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H. B. No. 485 As IntroducedAs Introduced
129th General Assembly | Regular Session | 2011-2012 |
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A BILL
To amend sections 4723.43, 4723.44, 4729.01, and
4761.17 of the Revised Code to authorize certified
registered nurse anesthetists to issue medication
orders for the administration of drugs to patients
during certain phases of patient care and to
specify the circumstances in which such nurses may
perform clinical support functions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 4723.43, 4723.44, 4729.01, and
4761.17 of the Revised Code be amended to read as follows:
Sec. 4723.43. A certified registered nurse anesthetist,
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner may provide to individuals and groups nursing
care that requires knowledge and skill obtained from advanced
formal education and clinical experience. In this capacity as an
advanced practice nurse, a certified nurse-midwife is subject to
division (A) of this section, a certified registered nurse
anesthetist is subject to division (B) of this section, a
certified nurse practitioner is subject to division (C) of this
section, and a clinical nurse specialist is subject to division
(D) of this section.
(A) A nurse authorized to practice as a certified
nurse-midwife, in collaboration with one or more physicians, may
provide the management of preventive services and those primary
care services necessary to provide health care to women
antepartally, intrapartally, postpartally, and gynecologically,
consistent with the nurse's education and certification, and in
accordance with rules adopted by the board of nursing.
No certified nurse-midwife may perform version, deliver
breech or face presentation, use forceps, do any obstetric
operation, or treat any other abnormal condition, except in
emergencies. Division (A) of this section does not prohibit a
certified nurse-midwife from performing episiotomies or normal
vaginal deliveries, or repairing vaginal tears. A certified
nurse-midwife who holds a certificate to prescribe issued under
section 4723.48 of the Revised Code may, in collaboration with one
or more physicians, prescribe drugs and therapeutic devices in
accordance with section 4723.481 of the Revised Code.
(B)(1) A nurse authorized to practice as a certified
registered nurse anesthetist, with the supervision and in the
immediate presence of a physician, podiatrist, or dentist who is
actively engaged in practice in this state,
consistent with the
nurse's education and certification, and in accordance with rules
adopted by the board, may administer
do all of the following:
(a) While in the immediate presence of a physician,
podiatrist, or dentist, administer anesthesia and perform
anesthesia induction, maintenance, and emergence, and may perform
with supervision;
(b) Perform preanesthetic preparation and evaluation, and
postanesthesia care, and clinical support functions, consistent
with the nurse's education and certification, and in accordance
with rules adopted by the board.;
(c) Only in a facility in which the nurse engages in the
activities described in division (B)(1)(a) or (b) of this section,
perform clinical support functions using the same skills and
competencies the nurse uses to engage in the activities described
in division (B)(1)(a) or (b) of this section;
(d) Only during the phases of patient care directly related
to the activities described in divisions (B)(1)(a) to (c) of this
section and subject to divisions (B)(2), (4), and (5) of this
section, issue a written, oral, or electronic medication order
under which the certified registered nurse anesthetist directs any
of the following to administer a drug to a patient:
(i) An individual who is licensed under this chapter as a
registered nurse or a licensed practical nurse and is acting
within the scope of that individual's practice;
(ii) An individual who is licensed under Chapter 4761. of the
Revised Code as a respiratory therapist and is acting within the
scope of that individual's practice;
(iii) Any other individual who is licensed or otherwise
specifically authorized by the Revised Code to administer drugs
and is acting within the scope of that individual's practice.
(2) When, during the performance of a clinical support
function, a certified registered nurse anesthetist issues a
medication order directing an individual to administer a drug to a
patient receiving clinical support, the individual shall
administer the drug in the immediate presence of that certified
registered nurse anesthetist.
(3) A certified registered nurse anesthetist is not required
to obtain a certificate to prescribe in order to provide the
anesthesia care
described in this division or issue a medication
order.
The physician, podiatrist, or dentist supervising a certified
registered nurse anesthetist must be actively engaged in practice
in this state.
(4) When a certified registered nurse anesthetist is
supervised by a podiatrist, the all of the following conditions
apply:
(a) The nurse's scope of practice is limited to the
anesthesia procedures that the podiatrist has the authority under
section 4731.51 of the Revised Code to perform. A certified
registered nurse anesthetist may
(b) The nurse shall not administer general anesthesia under
the podiatrist's supervision of a podiatrist in a
the podiatrist's
office. When
(c) The nurse's authority to issue a medication order shall
not exceed the podiatrist's authority to issue such orders.
(5) When a certified registered nurse anesthetist is
supervised by a dentist, the all of the following conditions
apply:
(a) The nurse's scope of practice is limited to the
anesthesia procedures that the dentist has the authority under
Chapter 4715. of the Revised Code to perform.
(b) The nurse's authority to issue a medication order shall
not exceed the dentist's authority to issue such orders.
(c) The nurse shall not issue a medication order for
treatment of a patient in a dental office.
(C) A nurse authorized to practice as a certified nurse
practitioner, in collaboration with one or more physicians or
podiatrists, may provide preventive and primary care services and
evaluate and promote patient wellness within the nurse's nursing
specialty, consistent with the nurse's education and
certification, and in accordance with rules adopted by the board.
A certified nurse practitioner who holds a certificate to
prescribe issued under section 4723.48 of the Revised Code may, in
collaboration with one or more physicians or podiatrists,
prescribe drugs and therapeutic devices in accordance with section
4723.481 of the Revised Code.
When a certified nurse practitioner is collaborating with a
podiatrist, the nurse's scope of practice is limited to the
procedures that the podiatrist has the authority under section
4731.51 of the Revised Code to perform.
(D) A nurse authorized to practice as a clinical nurse
specialist, in collaboration with one or more physicians or
podiatrists, may provide and manage the care of individuals and
groups with complex health problems and provide health care
services that promote, improve, and manage health care within the
nurse's nursing specialty, consistent with the nurse's education
and in accordance with rules adopted by the board. A clinical
nurse specialist who holds a certificate to prescribe issued under
section 4723.48 of the Revised Code may, in collaboration with one
or more physicians or podiatrists, prescribe drugs and therapeutic
devices in accordance with section 4723.481 of the Revised Code.
When a clinical nurse specialist is collaborating with a
podiatrist, the nurse's scope of practice is limited to the
procedures that the podiatrist has the authority under section
4731.51 of the Revised Code to perform.
Sec. 4723.44. (A) No person shall do any of the following
unless the person holds a current, valid certificate of authority
to practice nursing as a certified registered nurse anesthetist,
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner issued by the board of nursing under this
chapter:
(1) Engage in the practice of nursing as a certified
registered nurse anesthetist, clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner for a fee, salary,
or other consideration, or as a volunteer;
(2) Represent the person as being a certified registered
nurse anesthetist, clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner;
(3) Use any title or initials implying that the person is a
certified registered nurse anesthetist, clinical nurse specialist,
certified nurse-midwife, or certified nurse practitioner;
(4) Represent the person as being an advanced practice nurse;
(5) Use any title or initials implying that the person is an
advanced practice nurse.
(B) No person who is not certified by the national council on
certification of nurse anesthetists of the American association of
nurse anesthetists, the national council on recertification of
nurse anesthetists of the American association of nurse
anesthetists, or another national certifying organization approved
by the board under section 4723.46 of the Revised Code shall use
the title "certified registered nurse anesthetist" or the initials
"C.R.N.A.," or any other title or initial implying that the person
has been certified by the council or organization.
(C) No certified registered nurse anesthetist, clinical nurse
specialist, certified nurse-midwife, or certified nurse
practitioner shall do any of the following:
(1) Engage, for a fee, salary, or other consideration, or as
a volunteer, in the practice of a nursing specialty other than the
specialty designated on the nurse's current, valid certificate of
authority issued by the board under this chapter;
(2) Represent the person as being authorized to practice any
nursing specialty other than the specialty designated on the
current, valid certificate of authority;
(3) Use the title "certified registered nurse anesthetist" or
the initials "N.A." or "C.R.N.A.," the title "clinical nurse
specialist" or the initials "C.N.S.," the title "certified
nurse-midwife" or the initials "C.N.M.," the title "certified
nurse practitioner" or the initials "C.N.P.," the title "advanced
practice nurse" or the initials "A.P.N.," or any other title or
initials implying that the nurse is authorized to practice any
nursing specialty other than the specialty designated on the
nurse's current, valid certificate of authority;
(4) Enter into a standard care arrangement with a physician
or podiatrist whose practice is not the same as or similar to the
nurse's nursing specialty;
(5) Prescribe (a) In the case of a clinical nurse specialist,
certified nurse-midwife, or certified nurse practitioner,
prescribe or issue orders for drugs or therapeutic devices unless
the nurse holds a current, valid certificate to prescribe issued
under section 4723.48 of the Revised Code;
(b) In the case of a certified registered nurse anesthetist,
issue medication orders in a manner that does not comply with
division (B) of section 4723.43 of the Revised Code.
(6) Prescribe In the case of a clinical nurse specialist,
certified nurse-midwife, or certified nurse practitioner who holds
a certificate to prescribe issued under section 4723.48 of the
Revised Code, prescribe or issue orders for drugs or therapeutic
devices under a certificate to prescribe in a manner that does not
comply with section 4723.481 of the Revised Code;
(7) Prescribe any drug or device to perform or induce an
abortion, or otherwise Perform perform or induce an abortion.
(D) No person shall knowingly employ a person to engage in
the practice of nursing as a certified registered nurse
anesthetist, clinical nurse specialist, certified nurse-midwife,
or certified nurse practitioner unless the person so employed
holds a current, valid certificate of authority to engage in that
nursing specialty issued by the board under this chapter.
(E) A certificate certified by the executive director of the
board, under the official seal of the board, to the effect that it
appears from the records that no certificate of authority to
practice nursing as a certified registered nurse anesthetist,
clinical nurse specialist, certified nurse-midwife, or certified
nurse practitioner has been issued to any person specified
therein, or that a certificate, if issued, has been revoked or
suspended, shall be received as prima-facie evidence of the record
in any court or before any officer of the state.
Sec. 4729.01. As used in this chapter:
(A) "Pharmacy," except when used in a context that refers to
the practice of pharmacy, means any area, room, rooms, place of
business, department, or portion of any of the foregoing where the
practice of pharmacy is conducted.
(B) "Practice of pharmacy" means providing pharmacist care
requiring specialized knowledge, judgment, and skill derived from
the principles of biological, chemical, behavioral, social,
pharmaceutical, and clinical sciences. As used in this division,
"pharmacist care" includes the following:
(1) Interpreting prescriptions;
(2) Dispensing drugs and drug therapy related devices;
(4) Counseling individuals with regard to their drug therapy,
recommending drug therapy related devices, and assisting in the
selection of drugs and appliances for treatment of common diseases
and injuries and providing instruction in the proper use of the
drugs and appliances;
(5) Performing drug regimen reviews with individuals by
discussing all of the drugs that the individual is taking and
explaining the interactions of the drugs;
(6) Performing drug utilization reviews with licensed health
professionals authorized to prescribe drugs when the pharmacist
determines that an individual with a prescription has a drug
regimen that warrants additional discussion with the prescriber;
(7) Advising an individual and the health care professionals
treating an individual with regard to the individual's drug
therapy;
(8) Acting pursuant to a consult agreement with a physician
authorized under Chapter 4731. of the Revised Code to practice
medicine and surgery or osteopathic medicine and surgery, if an
agreement has been established with the physician;
(9) Engaging in the administration of immunizations to the
extent authorized by section 4729.41 of the Revised Code.
(C) "Compounding" means the preparation, mixing, assembling,
packaging, and labeling of one or more drugs in any of the
following circumstances:
(1) Pursuant to a prescription issued by a licensed health
professional authorized to prescribe drugs;
(2) Pursuant to the modification of a prescription made in
accordance with a consult agreement;
(3) As an incident to research, teaching activities, or
chemical analysis;
(4) In anticipation of orders for drugs pursuant to
prescriptions, based on routine, regularly observed dispensing
patterns;
(5) Pursuant to a request made by a licensed health
professional authorized to prescribe drugs for a drug that is to
be used by the professional for the purpose of direct
administration to patients in the course of the professional's
practice, if all of the following apply:
(a) At the time the request is made, the drug is not
commercially available regardless of the reason that the drug is
not available, including the absence of a manufacturer for the
drug or the lack of a readily available supply of the drug from a
manufacturer.
(b) A limited quantity of the drug is compounded and provided
to the professional.
(c) The drug is compounded and provided to the professional
as an occasional exception to the normal practice of dispensing
drugs pursuant to patient-specific prescriptions.
(D) "Consult agreement" means an agreement to manage an
individual's drug therapy that has been entered into by a
pharmacist and a physician authorized under Chapter 4731. of the
Revised Code to practice medicine and surgery or osteopathic
medicine and surgery.
(1) Any article recognized in the United States pharmacopoeia
and national formulary, or any supplement to them, intended for
use in the diagnosis, cure, mitigation, treatment, or prevention
of disease in humans or animals;
(2) Any other article intended for use in the diagnosis,
cure, mitigation, treatment, or prevention of disease in humans or
animals;
(3) Any article, other than food, intended to affect the
structure or any function of the body of humans or animals;
(4) Any article intended for use as a component of any
article specified in division (E)(1), (2), or (3) of this section;
but does not include devices or their components, parts, or
accessories.
(F) "Dangerous drug" means any of the following:
(1) Any drug to which either of the following applies:
(a) Under the "Federal Food, Drug, and Cosmetic Act," 52
Stat. 1040 (1938), 21 U.S.C.A. 301, as amended, the drug is
required to bear a label containing the legend "Caution: Federal
law prohibits dispensing without prescription" or "Caution:
Federal law restricts this drug to use by or on the order of a
licensed veterinarian" or any similar restrictive statement, or
the drug may be dispensed only upon a prescription;
(b) Under Chapter 3715. or 3719. of the Revised Code, the
drug may be dispensed only upon a prescription.
(2) Any drug that contains a schedule V controlled substance
and that is exempt from Chapter 3719. of the Revised Code or to
which that chapter does not apply;
(3) Any drug intended for administration by injection into
the human body other than through a natural orifice of the human
body.
(G) "Federal drug abuse control laws" has the same meaning as
in section 3719.01 of the Revised Code.
(H) "Prescription" means a written, electronic, or oral order
for drugs or combinations or mixtures of drugs to be used by a
particular individual or for treating a particular animal, issued
by a licensed health professional authorized to prescribe drugs.
(I) "Licensed health professional authorized to prescribe
drugs" or "prescriber" means an individual who is authorized by
law to prescribe drugs or dangerous drugs or drug therapy related
devices in the course of the individual's professional practice,
including only the following:
(1) A dentist licensed under Chapter 4715. of the Revised
Code;
(2) A clinical nurse specialist, certified nurse-midwife, or
certified nurse practitioner who holds a certificate to prescribe
issued under section 4723.48 of the Revised Code;
(3) A certified registered nurse anesthetist, to the extent
that the nurse is authorized by division (B) of section 4723.43 of
the Revised Code to order the administration of a drug to a
patient;
(4) An optometrist licensed under Chapter 4725. of the
Revised Code to practice optometry under a therapeutic
pharmaceutical agents certificate;
(4)(5) A physician authorized under Chapter 4731. of the
Revised Code to practice medicine and surgery, osteopathic
medicine and surgery, or podiatric medicine and surgery;
(5)(6) A physician assistant who holds a certificate to
prescribe issued under Chapter 4730. of the Revised Code;
(6)(7) A veterinarian licensed under Chapter 4741. of the
Revised Code.
(J) "Sale" and "sell" include delivery, transfer, barter,
exchange, or gift, or offer therefor, and each such transaction
made by any person, whether as principal proprietor, agent, or
employee.
(K) "Wholesale sale" and "sale at wholesale" mean any sale in
which the purpose of the purchaser is to resell the article
purchased or received by the purchaser.
(L) "Retail sale" and "sale at retail" mean any sale other
than a wholesale sale or sale at wholesale.
(M) "Retail seller" means any person that sells any dangerous
drug to consumers without assuming control over and responsibility
for its administration. Mere advice or instructions regarding
administration do not constitute control or establish
responsibility.
(N) "Price information" means the price charged for a
prescription for a particular drug product and, in an easily
understandable manner, all of the following:
(1) The proprietary name of the drug product;
(2) The established (generic) name of the drug product;
(3) The strength of the drug product if the product contains
a single active ingredient or if the drug product contains more
than one active ingredient and a relevant strength can be
associated with the product without indicating each active
ingredient. The established name and quantity of each active
ingredient are required if such a relevant strength cannot be so
associated with a drug product containing more than one
ingredient.
(5) The price charged for a specific quantity of the drug
product. The stated price shall include all charges to the
consumer, including, but not limited to, the cost of the drug
product, professional fees, handling fees, if any, and a statement
identifying professional services routinely furnished by the
pharmacy. Any mailing fees and delivery fees may be stated
separately without repetition. The information shall not be false
or misleading.
(O) "Wholesale distributor of dangerous drugs" means a person
engaged in the sale of dangerous drugs at wholesale and includes
any agent or employee of such a person authorized by the person to
engage in the sale of dangerous drugs at wholesale.
(P) "Manufacturer of dangerous drugs" means a person, other
than a pharmacist, who manufactures dangerous drugs and who is
engaged in the sale of those dangerous drugs within this state.
(Q) "Terminal distributor of dangerous drugs" means a person
who is engaged in the sale of dangerous drugs at retail, or any
person, other than a wholesale distributor or a pharmacist, who
has possession, custody, or control of dangerous drugs for any
purpose other than for that person's own use and consumption, and
includes pharmacies, hospitals, nursing homes, and laboratories
and all other persons who procure dangerous drugs for sale or
other distribution by or under the supervision of a pharmacist or
licensed health professional authorized to prescribe drugs.
(R) "Promote to the public" means disseminating a
representation to the public in any manner or by any means, other
than by labeling, for the purpose of inducing, or that is likely
to induce, directly or indirectly, the purchase of a dangerous
drug at retail.
(S) "Person" includes any individual, partnership,
association, limited liability company, or corporation, the state,
any political subdivision of the state, and any district,
department, or agency of the state or its political subdivisions.
(T) "Finished dosage form" has the same meaning as in section
3715.01 of the Revised Code.
(U) "Generically equivalent drug" has the same meaning as in
section 3715.01 of the Revised Code.
(V) "Animal shelter" means a facility operated by a humane
society or any society organized under Chapter 1717. of the
Revised Code or a dog pound operated pursuant to Chapter 955. of
the Revised Code.
(W) "Food" has the same meaning as in section 3715.01 of the
Revised Code.
(X) "Pain management clinic" has the same meaning as in
section 4731.054 of the Revised Code.
Sec. 4761.17. All of the following apply to the practice of
respiratory care by a person who holds a license or limited permit
issued under this chapter:
(A) The person shall practice only pursuant to a
prescription, medication order, or other order for respiratory
care issued by a physician or by a one or more of the following:
(2) A registered nurse who holds a certificate of authority
issued under Chapter 4723. of the Revised Code to practice as a
certified nurse practitioner or clinical nurse specialist and has
entered into a standard care arrangement with a physician that
allows the nurse to prescribe or order respiratory care services;
(3) A certified registered nurse anesthetist when the order
for the administration of drugs is issued in accordance with
division (B) of section 4723.43 of the Revised Code.
(B) The person shall practice only under
one of the following
conditions:
(1) Pursuant to the supervision of a physician or under;
(2) Pursuant to the supervision of a certified nurse
practitioner or clinical nurse specialist who is authorized to
prescribe or order respiratory care services as provided in
division (A)(2) of this section;
(3) Pursuant to the authority of a certified registered nurse
anesthetist who is supervised by a physician in accordance with
division (B) of section 4723.43 of the Revised Code.
(C)(1) When practicing under the prescription or order of a
certified nurse practitioner or clinical nurse specialist or under
pursuant to the supervision of such a nurse, the person's
administration of medication that requires a prescription is
limited to the drugs that the nurse is authorized to prescribe
pursuant to the nurse's certificate to prescribe issued under
section 4723.48 of the Revised Code.
(2) When practicing under a medication order issued by a
certified registered nurse anesthetist or pursuant to the
authority of such a nurse, the person's administration of
medication shall occur only during the phases of patient care
directly related to the nurse's activities described in divisions
(B)(1)(a) to (c) of section 4723.43 of the Revised Code and in
accordance with the nurse's authority to order the administration
of a drug to a patient during those phases.
Section 2. That existing sections 4723.43, 4723.44, 4729.01,
and 4761.17 of the Revised Code are hereby repealed.
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