(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.
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