to advance the pharmacy profession forward and deliver optimal patient care in the changing healthcare landscape.

Despite the implementation challenges, OHSU embarked on this ambitious venture to promote the services and value of pharmacist practitioners. While there is increasing recognition and demand for pharmacists in various patient care settings, credentialing and privileging lends additional credenceto the critical role that pharmacist practitioners contribute to patient-centered care. The expanded scope in direct patient managementas well as the availability of pharmacists to serve as care providersis essential to meet the increased demand for access to care. The innovative credentialing and privileging process may serve as a replicable model for advancing pharmacist practice, provide value-based careandpromote recognition  to improve access and care for patients.