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H. B. No. 301 As IntroducedAs Introduced
130th General Assembly | Regular Session | 2013-2014 |
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Representatives Pelanda, Bishoff
Cosponsors:
Representatives Hood, Blessing, Brenner, Antonio, Reece, Fedor
A BILL
To amend sections 4723.48 and 4723.50 and to enact
section 4723.488 of the Revised Code to authorize
a person not otherwise authorized to do so to
administer certain drugs pursuant to delegation by
an advanced practice registered nurse who holds a
certificate to prescribe.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 4723.48 and 4723.50 be amended and
section 4723.488 of the Revised Code be enacted to read as
follows:
Sec. 4723.48. (A) A clinical nurse specialist, certified
nurse-midwife, or certified nurse practitioner seeking authority
to prescribe drugs and therapeutic devices shall file with the
board of nursing a written application for a certificate to
prescribe. The board of nursing shall issue a certificate to
prescribe to each applicant who meets the requirements specified
in section 4723.482 or 4723.485 of the Revised Code.
Except as provided in division (B) of this section, the
initial certificate to prescribe that the board issues to an
applicant shall be issued as an externship certificate. Under an
externship certificate, the nurse may obtain experience in
prescribing drugs and therapeutic devices by participating in an
externship that evaluates the nurse's competence, knowledge, and
skill in pharmacokinetic principles and their clinical application
to the specialty being practiced. During the externship, the nurse
may prescribe drugs and therapeutic devices only when one or more
physicians are providing supervision in accordance with rules
adopted under section 4723.50 of the Revised Code.
After completing the externship, the holder of an externship
certificate may apply for a new certificate to prescribe. On
receipt of the new certificate, the nurse may prescribe drugs and
therapeutic devices in collaboration with one or more physicians
or podiatrists.
(B) In the case of an applicant who meets the requirements of
division (C) of section 4723.482 of the Revised Code, the initial
certificate to prescribe that the board issues to the applicant
under this section shall not be an externship certificate. The
applicant shall be issued a certificate to prescribe that permits
the recipient to prescribe drugs and therapeutic devices in
collaboration with one or more physicians or podiatrists.
(C)(1) The holder of a certificate issued under this section
may delegate to a person not otherwise authorized to administer
drugs the authority to administer a drug, other than a controlled
substance, listed in the formulary established under division
(B)(1) of section 4723.50 of the Revised Code to a specified
patient. The delegation shall be in accordance with division
(C)(2) of this section and standards and procedures established in
rules adopted under division (B)(8) of section 4723.50 of the
Revised Code.
(2) Prior to delegating authority, the certificate holder
shall do both of the following:
(a) Assess the patient and determine that the drug is
appropriate for the patient;
(b) Determine that the person to whom the authority will be
delegated has met the conditions specified in division (D) of
section 4723.488 of the Revised Code.
Sec. 4723.488. A person not otherwise authorized to
administer drugs may administer a drug to a specified patient if
all of the following conditions are met:
(A) The authority to administer the drug is delegated to the
person by an advanced practice registered nurse who is a clinical
nurse specialist, certified nurse-midwife, or certified nurse
practitioner and holds a certificate to prescribe issued under
section 4723.48 of the Revised Code.
(B) The drug is listed in the formulary established under
division (B) of section 4723.50 of the Revised Code but is not a
controlled substance and is not to be administered intravenously.
(C) The drug is to be administered at a location other than a
hospital inpatient care unit, as defined in section 3727.50 of the
Revised Code, a hospital emergency department or a freestanding
emergency department.
(D) The person has successfully completed education based on
a recognized body of knowledge concerning drug administration and
demonstrates to the person's employer the knowledge, skills, and
ability to administer the drug safely.
(E) The person's employer has given the advanced practice
registered nurse access to documentation, in written or electronic
form, showing that the person has met the conditions specified in
division (D) of this section.
(F) The advanced practice registered nurse is physically
present at the location where the drug is administered.
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.
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 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), (C)(5), or (D)(5) of section 4723.482 or division (B)(3)
of section 4723.485 of the Revised Code;
(5) Establish standards for board approval of the course of
study in advanced pharmacology and related topics required by
section 4723.482 of the Revised Code;
(6) Establish requirements for board approval of the two-hour
course of instruction in the laws of this state as required under
division (C)(4) of section 4723.482 of the Revised Code and
division (B)(2) of section 4723.484 of the Revised Code;
(7) Establish standards and procedures for the appropriate
conduct of an externship as described in section 4723.484 of the
Revised Code, including the following:
(a) Standards and procedures to be used in evaluating an
individual's participation in an externship;
(b) Standards and procedures for the supervision that a
physician must provide during an externship, including supervision
provided by working with the participant and supervision provided
by making timely reviews of the records of patients treated by the
participant. The manner in which supervision must be provided may
vary according to the location where the participant is practicing
and with the participant's level of experience.
(8) Establish standards and procedures for delegation under
division (C) of section 4723.48 of the Revised Code of the
authority to administer drugs.
Section 2. That existing sections 4723.48 and 4723.50 of the
Revised Code are hereby repealed.
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