Prescriptive Authority for Nurse-Midwives in Georgia

1. Prescriptive Authority for Nurse-Midwives in Georgia Georgia Affiliate of the American College of Nurse-Midwives Summer 2014 meeting August 21, 2014

2. APRN Prescriptive Authority • Definition: the ability of advanced practice registered nurses (APRNs) to prescribe, without limitation, legend (prescription) and controlled drugs, devices, adjunct health/medical services, durable medical goods, and other equipment and supplies

3. APRN Campaign for Consensus • Website: https://www.ncsbn.org/4214.htm • Recommendations for what state rules and regulations for APRN practice should look like • Proposed in 2008 for rollout nationwide by 2015 • Goal: eliminate barriers that prevent APRNs from practicing, increased patient access to APRNs. • Developed over several years, with input from 73 organizations. Includes CRNA, CNM, CNM, CNPs.

4. LACE • Key essential elements of APRN Regulation: (LACE) • Licensure • Accreditation • Certification • Education

5. Campaign for Consensus & Rx Authority • Section 5 of APRN Consensus Model: Prescribing, Ordering, Dispensing and Furnishing Authority (essential ingredients in any state’s prescriptive authority regulation, according to the APRN Consensus Model):

6. Section 5 of Consensus Model • The BON shall grant prescribing, ordering, dispensing and furnishing authority through the APRN license (no separate application). B. Prescribing, ordering, dispensing and furnishing shall include the authority to: • 1. Diagnose, prescribe and institute therapy or referrals of patients to health care agencies, health care providers and community resources • 2. Prescribe, procure, administer, dispense and furnish pharmacological agents, including over the counter, legend and controlled substances • 3. Plan and initiate a therapeutic regimen that includes ordering and prescribing non-pharmacological interventions, including, but not limited to, durable medical equipment, medical devices, nutrition, blood and blood products, and diagnostic and supportive services including, but not limited to, home health care, hospice, and physical and occupational therapy.

7. How does GA compare? Consensus Guidelines Georgia APRNs Separate application delegating prescriptive authority, with renewal yearly, requiring separate physician signature • No separate application for Rx authority

8. How does GA compare? Consensus Guidelines Georgia APRNs OTC, legend (within specialty area) and controlled substances (Schedule III-IV only) • Prescribe, procure, administer, dispense and furnish pharmacological agents, including over the counter, legend and controlled substances

9. How does GA compare? Consensus Guidelines Georgia APRNs If delegated by physician • Prescribe durable medical equipment, medical devices, nutrition, blood and blood products, and diagnostic and supportive services including, but not limited to, home health care, hospice, and physical and occupational therapy.

10. Comparison of SE states on Prescriptive Authority

11. Georgia Rx Authority Steps • Nurse protocol agreements between APRN & MD of comparable specialty. • Submit this agreement, signed by MD and APRN, to Medical Board within 30 days. • Receive letter from medical board that they have reviewed your protocol. • If APRN will prescribe controlled substances, get DEA number. (May prescribe Schedule II-V drugs in GA). • Each APRN must have a separate Nurse Protocol Agreement signed by a MED. Other physicians in practice can be named as designated physicians in agreement. (Consulting physician in absence of delegating physician). • Annual renewals and revisions of Nurse Protocol Agreements are necessary for every APRN. Annual updates are stored at practice location, and only submitted to Medical Board if they request.

12. Georgia Rx Authority • Designated physicians must have same scope of practice as delegating physician. • One delegating physician may enter into nurse protocol agreement with up to four APRN at one time. • Delegating physician does not have to work at same physical location as APRN. • Quarterly onsite observation and review of medical records of APRN by delegating MD required. • Formulary is not necessary. However, must list no more than 20 commonly used meds in your practice which may be written. Not limited to these 20 drugs when writing Rx, however. • Must submit your practice guidelines to Medial Board with your application. • Also must list procedures you perform with your application.