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| To amend sections 4723.48 and 4723.50 and to enact | 1 |
| section 4723.488 of the Revised Code to authorize | 2 |
| a person not otherwise authorized to do so to | 3 |
| administer certain drugs pursuant to delegation by | 4 |
| an advanced practice registered nurse who holds a | 5 |
| certificate to prescribe. | 6 |
| Section 1. That sections 4723.48 and 4723.50 be amended and | 7 |
| section 4723.488 of the Revised Code be enacted to read as | 8 |
| follows: | 9 |
| Sec. 4723.48. (A) A clinical nurse specialist, certified | 10 |
| nurse-midwife, or certified nurse practitioner seeking authority | 11 |
| to prescribe drugs and therapeutic devices shall file with the | 12 |
| board of nursing a written application for a certificate to | 13 |
| prescribe. The board of nursing shall issue a certificate to | 14 |
| prescribe to each applicant who meets the requirements specified | 15 |
| in section 4723.482 or 4723.485 of the Revised Code. | 16 |
| Except as provided in division (B) of this section, the | 17 |
| initial certificate to prescribe that the board issues to an | 18 |
| applicant shall be issued as an externship certificate. Under an | 19 |
| externship certificate, the nurse may obtain experience in | 20 |
| prescribing drugs and therapeutic devices by participating in an | 21 |
| externship that evaluates the nurse's competence, knowledge, and | 22 |
| skill in pharmacokinetic principles and their clinical application | 23 |
| to the specialty being practiced. During the externship, the nurse | 24 |
| may prescribe drugs and therapeutic devices only when one or more | 25 |
| physicians are providing supervision in accordance with rules | 26 |
| adopted under section 4723.50 of the Revised Code. | 27 |
| After completing the externship, the holder of an externship | 28 |
| certificate may apply for a new certificate to prescribe. On | 29 |
| receipt of the new certificate, the nurse may prescribe drugs and | 30 |
| therapeutic devices in collaboration with one or more physicians | 31 |
| or podiatrists. | 32 |
| (B) In the case of an applicant who meets the requirements of | 33 |
| division (C) of section 4723.482 of the Revised Code, the initial | 34 |
| certificate to prescribe that the board issues to the applicant | 35 |
| under this section shall not be an externship certificate. The | 36 |
| applicant shall be issued a certificate to prescribe that permits | 37 |
| the recipient to prescribe drugs and therapeutic devices in | 38 |
| collaboration with one or more physicians or podiatrists. | 39 |
| (C)(1) The holder of a certificate issued under this section | 40 |
| may delegate to a person not otherwise authorized to administer | 41 |
| drugs the authority to administer a drug, other than a controlled | 42 |
| substance, listed in the formulary established under division | 43 |
| (B)(1) of section 4723.50 of the Revised Code to a specified | 44 |
| patient. The delegation shall be in accordance with division | 45 |
| (C)(2) of this section and standards and procedures established in | 46 |
| rules adopted under division (B)(8) of section 4723.50 of the | 47 |
| Revised Code. | 48 |
| (2) Prior to delegating authority, the certificate holder | 49 |
| shall do both of the following: | 50 |
| (a) Assess the patient and determine that the drug is | 51 |
| appropriate for the patient; | 52 |
| (b) Determine that the person to whom the authority will be | 53 |
| delegated has met the conditions specified in division (D) of | 54 |
| section 4723.488 of the Revised Code. | 55 |
| Sec. 4723.488. A person not otherwise authorized to | 56 |
| administer drugs may administer a drug to a specified patient if | 57 |
| all of the following conditions are met: | 58 |
| (A) The authority to administer the drug is delegated to the | 59 |
| person by an advanced practice registered nurse who is a clinical | 60 |
| nurse specialist, certified nurse-midwife, or certified nurse | 61 |
| practitioner and holds a certificate to prescribe issued under | 62 |
| section 4723.48 of the Revised Code. | 63 |
| (B) The drug is listed in the formulary established under | 64 |
| division (B) of section 4723.50 of the Revised Code but is not a | 65 |
| controlled substance and is not to be administered intravenously. | 66 |
| (C) The drug is to be administered at a location other than a | 67 |
| hospital inpatient care unit, as defined in section 3727.50 of the | 68 |
| Revised Code, a hospital emergency department or a freestanding | 69 |
| emergency department. | 70 |
| (D) The person has successfully completed education based on | 71 |
| a recognized body of knowledge concerning drug administration and | 72 |
| demonstrates to the person's employer the knowledge, skills, and | 73 |
| ability to administer the drug safely. | 74 |
| (E) The person's employer has given the advanced practice | 75 |
| registered nurse access to documentation, in written or electronic | 76 |
| form, showing that the person has met the conditions specified in | 77 |
| division (D) of this section. | 78 |
| (F) The advanced practice registered nurse is physically | 79 |
| present at the location where the drug is administered. | 80 |
| Sec. 4723.50. (A) In accordance with Chapter 119. of the | 81 |
| Revised Code, the board of nursing shall adopt rules as necessary | 82 |
| to implement the provisions of this chapter pertaining to the | 83 |
| authority of clinical nurse specialists, certified nurse-midwives, | 84 |
| and certified nurse practitioners to prescribe drugs and | 85 |
| therapeutic devices and the issuance and renewal of certificates | 86 |
| to prescribe. | 87 |
| The board shall adopt rules that are consistent with the | 88 |
| recommendations the board receives from the committee on | 89 |
| prescriptive governance pursuant to section 4723.492 of the | 90 |
| Revised Code. After reviewing a recommendation submitted by the | 91 |
| committee, the board may either adopt the recommendation as a rule | 92 |
| or ask the committee to reconsider and resubmit the | 93 |
| recommendation. The board shall not adopt any rule that does not | 94 |
| conform to a recommendation made by the committee. | 95 |
| (B) The board shall adopt rules under this section that do | 96 |
| all of the following: | 97 |
| (1) Establish a formulary listing the types of drugs and | 98 |
| therapeutic devices that may be prescribed by a clinical nurse | 99 |
| specialist, certified nurse-midwife, or certified nurse | 100 |
| practitioner. The formulary may include controlled substances, as | 101 |
| defined in section 3719.01 of the Revised Code. The formulary | 102 |
| shall not permit the prescribing of any drug or device to perform | 103 |
| or induce an abortion. | 104 |
| (2) Establish safety standards to be followed by a clinical | 105 |
| nurse specialist, certified nurse-midwife, or certified nurse | 106 |
| practitioner when personally furnishing to patients complete or | 107 |
| partial supplies of antibiotics, antifungals, scabicides, | 108 |
| contraceptives, prenatal vitamins, antihypertensives, drugs and | 109 |
| devices used in the treatment of diabetes, drugs and devices used | 110 |
| in the treatment of asthma, and drugs used in the treatment of | 111 |
| dyslipidemia; | 112 |
| (3) Establish criteria for the components of the standard | 113 |
| care arrangements described in section 4723.431 of the Revised | 114 |
| Code that apply to the authority to prescribe, including the | 115 |
| components that apply to the authority to prescribe schedule II | 116 |
| controlled substances. The rules shall be consistent with that | 117 |
| section and include all of the following: | 118 |
| (a) Quality assurance standards; | 119 |
| (b) Standards for periodic review by a collaborating | 120 |
| physician or podiatrist of the records of patients treated by the | 121 |
| clinical nurse specialist, certified nurse-midwife, or certified | 122 |
| nurse practitioner; | 123 |
| (c) Acceptable travel time between the location at which the | 124 |
| clinical nurse specialist, certified nurse-midwife, or certified | 125 |
| nurse practitioner is engaging in the prescribing components of | 126 |
| the nurse's practice and the location of the nurse's collaborating | 127 |
| physician or podiatrist; | 128 |
| (d) Any other criteria recommended by the committee on | 129 |
| prescriptive governance. | 130 |
| (4) Establish standards and procedures for issuance and | 131 |
| renewal of a certificate to prescribe, including specification of | 132 |
| any additional information the board may require under division | 133 |
| (A)(4), (C)(5), or (D)(5) of section 4723.482 or division (B)(3) | 134 |
| of section 4723.485 of the Revised Code; | 135 |
| (5) Establish standards for board approval of the course of | 136 |
| study in advanced pharmacology and related topics required by | 137 |
| section 4723.482 of the Revised Code; | 138 |
| (6) Establish requirements for board approval of the two-hour | 139 |
| course of instruction in the laws of this state as required under | 140 |
| division (C)(4) of section 4723.482 of the Revised Code and | 141 |
| division (B)(2) of section 4723.484 of the Revised Code; | 142 |
| (7) Establish standards and procedures for the appropriate | 143 |
| conduct of an externship as described in section 4723.484 of the | 144 |
| Revised Code, including the following: | 145 |
| (a) Standards and procedures to be used in evaluating an | 146 |
| individual's participation in an externship; | 147 |
| (b) Standards and procedures for the supervision that a | 148 |
| physician must provide during an externship, including supervision | 149 |
| provided by working with the participant and supervision provided | 150 |
| by making timely reviews of the records of patients treated by the | 151 |
| participant. The manner in which supervision must be provided may | 152 |
| vary according to the location where the participant is practicing | 153 |
| and with the participant's level of experience. | 154 |
| (8) Establish standards and procedures for delegation under | 155 |
| division (C) of section 4723.48 of the Revised Code of the | 156 |
| authority to administer drugs. | 157 |
| Section 2. That existing sections 4723.48 and 4723.50 of the | 158 |
| Revised Code are hereby repealed. | 159 |