Hospital Pharmacy - December 2019 - 367

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Richards et al
Table 2. Respondents Indicating They Have an Established Privileging Process in Place (n = 14).
Survey questionsa

Median

The support of the medical staff board was instrumental to the successful development of the
privileging process at my institution (n = 13).
The pharmacy staff was supportive in the development of the privileging process at my institution.
The state/statute was supportive to the implementation of the privileging process at my institution.
A lack of resources was a barrier to the implementation of the privileging process at my institution.

5
4
4
2

Rated on a 5-point Likert scale: 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree.

Table 3. Barriers to Implementation of Privileging Process for Respondents Indicating They Have an Established Process in Place
(n = 8).
People
Nursing pushback
Unable to include
pharmacy residents
Medical staff office
understanding

Education

Time

Lack of awareness of pharmacy practice by
nonpharmacists. Significant amount of time spent
educating leadership to gain their support
Physician understanding of clinical pharmacist training

series of 12 questions; however, not all respondents answered
all questions. When asked what environment their pharmacists
were privileged in the responses were as follows: 14% (2/14)
inpatient only, 21% (3/14) outpatient only, and 64% (9/14)
both inpatient and outpatient. Pharmacy directors were asked
how long their privileging process has been in place. The
majority of respondents indicated the privileging process at
their institution was developed within the last 2 years or within
the last 2 to 5 years (50%, 7/14; 36%, 5/14, respectively). Only
two directors (14%; 2/14) indicated the privileging process at
their institution was established greater than 5 years ago. To
further appreciate the magnitude of current privileging processes nationwide, pharmacy directors were asked how many
pharmacists are currently privileged at their institution. Six
directors (43%; 6/14) indicated that 11 to 20 pharmacists were
privileged at their institution; 4 directors (29%; 4/14) indicated
1 to 10 pharmacists were privileged, and the remaining 4
directors indicated that there were greater than 30 pharmacists
with privileges at their institution. At institutions with 1 to 10
privileged pharmacists, all directors indicated less than 20% of
their pharmacy staff were privileged. For institutions with 11
to 20 privileged pharmacists, the total percentage of pharmacy
staff ranged from less than 20% to 59%. For institutions with
greater than or equal to 31 privileged pharmacists, 3 of 4 directors indicated 40% to 59% of their pharmacy staff were privileged. The majority of institutions did not privilege residents
(79%; 11/14). None of the respondents indicated they did not
have a residency program.
To quantify barriers encountered and support needed to
establish a privileging process, pharmacy directors were
asked a series of 5-point Likert scale questions (Table 2). The

Time involved to get process established
Setting privileging criteria and scope
Extensive commitment of medical staff office
to process all pharmacist applications

majority of pharmacy directors agreed or strongly agreed the
pharmacy staff was supportive in the development of the
privileging process (85%; 11/13), the support of the medical
staff board was instrumental to the successful development
of the privileging process (93%; 13/14), and the state/statute
was supportive to the implementation of the privileging process at their institution (64%; 9/14). Conversely, the majority
of pharmacy directors disagreed or strongly disagreed that a
lack of resources was a barrier to the implementation of the
privileging process (71%; 10/14).
Pharmacy directors were able to comment on additional
barriers to the implementation of the privileging process at
their institution. The common themes revolved around people, education, and a lack of time (Table 3).
Directors were also asked to list any vital resources
needed to establish a privileging process at their institution.
Identified themes included the following: finding a pharmacy leader to manage the process, utilization of the
American Society of Health-System Pharmacy (ASHP) credentialing resource center, establishment of a competency
process, and ascertainment of medical staff champions. The
final question was designed to determine what activities
pharmacists are currently privileged to perform. All respondents (100%; 12/12) indicated their pharmacists are privileged to order laboratory tests and adjust medication doses
related to the monitoring of medication therapy, adjust
administration routes of existing medication orders, transition patients from intravenous to oral therapy, and monitor
and adjust medications based on patient specific parameters.
About 83% (10/12) also indicated their pharmacists were
privileged to delete duplicate medication therapy within the

Hospital Pharmacy - December 2019

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