Procedural Pain Management

Background

In 2016, the College announced and began an initiative to develop standards for the accreditation of procedural pain management (PPM) performed outside the hospital setting in community-based physician offices, practices and clinics. The purpose was to establish a process for accrediting these facilities, to credential physicians performing procedures that require an accredited setting, and to ensure that sufficient safety and quality measures are in place.

Accreditation standards for community-based PPM offices, practices and clinics have been developed and were recently approved by the Non-Hospital Medical and Surgical Facilities Accreditation Program (NHMSFAP) Committee. The process for developing these standards included convening an advisory panel of subject-matter experts in pain medicine, anesthesiology (including family practice anesthesia), interventional radiology, and physical medicine and rehabilitation, as well as two rounds of public consultation.

The PPM accreditation standards address physician credentialing and privileging; procedures that require an accredited facility or should only be done in a hospital; imaging requirements (ultrasound, fluoroscopy, CT); infection, prevention and control requirements; and patient safety and quality care requirements.

Credentialing and Privileging for PPM

Physicians wishing to continue performing caudal and interlaminar lumbar epidurals, advanced I and advanced II procedures in the community setting must meet the requirements outlined in the BC Medical Quality Initiative (BCMQI) privileging dictionary for their specialty for training and current experience. The BCMQI dictionaries are available here.

All physicians meeting the criteria to perform the procedures in Appendix A must complete an application package and submit it to the NHMSFAP by November 15, 2020.

Physicians who do not meet the requirements as outlined in their respective dictionary may no longer perform these procedures as of March 15, 2021. This deadline will allow time for these physicians to refer their patients to other appropriate community-based physicians or programs within the health authority.

Note: Physicians who perform PPM procedures only in health authority settings do not need to apply for privileges through the NHMSFAP.

Accreditation

Accreditation to perform procedural pain management will be a phased approach.

Effective March 16, 2021, provisional accreditation will be required to continue performing caudal and interlaminar lumbar epidural procedures, advanced I procedures, and advanced II procedures in community-based physician offices, practices and clinics. In order to be awarded provisional accreditation, community-based physician offices, practices and clinics will be required to submit an application for provisional accreditation, complete a checklist confirming that they meet a subset of the PPM standards (minimum requirements) to ensure patient safety, and pay their annual fees. The application and standards checklist will be forwarded to the physician identified on the application (i.e. single physician or the medical director for multi-physician facilities) to complete and submit to the NHMSFAP for review. Facilities will have until February 28, 2021 to complete their application and submit their checklist and annual fees. Facilities that do not meet the deadline will not be permitted to perform PPM until their application, checklist and annual fees are received.

Once awarded provisional accreditation, facilities will have until February 28, 2022, to come into conformance with the PPM standards, including the applicable imaging modalities, and prepare for an on-site accreditation assessment. On-site accreditation assessments will begin to be scheduled in March 2022. Following their on-site assessment, facilities demonstrating conformance with all of the PPM standards will be awarded full accreditation.

Forms

Guidelines

Accreditation standards