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Sub. H. B. No. 206 As Passed by the HouseAs Passed by the House
128th General Assembly | Regular Session | 2009-2010 |
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Representatives Boyd, Oelslager
Cosponsors:
Representatives Combs, Domenick, Wachtmann, Ujvagi, Letson, Yuko, Okey, Chandler, Brown, Celeste, Dyer, Evans, Gerberry, Heard, Hite, Koziura, Luckie, Mallory, Reece, Stewart, Szollosi, Walter, Williams, B., Williams, S.
A BILL
To amend sections 3719.06, 4723.06, 4723.481,
4723.482,
4723.492, and 4723.50 and to enact
section 4723.486 of the Revised
Code to
modify
the authority of certain advanced
practice
nurses to prescribe schedule II
controlled
substances.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 3719.06, 4723.06, 4723.481,
4723.482,
4723.492, and 4723.50 be amended and section 4723.486
of the Revised Code be enacted to
read as
follows:
Sec. 3719.06. (A)(1) A licensed health professional
authorized to
prescribe drugs, if acting in the course of
professional practice, in accordance with the laws regulating the
professional's practice, and in accordance with rules adopted by
the state
board of pharmacy, may, except as provided in division
(A)(2) or (3) of this section, do the following:
(a) Prescribe schedule II, III, IV, and
V controlled
substances;
(b) Administer or personally furnish to
patients schedule II,
III,
IV, and V controlled substances;
(c) Cause schedule II, III, IV, and
V
controlled substances
to be administered under the prescriber's
direction and
supervision.
(2) A licensed health professional authorized to
prescribe
drugs who
is a clinical nurse specialist, certified nurse-midwife,
or certified
nurse practitioner
is subject to both of the
following:
(a) A schedule II controlled substance may be prescribed
only
for
a patient with a terminal condition, as defined in section
2133.01 of the
Revised Code, only if the nurse's collaborating
physician
initially prescribed the substance for the patient, and
only in an
amount
that does not exceed the amount necessary for
the patient's use in a
single, twenty-four-hour period.
(b) No shall not personally furnish to patients any schedule
II controlled substance shall be personally furnished to any
patient.
(3) A licensed health professional authorized to prescribe
drugs who is a physician assistant shall not prescribe or
personally furnish to patients any controlled substance that is
not included in the physician-delegated prescriptive authority
granted to the physician assistant in accordance with Chapter
4730. of the Revised Code.
(B) No licensed health professional
authorized to prescribe
drugs shall prescribe,
administer, or personally furnish a
schedule III anabolic
steroid for the purpose of
human muscle
building or enhancing human athletic performance
and no pharmacist
shall dispense a schedule III anabolic steroid
for either purpose,
unless it has been approved for that purpose
under the "Federal
Food, Drug, and Cosmetic Act," 52 Stat. 1040 (1938), 21 U.S.C.A.
301, as amended.
(C) Each written prescription shall be properly
executed,
dated, and signed by the prescriber on the
day when issued and
shall bear the full name and address of the person for
whom, or
the owner of the animal for which, the
controlled
substance is
prescribed and the full name,
address, and registry number under
the federal drug abuse control
laws of the prescriber. If the
prescription is for an animal, it
shall state the species
of the
animal for which the controlled substance is prescribed.
Sec. 4723.06. (A) The board of nursing shall:
(1) Administer and enforce the provisions of this chapter,
including the taking of disciplinary action for violations of
section 4723.28 of the Revised Code, any other provisions of this
chapter, or rules adopted under this chapter;
(2) Develop criteria that an applicant must meet
to be
eligible to sit for the examination for licensure to practice as a
registered nurse or as a licensed practical nurse;
(3) Issue and renew nursing licenses, dialysis technician
certificates, and community health worker certificates, as
provided in this chapter;
(4) Define the minimum curricula and standards for
educational programs of the schools of professional nursing and
schools of practical nursing in this state;
(5) Survey, inspect, and grant full approval to
prelicensure
nursing education programs that
meet the standards established by
rules adopted under section
4723.07 of the Revised Code.
Prelicensure nursing education
programs include, but are not
limited to, associate degree,
baccalaureate degree, diploma, and
doctor of nursing programs
leading to initial licensure to
practice nursing as a registered
nurse and practical nurse
programs leading to initial licensure
to practice nursing as a
licensed practical nurse.
(6) Grant conditional approval, by a vote of a quorum of
the
board, to a new prelicensure nursing education program or a
program that is being
reestablished after having ceased to
operate, if the program meets and
maintains
the minimum standards
of the
board established by rules adopted under section 4723.07 of
the
Revised Code. If the board does not grant conditional
approval,
it shall hold an adjudication under Chapter 119. of
the
Revised Code to
consider conditional approval of the program. If
the board grants conditional approval, at its first meeting after
the first class has completed the program, the board shall
determine whether to grant full approval to the program. If the
board
does not
grant full approval or if it
appears that the
program has failed to meet and maintain
standards established by
rules adopted under section 4723.07 of
the Revised Code, the board
shall hold an adjudication
under Chapter
119. of the Revised Code
to consider the program. Based on
results of the adjudication,
the
board may continue or
withdraw
conditional approval, or grant
full
approval.
(7) Place on provisional approval, for a period of time
specified by the board, a program that has ceased
to meet and
maintain the minimum standards of the board
established by rules
adopted under section 4723.07 of the Revised
Code. At the end of
the period, the board shall reconsider
whether the program meets
the standards and
shall
grant full approval if it does. If it
does
not, the board may
withdraw approval, pursuant to an
adjudication
under
Chapter 119. of
the Revised Code.
(8) Approve continuing nursing education programs and
courses
under standards established in rules adopted under
section
4723.07
of the Revised Code;
(9) Approve peer support programs, under rules
adopted under
section 4723.07 of the Revised Code, for nurses, for dialysis
technicians, and for certified community health workers;
(10) Establish a program for monitoring
chemical dependency
in
accordance with section 4723.35 of the Revised Code;
(11) Establish the practice intervention and improvement
program in
accordance with section 4723.282 of the Revised Code;
(12) Issue and renew certificates of authority to practice
nursing
as a
certified registered nurse anesthetist, clinical
nurse specialist, certified
nurse-midwife, or certified nurse
practitioner;
(13) Approve under section 4723.46 of the
Revised Code
national certifying organizations for examination and
certification of
certified registered nurse anesthetists, clinical
nurse specialists, certified
nurse-midwives, or certified nurse
practitioners;
(14) Issue and renew certificates to prescribe in accordance
with
sections 4723.48 and 4723.485 of the Revised Code;
(15) Grant approval to the planned classroom and clinical
study required by section 4723.483 4723.482 of the Revised Code to
be
eligible for a certificate to prescribe;
(16) Make an annual edition of
the formulary established in
rules adopted under section
4723.50 of the Revised Code available
to the public either
in printed form or by electronic means and,
as soon as possible after
any revision of the formulary becomes
effective, make the
revision available to the public in printed
form or by
electronic means;
(17) Provide guidance and make recommendations to the
general
assembly,
the governor, state agencies, and the federal
government
with respect to the
regulation of the practice of
nursing and the
enforcement of this chapter;
(18) Make an annual report to the governor, which shall be
open for public inspection;
(19) Maintain and have open for public inspection the
following records:
(a) A record of all its meetings and proceedings;
(b) A file of holders of nursing licenses,
registrations,
and
certificates granted under this chapter; dialysis
technician
certificates granted under this chapter; and community health
worker certificates granted under this chapter. The file
shall be
maintained in the form prescribed by rule of the board.
(c) A list of prelicensure nursing education programs
approved by the board;
(d) A list of approved peer support programs for nurses,
dialysis
technicians, and certified community health workers.
(B) The board may fulfill the requirement of division
(A)(8)
of this section by authorizing persons who meet the
standards
established in rules adopted under
section 4723.07 of the Revised
Code to approve continuing nursing
education programs and courses.
Persons so authorized shall
approve continuing nursing education
programs and courses in
accordance with standards established in
rules adopted under
section 4723.07 of the Revised Code.
Persons seeking authorization to approve continuing nursing
education programs and courses shall apply to the board and pay
the appropriate fee established under section 4723.08 of the
Revised Code. Authorizations to approve continuing nursing
education programs and courses shall expire, and may be renewed
according to the schedule established in rules adopted under
section 4723.07 of the Revised Code.
In addition to approving continuing nursing education
programs under division (A)(8) of this section, the board may
sponsor continuing education activities that are directly related
to the statutes and rules pertaining to the practice of nursing in
this state.
Sec. 4723.481. Under a certificate to prescribe issued under
section 4723.48 of the Revised Code, a clinical nurse
specialist,
certified nurse-midwife, or certified nurse practitioner is
subject to all of
the following:
(A) The clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner shall not prescribe any drug or
therapeutic
device
that is not included in the types of drugs and
devices listed on the formulary
established in
rules adopted under
section 4723.50 of the Revised Code.
(B) The nurse's prescriptive authority of the clinical nurse
specialist, certified nurse-midwife, or certified nurse
practitioner shall not exceed the
prescriptive authority of the
collaborating physician or podiatrist.
(C) The nurse may prescribe a schedule II controlled
substance
as specified in division (A)(2) of section 3719.06 of
the
Revised
Code, but shall not prescribe a schedule II controlled
substance in collaboration with a podiatrist.
(D) The clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner may personally furnish to a
patient a sample of
any drug or therapeutic device included in the
types of drugs and devices
listed on the formulary,
subject to all
of the following:
(1) The amount of the sample furnished shall not exceed a
seventy-two-hour supply, except when the minimum available
quantity of the
sample is packaged in an
amount that is greater
than a seventy-two-hour supply, in which case
the nurse may
furnish the sample in the packaged amount may be furnished.
(2) No charge may be imposed for the sample or for furnishing
it.
(3) Samples of controlled substances may not be personally
furnished.
(E)(D) The clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner may personally
furnish to a patient a complete
or
partial supply of a drug or
therapeutic device included in the types of drugs
and devices
listed
on the formulary, subject to all of the following:
(1) The clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner shall personally furnish only
antibiotics,
antifungals, scabicides, contraceptives, prenatal
vitamins, antihypertensives, drugs and devices used in the
treatment of diabetes, drugs and devices used in the treatment of
asthma, and drugs used in the treatment of dyslipidemia.
(2) The clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner shall not furnish the drugs and
devices in
locations other than a health department operated by
the board of
health of a city or general health district or the
authority
having the duties of a board of health under section
3709.05 of
the Revised Code, a federally funded comprehensive
primary
care
clinic, or a nonprofit health care clinic or program.
(3) The clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner shall comply with all safety
standards for
personally furnishing supplies of drugs and devices,
as established
in rules adopted under section 4723.50 of the
Revised Code.
Sec. 4723.482. (A) An applicant shall include with the
application submitted under section
4723.48 of the Revised Code
all of the following:
(1) Subject to section 4723.483 of the Revised Code,
evidence
of
holding a current, valid certificate of authority issued under
this chapter to practice as a
clinical
nurse specialist, certified
nurse-midwife, or certified nurse practitioner;
(2) Except for a person who on May 17, 2000, was approved to
prescribe drugs and
therapeutic devices under section 4723.56 of
the Revised Code, as that section existed on that date,
evidence
Evidence of successfully completing the instruction course of
study in
advanced
pharmacology and related topics in accordance
with the
requirements specified in division
(B) of this section;
(3) The fee required by section 4723.08 of the Revised
Code
for
a certificate to prescribe;
(4) Any additional information the board of nursing requires
pursuant to
rules adopted under section 4723.50 of the Revised
Code.
(B) All With respect to the course of study in advanced
pharmacology and related topics that must be successfully
completed to obtain a certificate to prescribe, all of the
following requirements apply to the instruction required under
division (A)(2)
of this section:
(1) The instruction must course of study shall be obtained
completed not longer
than three years
before the application for
the certificate to
prescribe is filed.
(2) The instruction must be obtained through a course of
study
consisting shall consist of planned classroom and clinical
study that is
instruction for a total of not less than forty-five
contact hours.
(3) The course of study shall meet the requirements to be
approved
by the board of nursing in accordance with
standards
established in
rules adopted under section 4723.50 of
the Revised
Code.
(3)(4) The content of the instruction must course of study
shall be specific
to the
applicant's nursing specialty and.
(5) The instruction provided in the course of study shall
include all of the
following:
(a) A minimum of thirty thirty-six contact hours of training
instruction
in advanced
pharmacology that includes pharmacokinetic
principles
and clinical application
and the use of
drugs and
therapeutic
devices in the prevention of illness and
maintenance
of health;
(b) Training Instruction in the fiscal and ethical
implications of
prescribing drugs and therapeutic devices;
(c) Training Instruction in the state and federal laws that
apply to the
authority to prescribe;
(d) Instruction that is specific to schedule II controlled
substances,
including instruction in all of the following:
(i) Indications for the use of schedule II controlled
substances in drug therapies, including pain management therapies;
(ii) The most recent guidelines for pain management
therapies,
as established by state and national organizations
such as the
Ohio pain initiative and the American pain society;
(iii) Ethical and fiscal implications of prescribing schedule
II controlled substances;
(iv) State and federal laws that apply to the authority to
prescribe schedule II controlled substances;
(v) Prevention of abuse and diversion of schedule II
controlled substances, including identification of the risk of
abuse and diversion, recognition of abuse and diversion, types of
assistance available for prevention of abuse and diversion, and
methods of establishing safeguards against abuse and diversion.
(e) Any additional training instruction required pursuant to
rules
adopted
under section 4723.50 of the Revised Code.
Sec. 4723.486. No holder of a certificate to prescribe issued
under section 4723.48 of the Revised Code shall prescribe in a
convenience care clinic any schedule II controlled substance to a
patient.
Sec. 4723.492. The committee on prescriptive governance
shall
develop recommendations regarding the authority to prescribe
drugs
and therapeutic devices pursuant to a certificate to
prescribe
issued under section 4723.48 of the Revised Code. Not
later
than fourteen months after the effective date of this
section, the The recommendations shall include provisions that
apply specifically to the authority to prescribe schedule II
controlled substances.
The committee
shall submit recommendations to the board of
nursing as necessary for the
board
to fulfill its duty to adopt
rules under section 4723.50 of the
Revised Code. At the board's
request, the committee shall
reconsider a recommendation it has
submitted and resubmit the
recommendation to the board
accordingly.
Sec. 4723.50. (A) In accordance with Chapter 119. of
the
Revised Code, the board of nursing shall adopt
rules as necessary
to implement the provisions of this chapter pertaining to
the
authority of clinical nurse
specialists, certified nurse-midwives,
and certified nurse practitioners
to prescribe drugs and
therapeutic devices and the issuance and renewal of
certificates
to prescribe. Initial rules
shall be adopted not later than twenty
months after the effective date of
this section.
The board shall adopt rules that are consistent with
the
recommendations the board receives from the committee on
prescriptive
governance pursuant to section 4723.492 of the
Revised Code. After reviewing
a recommendation submitted by the
committee, the board may either adopt the
recommendation as a rule
or ask the committee to reconsider and resubmit the
recommendation. The board shall not adopt any rule that does not
conform to a
recommendation made by the committee.
(B) The board shall adopt rules under this section that do
all of
the
following:
(1) Establish a formulary
listing the types of drugs and
therapeutic devices that may be
prescribed by a clinical nurse
specialist, certified nurse-midwife, or
certified nurse
practitioner.
The formulary may include
controlled substances, as
defined in section 3719.01 of the
Revised Code. The formulary
shall not
permit the prescribing of any drug or device to perform
or induce an
abortion.
(2) Establish safety standards to be followed by a clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner when personally
furnishing to patients complete or
partial supplies of antibiotics,
antifungals, scabicides,
contraceptives, prenatal vitamins, antihypertensives, drugs and
devices used in the treatment of diabetes, drugs and devices used
in the treatment of asthma, and drugs used in the treatment of
dyslipidemia.;
(3) Establish criteria for the components of the standard
care
arrangements described in section
4723.431 of the Revised
Code that apply to a nurse's the
authority to prescribe, including
the components that apply to the authority to prescribe schedule
II controlled substances. The rules shall be
consistent with that
section and include all of the following:
(a) Quality assurance standards;
(b) Standards for periodic review by a collaborating
physician or podiatrist of the records of patients treated by the
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner;
(c) Acceptable travel time between the location at which the
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner is engaging in the prescribing components of
the nurse's practice and
the
location of
the nurse's collaborating
physician or podiatrist;
(d) Any other criteria recommended by the
committee on
prescriptive governance.
(4) Establish standards and procedures for issuance and
renewal of a
certificate to prescribe, including specification of
any additional
information the board may require under division
(A)(4) of section 4723.482 or division (B)(3) of section
4723.484
of the Revised Code;
(5) Establish requirements standards for board approval of
the
instruction course of study in advanced pharmacology and
related topics required
by
section 4723.482 of the Revised Code;
(6) Establish standards and procedures for the appropriate
conduct of an
externship required by that must be completed to be
eligible for a subsequent certificate to prescribe, as provided in
division (B)(1) of
section
4723.484 of the Revised Code,
including
the following:
(a) Standards and procedures to be used in evaluating a
nurse's an individual's
participation
in an externship. Regardless
of the method of evaluation used, a the clinical nurse specialist,
certified nurse-midwife, or certified nurse practitioner shall
not
be required to participate in an externship longer than one
thousand eight
hundred hours.
(b) Standards and procedures for the supervision that a
physician
must
provide during an externship, including supervision
provided by
working with the nurse participant and
supervision
provided by making timely reviews of the records of
patients
treated by the nurse participant. The manner in which supervision
must be provided
may vary according to the location where the
nurse participant is
practicing and with the nurse's participant's
level of experience.
Section 2. That existing sections 3719.06, 4723.06, 4723.481,
4723.482, 4723.492, and 4723.50 of the Revised Code are hereby
repealed.
Section 3. (A) Notwithstanding the provisions of section
4723.485 of the Revised Code specifying the requirements for
renewal of a certificate to prescribe, or the provisions of
division (B) of
section 4723.484 of the Revised Code specifying
the conditions of
eligibility for a certificate to prescribe
issued after practicing
under an
externship certificate, a
clinical nurse
specialist,
certified nurse-midwife, or
certified nurse
practitioner holding
a certificate to prescribe
that was issued
prior to the
effective date of this act shall
successfully
complete, as a
condition of renewing the
certificate or receiving a new
certificate,
a
minimum of six
contact hours of instruction
regarding schedule II
controlled
substances as described in
section
4723.482 of the Revised
Code, as amended by this act. In
the case of a certificate that
is being renewed, the certificate
holder shall complete the
instruction in
addition to
all other
continuing nursing
education that must be
completed by
the
certificate holder not
later than August 31,
2011.
(B) Notwithstanding the amendments made by this act to
section 3719.06 of the Revised Code, until the applicable
requirements of division (A) of this section have been complied
with, a
certificate holder shall not
prescribe a schedule II
controlled
substance to a patient unless
all of the following
conditions are
met:
(1) The patient is in a terminal condition, as defined in
section 2133.01 of the Revised Code.
(2) The certificate holder's collaborating physician
initially prescribed the substance for the patient.
(3) The amount prescribed does not exceed the amount
necessary for the patient's use in a single, twenty-four-hour
period.
Section 4. Not later than 90 days after the effective date of
this section, the
Committee on Prescriptive Governance shall
develop
recommendations under section 4723.492 of the Revised
Code
regarding the authority to prescribe schedule II controlled
substances pursuant to a certificate to prescribe. The Committee
shall submit the recommendations to the Board of Nursing in
accordance with the procedures specified in section 4723.492 of
the Revised Code.
Section 5. The Board of Nursing shall adopt rules under
section
4723.50 of the Revised Code as necessary to implement the
provisions of this act pertaining to the
authority to prescribe
schedule II controlled substances pursuant
to a certificate to
prescribe. The rules shall conform to the recommendations
submitted by the Committee on Prescriptive Governance.
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