CRITICAL ELEMENTS IN DESIGNING A COLLABORATIVE
PRACTICE AGREEMENT (CPA) / CLINICAL PROTOCOL
Recommended by the National Clinical Pharmacy
Specialist Committee
Sample protocols may be viewed via the IHS Intranet. If you do not
have access to the IHS Intranet, please contact a National Clinical
Pharmacy Specialist Committee member. The following elements will be
reviewed and should be included in local CPA/Protocols:
- Statement of need
- Rationale/Purpose for clinic
- Why do you need this clinic?
- Not just National data, but focus on local need
- May include baseline data here for justification for new CPA
- May include current data for mature CPA
- Clinic information
- Process for obtaining referrals and determining clinic eligibility
- Clinic procedures
- Criteria for referral to clinic/primary care provider
- Process regarding referral back to primary provider and discharge of patient from clinic
- Clear statements that the pharmacist is authorized do all of the following
- Order laboratory tests
- Interpret laboratory tests
- Perform limited physical assessment
- Prescribe medications per the protocol. It should be clear that the pharmacist is responsible for dosing of the medications.
- Provide and document patient education
- Provide follow-up of the patient
- Outcomes (Clinical and Administrative)
- Identification of outcome measures to be collected
- Baseline outcomes data before clinic initiation
- Report of outcomes to local leadership and NCPSC
- At minimum, yearly outcome data should be obtained, documented and reported to NCPSC
- Examples of administrative outcomes may include: decreased physician workload, increased access to care, fiscal data, etc.
- Performance Improvement (PI)
- Description of continuous program PI processes
- Description of peer review process
- At minimum, yearly PI should be performed
- Training and Local Certification
- Define pharmacist training requirements and other qualifications to practice in a disease state management practice.
- Describe the process for annual evaluation and documentation of competencies.
- Reference
- National Clinical Practice Guidelines (if available) are referenced
- Protocol Approval
- Appropriate signatures
- Original date of approval
- Revision and/or review dates
