Current through Reg. 49, No. 38; September 20, 2024
(a) Acts that may
be delegated. One or more physicians licensed by the board shall be authorized
to delegate, to one or more physician assistants or advanced practice
registered nurses acting under adequate physician supervision whose practice is
facility-based at a hospital or licensed long-term care facility, prescribing
or ordering of a drug or device if each of the physicians is: the medical
director or chief of medical staff of the facility in which the physician
assistant or advanced practice registered nurse practices, the chair of the
facility's credentialing committee, a department chair of a facility department
in which the physician assistant or advanced practice registered nurse
practices, or a physician who consents to the request of the medical director
or chief of medical staff to delegate the prescribing or ordering of a drug or
device at the facility in which the physician assistant or advanced practice
registered nurse practices.
(b) The
limitations on the number of advanced practice registered nurses or physician
assistants to whom a physician may delegate under §
193.7(d)
of this title (relating to Prescriptive Authority Agreements Generally) do not
apply to a physician whose practice is facility-based under this chapter,
subject to the limitations in subsection (c)(4) of this section.
(c) Limitations on authority to delegate. A
physician's authority to delegate under this subsection is limited as follows:
(1) the delegation is pursuant to a
physician's order, standing medical order, standing delegation order, or other
order or protocol developed in accordance with policies approved by the
facility's medical staff or a committee thereof as provided in facility
bylaws;
(2) the delegation occurs
in the facility in which the physician is the medical director, the chief of
medical staff, the chair of the credentialing committee, a department chair, or
a physician who consents to delegate under § 157.054(a)(4) of the
Act;
(3) the delegation does not
permit the prescribing or ordering of a drug or device for the care or
treatment of the patients of any other physician without the prior consent of
that physician;
(4) delegation in a
long-term care facility must be by the medical director and the medical
director is limited to delegating the prescribing or ordering of a drug or
device to no more than seven advanced practice registered nurses or physician
assistants or their full-time equivalents; and
(5) under this section, a facility-based
physician may not delegate at more than one hospital or more than two long-term
care facilities pursuant to § 157.054 of the Act; however, facility-based
physicians are not prohibited from delegating the prescribing or ordering or
drugs or devices under § 157.0512 of the Act or §
193.7
and §193.8
of this title (relating to Prescriptive Authority Agreements Generally and
Prescriptive Authority Agreements: Minimum Requirements), at other practice
locations, including hospital or long-term care facilities, provided that the
delegation at those locations complies with all requirements under §
157.0512 of the Act.
(6) Physician
supervision. Physician supervision of the prescribing or ordering of a drug or
device shall conform to what a reasonable, prudent physician would find
consistent with sound medical judgment but may vary with the education and
experience of the advanced practice registered nurse or physician assistant. A
physician shall provide continuous supervision, but the constant physical
presence of the physician is not required.
