Background: Credentialing and privileging (C&P) formally authorize clinicians to perform defined scopes of practice within a healthcare organization and are widely used for physicians and advanced practice providers. Health‑system pharmacists increasingly deliver protocolized, outcome‑oriented care (dose adjustments, laboratory ordering, device‑data interpretation), yet local processes to recognize this work vary. In South Carolina, pharmacist C&P is not currently implemented, and statewide regulatory guidance for pharmacist‑physician collaborative practice is evolving. To inform the development of a systemwide pharmacist C&P policy and a privilege set that consolidates common, evidence‑based activities currently requiring provider co‑signature, we conducted two surveys: one to characterize internal pharmacist readiness and priorities, and one to benchmark external institutions’ C&P models, barriers, and practical mitigations.
Methods: A multi‑phase, mixed‑methods approach was used to guide development of the pharmacist credentialing and privileging framework. An internal survey was administered to outpatient and ambulatory pharmacists across the health system to evaluate readiness for a C&P process, identify priority privileges, and assess perceived value and competency evaluation preferences. A national benchmarking survey was then distributed through ASHP listservs to collect information on existing pharmacist C&P programs across diverse health systems, including governance models, eligibility criteria, and implementation challenges. Concurrently, existing institutional policies, guidance documents, and South Carolina pharmacy practice regulations were reviewed to identify requirements for alignment with Medical Staff Affairs processes. Findings from surveys and policy review informed the drafting of a standardized C&P policy, privilege structure, and governance pathway, which were reviewed with pharmacy leadership and Medical Staff Affairs to ensure consistency with established credentialing workflows. Next steps will include finalizing the framework, developing supporting education and operational workflows, piloting the process in select practice areas, and preparing for staged systemwide implementation.
Results: The internal survey included 53 respondents representing primarily ambulatory, oncology, and specialty practice settings. Respondents rated the anticipated impact of pharmacist C&P highly across all domains including top‑of‑license practice, efficiency, safety/quality, and provider workload reduction, with mean scores of approximately 4.3–4.5 on a 5‑point scale. A majority, 64.4%, reported feeling mostly or fully ready to undergo a C&P process. When asked which activities should be included in a basic privilege set, pharmacists most frequently endorsed medication dose adjustments (including renal, hepatic, and weight‑based), ordering and interpreting laboratory tests, interpreting device‑generated data (e.g., continuous glucose monitoring and blood pressure), therapeutic substitution, initiation and discontinuation of therapy within protocol, vaccination administration, and modifications to medication reconciliation. For assessment, respondents preferred a blended approach comprising continuing education, peer review of clinical documentation, competency examinations, and direct observation.
The external survey captured 22 responses from pharmacists and pharmacy leaders at other organizations. Most reported that pharmacist C&P is integrated with the Medical Staff Office and aligned to the medical staff appointment/reappointment cycle. Common eligibility models combined a PharmD with residency, board certification, or defined years of relevant experience. Frequently cited implementation barriers included infrastructure and process alignment with medical staff governance, scope clarity, and resource bandwidth; respondents mitigated these by engaging MSA early, standardizing privilege delineations, and specifying documentation and quality‑assurance expectations. Short‑term gains centered on autonomy and interprofessional trust, whereas longer‑term benefits included alignment with medical staff processes, expansion of pharmacist services, and maturation of reimbursement pathways in ambulatory settings.
Conclusions: Internal readiness and externally validated operating models converge on a feasible path to a pharmacist C&P framework in this South Carolina health system. Findings support drafting a broad privilege set covering high‑consensus activities currently requiring provider co‑sign and a aligned policy that specifies eligibility routes and a blended assessment approach. Early engagement with the MSA on format, committee pathway, and reappointment cadence is expected to streamline approval. Results will directly inform policy drafting and selection of an initial ambulatory pilot cohort in the next phase.
