What APNs Need to Know to Prescribe in Ohio

(1)

………..………..

What APNs

Need to Know

to Prescribe in

Ohio

Erin L. Keels RN MS CNP NNP-BC

Deb Pratt RN MS

(2)

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

(3)

………..………..

Title Protection and Prescriptive Authority

OAC 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

(4)

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

(5)

………..………..

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

(6)

………..………..

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

(7)

………..………..

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

(8)

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

(9)

………..………..

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

(10)

Ohio Board of Nursing and APN

Prescribing

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)

(11)

………..………..

Ohio Board of Nursing and APN

Prescribing

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 instruction

advanced pharmacology and related topics

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

(12)

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

(13)

………..………..

Prescriptive Authority in Ohio

• Certificate to Prescribe Externship (CTPE)

(14)

CTPE

OAC 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

(15)

………..………..

Requirements for CTPE

ORC 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 ☺

(16)

CTPE

1500 hours total supervision (maximum 1800 hours) during which the 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

(17)

………..………..

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

(18)

Educational Requirements

OAC 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

(19)

………..………..

National Certification

ORC 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

(20)

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)

(21)

………..………..

Standard Care Arrangement

ORC 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

(22)

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

(23)

………..………..

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

(24)

Standard Care Arrangement

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

(25)

………..………..

Standard Care Arrangement

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

(26)

Standard Care Arrangement

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

(27)

………..………..

Out of State Prescribers

OAC 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; NOT prescribing 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.

(28)

Prescribing

OAC 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)

(29)

………..………..

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

(30)

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

(31)

………..………..

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:

(32)

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 devices

pursuant 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

(33)

………..………..

CPG

ORC 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;

(34)

Formulary

OAC 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

(35)

………..………..

Facts and Comparisons

http://online.factsandcomparisons.com

Username: Nationwide Password: Hospital

Must know how the drug is categorized according to Facts and Comparisons

(36)

BON Formulary

• Then you must know how what the prescribing

parameters are for the drug per the Formulary at

the OBN:

(37)

………..………..

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)

(38)

Physician Initiated

OAC 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.

(39)

………..………..

Physician Consult

OAC 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

(40)

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

(41)

………..………..

Other Parameters

OAC 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).

(42)

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

(43)

………..………..

Drugs with Review Requirement:

Removed in 2012

☺

(44)

………..………..

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.

(45)

………..………..

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.

(46)

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:

(47)

………..………..

Requests to CPG for Formulary

Revision/Addition

Use downloadable form

Request for FormularReview/Revision

available 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

(48)

Sample and Stock Drugs

OAC 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

(49)

………..………..

Dispensing Stock Drugs

OAC 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

(50)

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

(51)

………..………..

Schedule II Prescribing

Opioids 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.

(52)

………..………..

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

(53)

………..………..

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

(54)

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

(55)

………..………..

6 hours of schedule II pharmacology

http://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 practice@nursing.ohio.gov.

(56)

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

(57)

………..………..

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

(58)

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.

(59)

………..………..

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

(60)

………..………..

Preparing for Schedule II

1.

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

(61)

………..………..

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

(62)

Quality Monitor Additions

• Bi-annual prescribing audits must include

representative sample of schedule IIs

prescribed

OAC 4723-8

(63)

………..………..

OARRS

OAC 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

(64)

OARRS

OAC 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

(65)

………..………..

DEA

OAC 4723-9

• Update your DEA to include Schedule II

and IIN

• Must be done prior to prescribing schedule

IIs

(66)

………..………..

Schedule II Drugs

See:

http://www.justice.gov/dea/pubs/scheduling.html

for entire list.

Alfentanil

Amphetamine

Cocaine

Codeine

Fentanyl

Hydrocodone

Hydromorphone

Meperidine

(67)

………..………..

Prescribing Basics

OAC 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),

(68)

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

(69)

………..………..

Prescribing Basics FAQs

http://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