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TITLE 22EXAMINING BOARDS
PART 11TEXAS BOARD OF NURSING
CHAPTER 222ADVANCED PRACTICE REGISTERED NURSES WITH PRESCRIPTIVE AUTHORITY
RULE §222.5Prescriptive Authority Agreement

(a) The prescriptive authority agreement is a mechanism by which an APRN is delegated the authority to order or prescribe drugs or devices by a physician.

(b) An APRN with full licensure and a valid prescriptive authorization number and a physician are eligible to enter into or be parties to a prescriptive authority agreement only if the APRN:

  (1) holds an active license to practice in this state that is in good standing. For purposes of this chapter, an APRN is in good standing if the APRN's license and prescriptive authorization number are not encumbered by a disciplinary action;

  (2) is not currently prohibited by the Board from executing a prescriptive authority agreement; and

  (3) before executing the prescriptive authority agreement, the APRN and the physician disclose to the other prospective party to the agreement any prior disciplinary action by the applicable licensing board.

(c) A prescriptive authority agreement must, at a minimum:

  (1) be in writing and signed and dated by the parties to the agreement;

  (2) state the name, address, and all professional license numbers of the parties to the agreement;

  (3) state the nature of the practice, practice locations, or practice settings;

  (4) identify either:

    (A) the types or categories of drugs or devices that may be ordered or prescribed; or

    (B) the types of categories of drugs or devices that may not be ordered or prescribed;

  (5) provide a general plan for addressing consultation and referral;

  (6) provide a plan for addressing patient emergencies;

  (7) state the general process for communication and the sharing of information between the APRN and the physician related to the care and treatment of patients;

  (8) if alternate physician supervision is to be utilized, designate one or more alternate physicians who may:

    (A) provide appropriate supervision on a temporary basis in accordance with the requirements established by the prescriptive authority agreement and the requirements of Chapter 157, Subchapter B, Occupations Code; and

    (B) participate in the prescriptive authority quality assurance and improvement plan meetings required under §157.0512, Occupations Code;

  (9) describe a prescriptive authority quality assurance and improvement plan and specify methods for documenting the implementation of the plan that includes the following:

    (A) chart review, with the number of charts to be reviewed determined by the APRN and physician; and

    (B) periodic face to face meetings between the APRN and the physician at a location agreed upon by both providers.

(d) The periodic face to face meetings described by subsection (c)(9)(B) of this section must:

  (1) include:

    (A) the sharing of information relating to patient treatment and care, needed changes in patient care plans, and issues relating to referrals; and

    (B) discussion of patient care improvement; and

  (2) be documented and occur:

    (A) except as provided by subparagraph (B) of this paragraph:

      (i) at least monthly until the third anniversary of the date the agreement is executed; and

      (ii) at least quarterly after the third anniversary of the date the agreement is executed, with monthly meetings held between the quarterly meetings by means of a remote electronic communications system, including video conferencing technology or the internet; or

    (B) if during the seven years preceding the date the agreement is executed, the APRN for at least five years was in a practice that included the exercise of prescriptive authority with required physician supervision:

      (i) at least monthly until the first anniversary of the date the agreement is executed; and

      (ii) at least quarterly after the first anniversary of the date the agreement is executed, with monthly meetings held between the quarterly meetings by means of a remote electronic communications system, including video conferencing technology or the internet.

(e) Although a prescriptive authority agreement must include the information specified by this section, the agreement may include other provisions agreed to by the APRN and physician, including provisions that were previously contained in protocols or other written authorization.

(f) The APRN shall participate in quality assurance meetings with an alternate physician if the alternate physician has been designated in the prescriptive authority agreement to conduct and document the meeting.

(g) The prescriptive authority agreement is not required to describe the exact steps that an APRN must take with respect to each specific condition, disease, or symptom.

(h) An APRN who is a party to a prescriptive authority agreement must retain a copy of the agreement until the second anniversary of the date the agreement is terminated.

(i) A party to the prescriptive authority agreement may not by contract waive, void, or nullify any provision of this rule or §157.0512 or §157.0513, Occupations Code.

(j) In the event that a party to a prescriptive authority agreement is notified that the individual has become the subject of an investigation by the respective licensing board, the individual shall immediately notify the other party to the prescriptive authority agreement.

(k) The prescriptive authority agreement and any amendments must be reviewed at least annually, dated, and signed by the parties to the agreement. The prescriptive authority agreement shall be made available to the Board, the Texas Medical Board, or the Texas Physician Assistant Board not later than the third business day after the date of receipt of the request from the respective licensing board.

(l) The prescriptive authority agreement should promote the exercise of professional judgment by the APRN commensurate with the APRN's education and experience and the relationship between the APRN and the physician.

(m) The calculation under Chapter 157, Occupations Code, of the amount of time an APRN has practiced under the delegated prescriptive authority of a physician under a prescriptive authority agreement shall include the amount of time the APRN practiced under the delegated prescriptive authority of that physician before November 1, 2013.


Source Note: The provisions of this §222.5 adopted to be effective November 20, 2013, 38 TexReg 8212

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