Since 2002 (the year the first national program to survey patients was adopted), patient satisfaction has become one of the primary, day-to-day concerns of a treating physician. One of the original initiatives behind the survey mandate was to publish patient satisfaction results, thereby improving physician accountability and arming patients with information to make more educated decisions with regard to their own health care.
Two weeks after the release of the revised Joint Commission FAQ, groups are still celebrating the decision to allow physician assistants and nurse practitioners to use scribes. Amidst the excitement, it is important to note one additional change to the FAQ: the statement that the Joint Commission does not support scribes being utilized to enter orders on behalf of physicians or other providers. While this language makes it clear that scribe order entry is not supported, the FAQ does not expressly prohibit this process either.
Topics: Joint Commission (TJC)
On July 12, 2012, the Joint Commission released a revised FAQ on the Use of Unlicensed Persons Acting as Scribes to now permit the use of scribes by Nurse Practitioners and Physician Assistants. Find the updated FAQ here.
Before the release of the FAQ regarding the use of scribes by the Joint Commission (TJC), physician groups and hospitals across the country had little guidance with regard to ensuring that the scribes working within their emergency departments were compliant with TJC standards. In May of 2011, the Joint Commission released an informative FAQ entitled, “Use of Unlicensed Persons Acting as Scribes” to accompany its Comprehensive Accreditation Manual for Hospitals. The guidelines cover different aspects of the scribe position, including the scope of duties, signature requirements, HR requirements, etc., and have served as a tremendous resource for groups and hospitals, alike. One aspect has evoked further reflection, and that is the language regarding the use of scribes by physicians or Licensed Independent Practitioners (LIPs), excluding Physician Assistants (and NPs in some states).
Independent vs. Dependent
In the glossary of the 2012 Hospital Accreditation Standards manual, the Joint Commission defines a Licensed Independent Practitioner as follows:
“Licensed Independent Practitioner: An individual permitted by law and by the organization to provide care, treatment, and services without direction or supervision. A licensed independent practitioner operates within the scope of his or her license and consistent with individually granted clinical privileges.”
By definition, PAs are dependent practitioners. They are state-licensed to practice medicine under the supervision of a physician through what is known as, “delegated autonomy;” in other words, PAs practice autonomously with regard to the duties delegated to them by a supervising physician and within the scope of practice as defined by state law, the PA’s education and experience, and facility policy. While the scope of practice may slightly vary across the states, PAs require some degree of physician supervision in all fifty states.
The scope of practice and the type of physician supervision required for Nurse Practitioners, on the other hand, is much more varied across the states. Most states require some degree of physician supervision, whether it is through direct supervision, a collaborative practice agreement, or written practice protocols. The degree of supervision required may also vary according to practice setting, type of service, or geographical location (e.g. rural areas).
However, in some states, Nurse Practitioners are permitted by law to practice without any physician supervision whatsoever. They may diagnose, treat, and prescribe medications without any sort of physician involvement. In these states, they are considered LIPs in accordance with the Joint Commission’s definition of such, thus presumably permitted to use scribes.
Topics: Joint Commission (TJC)