The Basics

This standard requires that the organization provide the staff with both appropriate P&Ps and necessary clinical decision support tools.  This means that each employee needs to know where to find the P&Ps and tools that help them understand the proper way to perform his/her job.  Having a general notion that the applicable P&Ps are "somewhere on the shared drive" or "somewhere in the supervisor's office" is not enough.  Each employee needs to have ready access to the applicable P&Ps and clinical tools.

Management Tips

The keys here are employee access and training.  We strongly recommend against reliance on paper P&Ps and tools.  Keeping a single copy of the current P&Ps and tools on a shared drive to which all employees have access is the best practice, and about the only way an organization can be sure that the correct version of P&Ps and tools are in the hands of the people who need them -- the employees.

URAC Accreditation Tips

Documentation for this 4-weighted standard is straightforward.  The Master List of P&Ps should be submitted here, as it was for Core 3.  In addition, the P&P or program description that describes the clinical decision support tools that the organization uses should be uploaded to AccreditNet.

The onsite review will test access as much as anything.  Employees are likely to be asked something like, "if you have a question about how to do a certain aspect of your job, where would you find the proper procedure described?"  The best answer will be if they can go directly to the P&P or clinical tool in question on their computer.  The reviewer will need to see that the P&Ps are a useful tool for employees, not simply a document occupying space on a hard drive or a shelf.