what apns need to know (2).ppt [read-only]

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What APNs Need to Know to Prescribe in Ohio

Erin L. Keels RN MS CNP NNP-BC

Deb Pratt RN MS

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Ohio Law

• Ohio Revised Code (ORC) – All laws in Ohio written by the legislature

– Nurse Practice Act section 4723

• Ex: items required for CTPE application including 45 hours of pharm.

• http://codes.ohio.gov/orc/4723

• Ohio Administrative Code (OAC) – Rules, regulations that further define the laws

– Written by regulatory boards and must be consistent with the law

• Ex: lists specific requirements of the cont. pharm course

• http://codes.ohio.gov/oac/4723-8

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Title Protection and Prescriptive AuthorityOAC 4723-8

Title protection: the state mandates that professional titles are restricted

to those individuals who have achieved specific requirements.

Ohio APNs gained Title protection in 2000.

●Gives legal recognition of the title

● Assures consumers

● Ties to reimbursement- federal and state

Advanced Practice Nurse is the current state protected title

Certified Nurse Practitioner

Certified Nurse Specialist

Certified Registered Nurse Anesthetist

Certified Nurse Midwife

- Will become APRN in 2013

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Certified Nurse Practitioner (CNP) ORC 4723.43

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 – added acute care language with HB 303

� Within the nurse’s nursing specialty, consistent with the nurse’s education and certification, and in accordance with rules adopted by the board.

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Clinical Nurse Specialist (CNS)ORC 4723.43

� 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.

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Certified Registered Nurse Anesthetist (CRNA)ORC 4723.43

� With the supervision and in the immediate presence of a physician, podiatrist, or dentist, may administer anesthesia and perform anesthesia functions

� Is not required to obtain a certificate to prescribe in order to provide the anesthesia care described in the ORC.

� When supervised by a podiatrist, the CRNA’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.

� May not administer general anesthesia under the supervision of a podiatrist in a podiatrist’s office.

� When supervised by a dentist, 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.

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Certified Nurse Midwife (CNM)ORC 4723.43

A nurse authorized to practice as a certified nurse-midwife:

• in collaboration with one or more physicians

• 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.

• 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.

• May perform episiotomies or normal vaginal deliveries, or repair 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

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Ohio Board of Nursing

� Primary function is to protect Ohio’s health consumers

� Authority to issue, renew, revoke licenses to LPN, RN, APN

� Test (or accepts specific national certification tests) to assure competence

� Sets criteria for licensure (and revocation) per the Ohio Revised Code and Ohio Administrative Code

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Ohio Board of Nursing and APN Prescribing

� Adopt rules as necessary to implement the provisions pertaining to the authority of clinical APNs to prescribe drugs and therapeutic devices and the issuance and renewal of certificates to prescribe.

� Consistent with the recommendations the board receives from the Committee on Prescriptive Governance (CPG).

� The Board shall not adopt any rule that does not conform to a recommendation made by the CPG.

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Established a formulary (based upon Drug Facts and Comparisons) 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.

● Established safety standards to be followed by a nurse when

personally furnishing to patients complete or partial supplies of certain drugs (listed in the OAC)

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Established standards and procedures for issuance and renewal of a certificate to prescribe, including specification of any additional information the board may require

● Established requirements for board approval of the instructionadvanced pharmacology and related topics

● Established standards and procedures for the appropriate conduct of an externship required

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In order to prescribe, you must possess:

� CTP or CTPE

� DEA for controlled substances

� COA

� Master Degree in Nursing

� National Certification

� SCA �Reviewed and signed by all collaborating physicians

�Annual quality monitors

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Prescriptive Authority in Ohio

• Certificate to Prescribe Externship (CTPE)

• Certificate to Prescribe (CTP)

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CTPEOAC 4723-9

� “Externship” means the practice relationship, consistent with the standard care arrangement, between a nurse who holds a current, valid externship certificate to prescribe and one or more licensed physicians.ORC4723.485

� During the externship, the nurse’s prescribing activities are reviewed and evaluated by a supervising professional for the purpose of ongoing improvement of the nurse’s competence, knowledge, and skill in pharmacokinetic principles and the application of these principles to the nurse’s area of practice.

� The standard care arrangement entered into between the collaborating physician and the nurse shall specify the frequency of the review needed for appropriate oversight

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Requirements for CTPEORC 4723.48, OAC 4723-9

� Documentation of successful completion of at least 45 contact hours in advanced pharmacology� A copy of a university/college transcript; AND/OR A copy of the certificate(s)

from an approved continuing education course(s).

� The advanced pharmacology course must be completed within 3 years immediately preceding application for a CTP-E.

� Hope that this will change to 5 years

� Current, valid Ohio RN and COA

� Documentation of both a graduate degree and appropriate national certification in order to obtain a COA.

� Valid SCA with one or more collaborating physicians

� Application and Fees ☺

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CTPE

� 1500 hours total supervision (maximum 1800 hours) during whichthe nurse’s prescribing practices are supervised as follows:

� Direct Supervision (Minimum of 500 Hours): The supervising professional is available on site. � At the discretion of the collaborating physician, a prescribing nurse may provide

up to 200 hours of direct supervision, provided the nurse is a current prescribing COA holder with a CTP (NOT a CTP-E).

� Indirect Supervision: The timely review by a physician of prescriptions written by and prescribing practices of a nurse holding an externship certificate to prescribe.

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Certificate to Prescribe

� CTP- issued once externship is completed and appropriate application is submitted.

� Valid for 2 years

� Requires additional 12 hour of continuing pharmacology education

to renew Q 2 years.

� Must include your CTP or CTPE number on all (outpatient)

prescriptions

OAC 4723-9

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Educational RequirementsOAC 4723-9

� The content of the instruction must be specific to the applicant’s nursing specialty and include all of the following:

� A minimum of 45 contact hours (36 from any one provider) of training 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

� Training in the fiscal and ethical implications of prescribing drugs and therapeutic devices

� Training in the state and federal laws that apply to the authority to prescribe

� Effective June 2012, 6 hours of content must be related to schedule II content.

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National CertificationORC 4723.46; OAC 4723-8

� OBN-approved National Certification for 2013• American Academy of Nurse Practitioners Certification Program

• American Association of Critical-Care Nurses Certification Corporation

• American Midwifery Certification Board– Formerly the American College of Nurse-Midwives.

• American Nurses Credentialing Center

• National Board for Certification of Hospice and Palliative Nurses

• National Board of Certification and Recertification for Nurse Anesthetists

• The Council on Certification of Nurse Anesthetists

• The Council on Recertification of Nurse Anesthetists– Prior to September 2007, the Councils were under the American Association of Nurse Anesthetists.

• National Certification Corporation

• Oncology Nursing Certification Corporation

• Pediatric Nursing Certification Board– Formerly the National Board of Pediatric Nurse Practitioners and Associates.

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Certificate of Authority

OAC 4723-8 of Authority� License to practice as an APN in the State of Ohio

� Master of Science in Nursing from approved program

� National Certification (see previous slide)

� Application and Fees ☺

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Standard Care ArrangementORC 4723.431; OAC 4723-8

� Formal, written document of the collaborative relationship between the APN and physician/s

� CNP, CNM, CNS must have SCA� Psych CNS only need SCA if they are prescribing

� CRNAs work under the supervision of the anesthesiologist and do not need a SCA

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Standard Care Arrangement� Collaboration= The Physician –APN Relationship

� The APN can practice “independently” within his/her scope and consults or collaborates with the physician as needed

� The SCA can further limit this scope- must be stated

� Each physician or podiatrist must be actively engaged in direct clinical practice in this state and practicing in a specialty that is the same as or similar to the nurse’s nursing specialty

� Must be reviewed and signed annually

� Must ALWAYS be current

� Must be kept at the site of employment

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Standard Care Arrangement

� General scope of practice of the APN

� Criteria for referral of a patient by the APN to a collaborating physician or podiatrist (references)

� Process of introducing new technology, devices, treatments

� A process for the APN to obtain a consultation with a collaborating physician or podiatrist

� A plan for coverage in instances of emergency or planned absences of either the APN or a collaborating physician or podiatrist that provides the means whereby a physician or podiatrist is available for emergency care

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The process for resolution of disagreements regarding matters of patient management between the APN and a collaborating physician or podiatrist

Preceptorship arrangements- notify collaborating physician at NCH

A procedure for a regular review of the referrals by the APN to other health care professionals and the care outcomes for a random sample of all patients seen by the nurse

If the APN regularly provides services to infants, a policy for care of infants up to age one and recommendations for collaborating physician visits for children from birth to age three

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� Quality assurance standards� Annual review of the SCA� Chart reviews (2 per year)� Prescribing practice reviews (10 prescriptions Q6 months)� Documentation of participation in an ongoing, systematic quality

assurance process at an institution� Schedule II additions

� Acceptable travel time between the location at which the nurse is engaging in the prescribing components of the nurse’s practice and the location of the nurse’s collaborating physician or podiatrist

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Prescribing privileges must be addressed in the SCA:

� Qualification of prescribing APN

� Timely evaluation by physician

� PI/PC drugs

� Use of off-label drugs

� Any additional parameters, limitations, and exclusions for

prescribing

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Out of State PrescribersOAC 4723-9

� SB 89 (enacted in 2010) Decreases or eliminates externship hours for practicing APNs outside of Ohio:

1. Actively practicing in the last 3 years, actively prescribing in last 1 year AND prescribing controlled substances.

Need: Documentation from collaborating physician, Complete 2 hour course on Ohio prescribing laws and rules

2. Actively practicing in the last 3 years, actively prescribing in last 1 year; NOTprescribing controlled substances.

Need: Documentation from collaborating physician; Complete 2 hour course on Ohio prescribing laws and rules; Complete 500 hours of externship

HB303- eliminated collaborating physician documentation for APNs coming to Ohio from an INDEPENDENT PRACTICE state.

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PrescribingOAC 4723-9

“Ordering” situations that DO NOT require prescriptive authority -each must be within the individual COA holder's appropriate patient population /scope:

� 1) Lab tests

� 2) Diagnostic x-rays

� 3) Over-the-counter (OTC) medications (not listed on formulary)� MSO bylaws may restrict to CTP holders

� 4) Diagnostic aids

� 5) Durable medical equipment: address in SCA

� 6) Blood products (other than plasma expanders)

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Prescribing

Prescriptive authority (holding a CTP/CTP-E) is required to order:

� 1) Medications approved by the FDA and governed by the

State Board of Pharmacy law and rules

� Must be listed in OBN Formulary and NCH Formulary

� 2) Oxygen is considered a medication

� 3) Plasma expanders are considered medications

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Prescribing

-Must be consistent with your certification, scope of authority, SCA and area of practice

-Except as provided, all drugs/therapeutic devices shall be prescribed in accordance with the manufacturer’s package insert, the United States Pharmacopoeia (USP), and Standard Care Arrangement. If not, it is considered off- label

-3:1 ratio of prescribing APN to Physician:

for the purposes of prescribing, a physician may not collaborate with more than 3 prescribing APNs at the same time. Does not limit employment numbers or regular APN practice. Physician accountability.

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Prescribing

-As a prescriber, you are responsible for safety alerts and recalls that occur.

-Appropriate follow-up with patients may include, among other actions, relaying information to your patients based on safety or recall information; discontinuing medication, and/or instituting new medication(s).

-Timely information including recalls, warnings, safety alerts and patient information is available on the FDA website at: http://www.fda.gov/oc/oha/default.htm

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Committee on Prescriptive Governance (CPG)

ORC 4723.49

Created in 2000, after passage of title recognition and prescriptive authority

The committee on prescriptive governance shall develop recommendations regarding the authority to prescribe drugs and therapeutic devicespursuant to a certificate to prescribe

● Committee Membership: � A clinical nurse specialist

� A certified nurse-midwife

� A certified nurse practitioner

� A member of the board of nursing who at a minimum as a registered nurse

� Four physicians

� A pharmacist member of the state board of pharmacy

� A pharmacist actively engaged in practice in this state as a clinical pharmacist

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CPGORC 4723.49-4723.491

-1 chairperson (Erin Keels for 2011-2013 ☺)

-Five members constitute a quorum for the transaction of official business.

-The clinical pharmacist member may participate in any meeting of the committee. Can only vote when the committee is considering one of the following:

� The composition of the formulary of drugs and therapeutic devices that may be prescribed by a CTP/E holder

� The manner in which a nurse may personally furnish to patients drugs and therapeutic devices packaged as samples and may personally furnish partial or complete supplies of other drugs and therapeutic devices;

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FormularyOAC 4723-9

OBN chose Drug Facts and Comparisons as the template for the Formulary as a method to categorize drugs

NUTRIENTS &NUTRITIONAL AGENTS HEMATOLOGICAL AGENTS

ENDOCRINE & METABOLIC AGENTS CARDIOVASCULAR AGENTS

RENAL &GENITOURINARY AGENTS RESPIRATORY AGENTS

CENTRAL NERVOUS SYSTEM AGENTS GASTROINTESTINAL AGENTS

ANTI-INFECTIVES, SYSTEMIC BIOLOGIC/IMMUNOLOGIC AGENTS

DERMATOLOGIC AGENTS OPHTHALMIC AGENTS

ANTINEOPLASTIC AGENTS DIAGNOSTIC AIDS

OTHER

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Facts and Comparisonshttp://online.factsandcomparisons.com

Username: Nationwide

Password: Hospital

Must know how the drug is categorized according to Facts and

Comparisons

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BON Formulary• Then you must know how what the prescribing

parameters are for the drug per the Formulary at

the OBN:

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Formulary

http://www.nursing.ohio.gov/PDFS/AdvPractice/Formulary5-10-10.pdf

� Drugs within the categories are deemed:

� Physician Initiated (PI)

� Physician Consult (PC)

� CTP MAY prescribe (CTP may)

� CTP MAY NOT prescribe/Nonformulary (CTP may not)

� OTC not specifically listed in Formulary (CTP may)

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Physician InitiatedOAC 4723-9

� Physician Initiated (PI): collaborating physician is required to have personally examined and evaluated the patient before therapy is initiated.

� Following discussion with the collaborating physician, the initial order or prescription may be written by an APN holding a certificate to prescribe.

� Once therapy has been initiated, the APN may continue, modify, or discontinue the medication without further consultation.

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Physician ConsultOAC 4723-9

� Physician Consultation (PC): a nurse holding a current, valid certificate to prescribe may initiate the medication after direct communication with the collaborating physician regarding a particular patient and documenting the consultation in the patient record.

� Once the medication is initially authorized by the collaborating physician, an APN holding a current valid certificate to prescribe may continue, modify, or discontinue the medication.

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PI/PC� Effective July, 2009, the drugs/categories listed as PI

or PC in the Formulary were combined into

PI- OR -PC (PI/PC)

� must be referenced in the SCA with the collaborating

physician in order for a CTP holder to prescribe

NCH combined all PI-PC drugs into the PC category- this is stated in the NCH SCA

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Other ParametersOAC 4723-9

� Non-Formulary and CTP Holder may NOT Prescribe:

Medications in this category may not be prescribed by any

CTP/CTP-E holder for any indication.

Ex: Many of the Heme drugs, anabolic steroids, investigational drugs

� Over-the-counter medications need not appear on the

formulary. A COA (Certificate of Authority) holder may

recommend/order OTC medications without holding a

Certificate to Prescribe (CTP/CTP-E).

Ex: Desitin, Acetaminophen

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Other Parameters

� Off-Label Use: A medication may be prescribed for purposes other than FDA indications when the purpose is supported by current peer review literature (to be produced by the CTP/CTP-E holder upon request, which emanates from a recognized body of knowledge and as provided in the standard care arrangement consistent with the formulary.Ex: 99% of the Neonatal drugs

●Combination Medication Preparations: In order to prescribe a combination drug, EACH of the component drugs must be "CTP holder may prescribe" in order for the APN prescriber to order the combination medication.Ex: Pentacel- each vaccine component is CTP may prescribe; many combination antibiotics

• For controlled medications, default to the DEA schedule

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Drugs with Review Requirement:

Removed in 2012 ☺

No longer have to review at 30, 60, 90 days

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Formulary Cont.

� A CTP/CTP-E holder may prescribe a drug within their scope of practice in any form unless a drug, category of drugs, or route of administration is listed as an exclusion, or there are additional parameters specified.

� Footnote 1: � The intravenous (IV) form of particular drugs and/or drug categories

identified with an asterisk (*) in the "Additional Parameters" column may ONLY be initiated by a prescriber holding advanced specialty certification as an Acute Care Nurse Practitioner, Acute Care Clinical Nurse Specialist, or Neonatal Nurse Practitioner.

� OR Non-acute Care CTP holders in an institutional setting WITH PHYSICIAN CONSULT per institution protocol for monitored patient care units and as stated in the standard care arrangement.

EX: IV electrolytes; IV inotropes and vasopressors- CTP may prescribe for the acute care APNs, with PC for non-acute care APNs with protocol and monitored patients.

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Formulary Cont.

� Verification of a Prescriber: You can verify whether a

particular APN holds current prescriptive authority by accessing

the Board’s website: http://www.nursing.ohio.gov and click on

Verification.

� A new formulation or route of administration of a drug used

for the same indication does not change the Formulary status

of that drug.

� If a drug has a new indication, it must be reviewed by the CPG

for Formulary status determination. You may not prescribe until

it is reviewed.

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New Drugs or Drug Formulations

Any drug(s) approved by the FDA subsequent to the effective

date of the current Formulary revision shall be considered NON-

FORMULARY:CTP Holder may NOT prescribe until reviewed by

the Committee on Prescriptive Governance (CPG).

The most current version of the Formulary is available on the Board of Nursing website:

www.nursing.ohio.gov in the “Nursing Practice” section.

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Requests to CPG for Formulary Revision/Addition

Use downloadable form Request for FormularReview/Revisionavailable on the Board’s website and MAIL them in

http://www.nursing.ohio.gov/Practice.htm#AdvancedPractice

To be considered, a written recommendation must be received at the Board no later than close of business 30 days prior to the scheduled CPG meeting

Requests should include the information requested on the Request for Formulary Review/Revision Form, including specific drug names (generic and trade names), and rationale for request

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Sample and Stock DrugsOAC 4723-9

� Sample Drugs: May provide samples of drugs that the

APN may prescribe. Samples must be provided without charge,

cannot exceed 72 hour supply, cannot be controlled substances

Must document:

� The name of the prescribing nurse

� The name of the patient

� Directions for use of the drug or therapeutic device

� The nurse shall maintain a written record of all drugs and

devices personally furnished by the nurse

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Dispensing Stock DrugsOAC 4723-9

� approved specific categories:� 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

� drugs used in the treatment of dyslipidemia

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Ohio APN Schedule II Prescribing

• SB 83, introduced by Senator Scott Oelslager

on February 16, 2011

• signed by Governor Kasich on March 9, 2012

• Became effective on June 8, 2012.

– Established sites where APNs can prescribe schedule IIIs

– Mandates 6 hours of schedule II advanced pharmacology

– Revisions to SCA

– Quality Monitors

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Schedule II PrescribingOpioids for treatment of drug addiction:No CTP holder may prescribe an opioid for the treatment of drug addiction.

Federal law requires that opioids for the treatment of drug addiction be prescribed by physicians only.

NOTE restrictions in the law regarding ANY/ALL

Schedule II drugs:Schedule II drugs may only be prescribed ONLY IF:

• 1) The particular drug appears on this formulary as Physician Initiated; AND

• 2) The patient to receive the drug is a patient with a terminal condition (as defined in

ORC 2133.01); AND

• 3) The collaborating physician initially prescribes the drug; AND

• 4) The amount subsequently prescribed by the CTP holder is not greater than a 24 hr supply.

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The restrictions on prescribing Schedule II drugs do not apply if a CTP holder issues the prescription to the patient from any of the

following locations (ORC 4723.481):

1) A hospital registered under Section 3701.07 of the ORC

2) A entity owned or controlled, in whole or in part, by a hospital or by an entity that

owns or controls, in whole or in part, one or more hospitals

3) A health care facility operated by the department of mental health or the department of developmental disabilities

4 ) A nursing home licensed under Section 3721.02 ORC or by a political subdivision

certified under section 3721.09 of the ORC

5) A county home or district home operated under Chapter 5155. of the ORC that is

certified under the Medicare or Medicaid program

6) A hospice care program, as defined in Section 3712.01of the ORC

7) A community mental health facility, as defined in Section 5122.01 of the ORC

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8) An ambulatory surgical facility, as defined in Section 3702.30 of the ORC

9) A freestanding birthing center, as defined in Section 3702.51 of the ORC

10) A federally qualified health center, as defined in Section 3701.047 of the ORC

11) A federally qualified health center look-alike, as defined in Section 3701.047

ORC

12) A health care office or facility 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 ORC

13) A site where a medical practice is operated, but only if the practice is comprised of one or more physicians who also are owners of the practice; the

practice is organized to provide direct patient care; and the clinical nurse specialist;

certified nurse-midwife; or certified nurse practitioner providing services at the site has

a standard care arrangement and collaborates with at least one of the physicians

owners who practices primarily at that site.

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Convenience Care Clinics

A clinical nurse specialist, certified nurse-midwife,

or certified nurse practitioner shall not issue to a

patient a prescription for a schedule II controlled

substance from a convenience care clinic even if

the clinic is owned or operated by an entity

specified in Section 4723.481(C)(2) ORC.

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6 hours of schedule II pharmacologyhttp://www.nursing.ohio.gov/Practice.htm#AdvancedPractice

• As directed by SB 83, the Board adopted rules pertaining to schedule II controlled substances, including prescribing and CE requirements for CTP holders.

• New Rule 4723-9-13, OAC, addresses the CE requirements and when you renew your CTP, you will be required to verify completion of the continuing education course.

The amended rules in Chapters 4723-8 and 4723-9 became effective on November 5, 2012 to provide ample time for CTP holders to complete the required six hours of continuing education before the renewal cycle ends on August 31, 2013.

• To review the rules, go to the front page of the web site and click on “Law and Rules”.

FAQs answering questions about the new prescribing law and CE requirements are located at the link below. If you have additional questions, please contact the Board at [email protected].

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Content must include: OAC 4723-9

Indications and contraindications

Periodic assessment and documentation of the patient’s functional status

The most recent guidelines and recommendations for pain management therapies, as

established by state and national organizations

Fiscal and ethical implications of prescribing schedule II controlled substances

REM

State and federal laws that apply to the authority to prescribe schedule II controlled

substances

State medical board of Ohio rules governing controlled substances and the treatment

of chronic pain

Ohio state board of pharmacy rules governing the manner of issuance of a

prescription

Prevention of abuse and diversion, types of assistance available for prevention of

abuse, addiction and diversion

The use of the Ohio Automated Rx Reporting System (OARRS), and other methods

of establishing safeguards against abuse and diversion

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HB 303 Board of Nursing Bill that “cleaned up” language and

made ensured that items are current.

Major changes:

a. Emergency rules take place immediately= online education

b. 90 day effective dates:

Included acute care in the scope of practice for CNPs

APNs may prescribe IV dialysis additives (was restricted to

physicians only)

Out of state prescribers from independent practice states

Change state title to APRN

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For future renewal periods, will the six-hour course in schedule II controlled substances be

required?

No.

However, you will need to obtain at least 12 hours in

advanced pharmacology, of which includes at least

some instruction in controlled substances.

There is no minimum hour component to the controlled

substances instruction.

OAC 4723-9-07

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Do I need to mail in a copy of my certificate documenting completion of the six hour course in schedule IIs with my CTP renewal application?

No.

You will be required to attest that you completed the six-

hour course, and the Board will conduct a random audit

to verify completion, so retain your certificate of

completion as evidence in the event you are audited.

You are required to keep this proof for a period of six

years. OAC 4723-14-06

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Preparing for Schedule II1. Successfully complete NCH self study

2. Change DEA to include Schedule II and IIN

3. Update SCA (final end of Oct):

– Provisions for the use of schedule IIs

• Pain management

• ADD, ADHD

• Seizures

– Use and documentation of OARRS

• Include in quality monitors

– Quality assurance monitors

• Include representative sample of Schedule IIs in biannual med audit

4. Complete Ohio mandated schedule II pharmacology education

by Aug 31, 2013

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SCA Revisions

SCA must address provisions for use of Schedule IIs OAC 4723-8

SCA must address use and documentation of OARRS OAC 4723-9

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Quality Monitor Additions

• Bi-annual prescribing audits must include representative sample of schedule IIs prescribed OAC 4723-8

• Audit for compliance with OARRS OAC 4723-9

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OARRSOAC 4723-9

1. Register with OARRS: https://www.ohiopmp.gov/Portal/Registration/Default.aspx

2. MUST Consult OARRS including:

(1) If a patient is exhibiting signs of drug abuse or diversion

(2) When you have a reason to believe the treatment of a patient with controlled substances or tramadol will continue for twelve weeks or more

(3) At least once a year thereafter for patients receiving treatment with controlled substances or tramadol for twelve weeks or more

http://www.med.ohio.gov/pdf/NEWS

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OARRSOAC 4723-9

3. Must document in the patient’s record when OARRS

is consulted and if any consultation with collaborating

physician occurred

4. Must audit for compliance

5. Currently working with NCH IS to develop mechanism

for ensuring compliance

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DEAOAC 4723-9

• Update your DEA to include Schedule II and IIN

• Must be done prior to prescribing schedule IIs

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Schedule II DrugsSee: http://www.justice.gov/dea/pubs/scheduling.html

for entire list.

Alfentanil

Amphetamine

Cocaine

Codeine

Fentanyl

Hydrocodone

Hydromorphone

Meperidine

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Prescribing BasicsOAC 4723-9

� Never prescribe with a lapsed CTP or CTPE

� Never practice on a lapsed national certification

� Never practice on a lapsed COA or RN license

� You are NOT considered to be current until the VERIFICATION site at the Ohio Board of Nursing has been updated to reflect the new expiration dates of your CTP, Certification, COA

� Always prescribe within your certification (acute vs. non acute), specialty, scope of practice and practice setting

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Prescribing Basics

� A nurse who holds a current valid certificate to prescribe shall prescribe in a valid prescriber-patient relationship. This includes, but is not limited to:� Obtaining a thorough history of the patient

� Conducting a physical examination of the patient

� Rendering a diagnosis

� Prescribing medication, ruling out the existence of any recognized contraindications

� Consulting with the collaborating physician when necessary; and

� Properly documenting these steps in the patient’s medical records.

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Prescribing Basics FAQshttp://www.nursing.ohio.gov/Practice.htm#AdvancedPractice

� Can a CTP holder prescribe for him/herself? � No. A CTP holder may only prescribe in a valid prescriber-patient relationship.

� Can a Medical Assistant administer a medication as ordered by a CTP holder? � A nurse may delegate the administration of ONLY the following

medications to unlicensed personnel including medical assistants: � Over-the counter medications

� topical medications to be applied to intact skin for the purpose of

� improving a skin condition or providing a barrier; and over-the-counter eye drop,

� ear drop, and suppository medications, foot soak treatments, and enemas

� CURRENTLY- NOT IMMUNIZATIONS

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Prescribing Basics

� Prescribing for family members: OAC 4723-9

� In 2010, CPG recommended that APNs MAY

prescribe for family members, just as physicians

may

� Recognized that there are some situations where a

family member may be a patient

� Recommended serious caution

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Medical Staff By Laws

� Approved by the Medical Staff Committee

� Directs the activities of the Medical and Allied Health

Staff

� Addresses medication ordering

� Can further limit the scope of the APNs’ practice

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NCH MSO By Laws

� Prescribing template:

� All medications orders shall include:

� patient name,

� age and medication,

� route of administration,

� dosage,

� frequency

� date and time when recorded.

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NCH MSO By Laws

Exception: vaccines, aerosols, and other medications where a

standard dose and route of administration are implied by

standard practice or by accepted protocol

When appropriate, the duration of the course of therapy should be

included

Indication of the dosage calculation, when based upon either a

weight, surface area, or age protocol is required (e.g., mg/kg)

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NCH MSO By Laws

Verbal Orders

� limited to situations in which recorded orders are impractical

� when the patient’s condition requires urgent intervention and

it is impractical for the ordering physician to come to the

patient care area in time to address the patient’s care need

� during the acute management of a life threatening

emergency such that the benefits outweigh the risks of a

verbally communicated order

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NCH MSO By Laws

• Verbal orders for DEA Schedule II Narcotics can only be for a single stat dose. unless given to an Advance Practice

Nurse by their collaborating attending practitioner or to a

pharmacist. Advance Practice Nurses and pharmacists may

take verbal orders for DEA Schedule II Narcotics either prn or

scheduled for a time frame up to 72 hours.

• Narcotic drugs will not be given for more than seventy-two

(72) hours and must be reordered.

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Questions??

what apns need to know (2).ppt [read-only]

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