By: Cedar Wang
As the benefits and efficacy of simulation training continue to grow, health care providers can expect to be engaged in this type of training not only in the academic setting, but throughout their careers. Many of today’s nursing and medical students who experience simulation during their formal schooling may also participate in simulation within the context of interdisciplinary teams. Scenarios designed for interprofessional teams allow practitioners to train in a realistic manner reflective of the complex environments in which they function.
Communication across disciplines is a key domain identified by the Interprofessional Education Collaborative. In 2007, with an increased focus on measurable quality outcomes and patient safety, the Joint Commission introduced its Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE) processes, which acknowledge simulation as a suggested component of these evaluations. Not only are simulation exercises important for students, they are equally important for experienced practitioners as they provide opportunities for both technical and soft skills to be practiced and evaluated.
Our hospital-based simulation center coordinates simulation courses to satisfy specific OPPE and FPPE requirements in conjunction with medical affairs and professional practice departments. According to the Joint Commission, FPPE is “a process whereby the organization evaluates the privilege-specific competence of the practitioner who does not have documented evidence of competently performing the requested privilege at the organization.” Usually this is accomplished during the initial credentialing period. OPPE, an ongoing process to ensure quality and safe practice, is defined as “a document summary of ongoing data collected for the purpose of assessing a practitioner’s clinical competence and professional behavior.” Our institution identified both FPPE and OPPE gaps in current evaluations methods.
One example includes FPPE required to gain moderate sedation privileges for newly credentialed, nonanesthesiologist providers. This evaluation now benefits from a more standardized approach using interprofessional simulation. In collaboration with the chair of anesthesiology, our simulation center designed several scenarios to serve as an evaluation tool for providers requesting permission to incorporate moderate sedation into their clinical practice. The scenarios – programmed into Laerdal’s LLEAP platform and run on SimMan 3G and SimJunior – have RN and MD participants interacting in patient cases in which the MD must demonstrate skills consistent with FPPE objectives. An accompanying checklist created for completion by the reviewing physician documents the evaluation in compliance with regulatory requirements. The RN, who volunteers to participate as a professional development opportunity, is not formally evaluated.
The physician checklist includes several competencies outlined in the Joint Commission Standards BoosterPakÔ for Focused Professional Practice Evaluation/Ongoing Professional Practice Evaluation (FPPE/OPPE):
- Patient care
- Medical/clinical knowledge
- Practice-based learning and improvement
- Interpersonal and communication skills
- Systems-based practice
The BoosterPak for FPPE/OPPE is supplied to organizations accredited by the Joint Commission. The Joint Commission gives permission for those organizations to copy it for use internally within the organization. If your institution is accredited, request a copy from your compliance officer.
Though they target physician practice, assessments such as FPPE and OPPE are driven by performance data supported by nursing practice. Therefore, training and evaluation, conducted in an interdisciplinary manner, mirror the reality of practice throughout the practice trajectory. Since simulation is recognized by the Joint Commission as a suggested review measure for performance evaluation, more simulation centers will be employed to conduct this important work to ensure safe patient care.