Current through Rules and Regulations filed through March 20, 2024
(1) A
physician entering into a nurse protocol agreement with an APRN pursuant to
Code Section
43-34-25shall include the following general data in the protocol agreement:
(a) Names, addresses, telephone numbers,
license numbers, and DEA registration number for all parties to the nurse
protocol agreement, including any other designated physicians that will be
utilized if the delegating physician is not available;
(b) The delegating physician must provide the
APRN's DEA number to the Board within 30 days of issuance.
(c) Description of practice and number of
locations, including primary and proposed satellite site(s);
(d) Dates of initiation and amendments. Any
amendments made to the protocol agreement shall be filed with the Board for
review within 30 days of execution; and
(e) Information regarding the specialty area
or field of the APRN.
(2) The agreement shall contain a provision
for immediate consultation, as defined in Rule
360-32-.01, between the APRN and the
delegating physician.
(3) If the
delegating physician is not available for consultation, the delegating
physician may designate another physician who concurs with the terms of the
nurse protocol agreement. The designation of another physician must also meet
the following terms:
(a) Such designation by
the delegating physician shall be in writing and attached to the nurse protocol
agreement;
(b) Such designation
must be to a physician whose scope of practice is the same as that of the
delegating physician; and
(c) Such
designation must include the printed name, license number and signature of the
other designated physician with an affirmation from the other designated
physician that he or she has agreed to serve as an, other designated physician,
has reviewed the nurse protocol agreement and concurs with the terms of the
agreement.
(4) The
nurse protocol agreement shall outline and identify the applicable standard of
care and shall be specific to the patient population seen.
(5) The nurse protocol agreement shall
identify the parameters under which the delegated act may be performed by the
APRN, including but not limited to:
(a)
Drugs, devices, medical treatments, diagnostic studies that may be ordered and
implemented by the APRN.
(b)
Circumstances under which a prescription drug order or device may be
executed;
(c) Number of refills
which may be ordered. Nothing in this Rule shall be construed to authorize an
advanced practice registered nurse to issue a prescription drug order for a
Schedule I or II controlled substance or authorize refills of any drug for more
than 12 months from the date of the original order except in the case of oral
contraceptives, hormone replacement therapy, or prenatal vitamins which may be
refilled for a period of 24 months as provided in O.C.G.A.
43-34-25.
(d) Provide that a patient who receives a
prescription drug order for any controlled substance pursuant to a nurse
protocol agreement shall be evaluated or examined by the delegating physician
or other physician designated by the delegating physician as provided in
O.C.G.A.
43-34-25on at least a quarterly basis or at a more frequent interval as consistent with
the minimum acceptable standards of the practice of medicine as determined by
the Board.
(e) Extent to which
medical imaging may be ordered;
(f)
A predetermined plan for emergency services;
(g) If the delegating physician authorizes
the APRN to order an X-ray, ultrasound or medical imaging, the nurse protocol
agreement shall contain provisions whereby such tests shall be read and
interpreted by a physician who is trained in reading and interpretation of such
tests and provide that a copy of such report shall be forwarded to the
delegating physician. However, such provision for an ultrasound shall not be
required for an APRN acting within his or her scope of practice as authorized
by Code Sections
43-26-3 and
43-26-5.
Orders for medical imaging should include the indication for testing as well as
the name, address, and telephone number of the delegating physician;
(h) A section that details specific patient
conditions and circumstances that require direct, on-site evaluation or
consultation by the delegating physician; and
(i) If the protocol agreement delegates to
the APRN to prescribe/order prescription drugs, then a section that
specifically provides that such delegation does not include the to
prescribe/order prescription drugs intended to cause an abortion to occur
pharmacologically.
(j) A physician
may delegate to an advanced practice registered nurse in accordance with a
nurse protocol agreement the authority to pronounce death and to certify such
pronouncement in the same manner as a physician.
(6) The nurse protocol agreement shall
require documentation by the APRN of those acts performed by the APRN that are
specific to the medical acts authorized by the delegating physician and provide
that, if the APRN has prescribing pursuant to the protocol agreement, each
prescription shall be noted in the patient's medical record.
(a) If the protocol agreement delegates to
the APRN to prescribe/order prescription drugs or devices, a copy of the
prescription drug or device order delivered to the patient shall be maintained
in the patient's medical file. For purposes of this paragraph a copy shall mean
a duplicate prescription or a photocopy or electronic equivalent.
(b) If the protocol agreement delegates to
the APRN to prescribe/order prescription drugs or devices, the protocol shall
provide that the prescription/order shall be issued on a form which contains
the following:
1. The name, address and
telephone number of the delegating physician, the name of the APRN, the APRN's
DEA number, if applicable, and the name and address of the patient, the drug or
device prescribed, the number of refills and directions to the patient with
regard to taking and dosage of the drug; and
2. The prescription shall be signed by the
APRN and shall be on a form which shall include the names of the APRN and
delegating physician who are parties to the nurse protocol agreement.
(7)
(a) Unless the physician meets the
requirements of paragraph (b), the nurse protocol agreement shall include a
schedule for periodic review of patient records. The Board has determined that
the minimum accepted standards of medical practice require the following:
1. In as much as O.C.G.A.
43-34-25requires that a delegating physician or other designated physician evaluate or
examine all patients who receive any controlled substance prescription pursuant
to a nurse protocol agreement, a delegating physician or other designated
physician must review and sign 100% of patient records for patients receiving
prescriptions for controlled substances to comply with the law. Such review
shall occur at least quarterly after issuance of the controlled substance
prescription.
2. The delegating
physician or other designated physician review and sign 100% of patient records
in which an adverse outcome has occurred. Such review shall occur no more than
30 days after the discovery of an adverse outcome.
3. The delegating physician or other
designated physician review and sign 10% of all other patient records. Such
review shall occur at least annually.
(b) Pursuant to O.C.G.A. Section
43-34-25(g.1),
a physician at a location that maintains evidence-based clinical practice
guidelines and is accredited by an accrediting body approved by the Board such
as Joint Commission may enter into a nurse protocol agreement with not more
than eight advanced registered nurses at any one time and supervise not more
than four advanced registered nurses. At those locations, such protocol must
include the following:
1. The delegating
physician must document and maintain a record of review of at least 10 percent
of the advanced practice registered nurses' medical records to monitor the
quality of care being provided to patients, which may be conducted
electronically or onsite;
2. The
delegating physician and the advanced practice registered nurse must
participate in and maintain documentation of quarterly clinical collaboration
meetings, either by telephone, in person, or onsite, for the purposes of
monitoring care being provided to patients, and
3. The delegating physician's name, contact
information, and record of the visit must be provided to the patient's primary
care provider of choice with the patient's consent within 24 hours of the
visit.
(8)
The nurse protocol agreement shall indicate whether the APRN is authorized
under the nurse protocol agreement to request, receive, sign for and distribute
professional samples.
(a) If the nurse
protocol agreement provides this, the APRN shall comply with O.C.G.A.
43-34-25which states: An advanced practice registered nurse may be authorized under a
nurse protocol agreement to request, receive, and sign for professional samples
and may distribute professional samples to patients. The office or facility at
which the advanced practice registered nurse is working shall maintain a list
of the professional samples approved by the delegating physician for request,
receipt, and distribution by the advanced practice registered nurse as well as
a complete list of the specific number and dosage of each professional sample
and medication voucher received and dispensed. In addition to the requirements
of this Code section, all professional samples shall be maintained as required
by applicable state and federal laws and regulations.
(9) Copies of the nurse protocol agreement
shall be available at each practice site where the APRN is authorized to
perform the delegated acts and shall be made available upon written request by
the Board to the physician at the appropriate practice site.
(10) The nurse protocol agreement shall be
dated and signed by the delegating physician, other designated physician, if
applicable, and the APRN.
(11) A
nurse protocol agreement between a physician and an advanced practice
registered nurse shall be reviewed, revised, or updated annually by the
delegating physician and the advanced practice registered nurse.
O.C.G.A.
§§
43-26-3;
43-26-5, 43-34-25.
