| (a) An APRN with full licensure and a valid prescriptive
authorization number may order or prescribe a drug or device at a
facility based practice pursuant to a prescriptive authority agreement
or through protocols or other written authorization developed in accordance
with facility medical staff policies.
(1) If ordering or prescribing at a facility based
practice pursuant to a prescriptive authority agreement, the APRN
must maintain a prescriptive authority agreement that meets the requirements
of §222.5 (relating to Prescriptive Authority Agreement) of this
chapter.
(2) If ordering or prescribing at a facility based
practice pursuant to protocols or other written authorization developed
in accordance with facility medical staff policies, the APRN must:
(A) review the authorizing documents with the appropriate
medical staff at least annually;
(B) order or prescribe drugs and devices in a hospital
based facility in which the delegating physician is the medical director,
the chief of medical staff, the chair of the credentialing committee,
or a department chair, or a physician who consents to the request
of the medical director or chief of the medical staff to delegate;
(C) order or prescribe drugs and devices in a long
term care facility in which the delegating physician is the medical
director; and
(D) order or prescribe drugs and devices for the care
or treatment of only those patients for whom physicians have given
their prior consent.
(b) Protocols or other written authorization is authorization
to provide medical aspects of patient care that are agreed upon and
signed by the APRN and the physician, reviewed and signed at least
annually, and maintained in the practice setting of the APRN. Protocols
or other written authorization shall be defined to promote the exercise
of professional judgment by the APRN commensurate with his/her education
and experience. Protocols or other written authorization need not
describe the exact steps that the APRN must take with respect to each
specific condition, disease, or symptom and may state types or categories
of drugs or devices that may be ordered or prescribed.
(c) A facility based physician may not be prohibited
from delegating the prescribing or ordering of drugs or devices to
an APRN under §157.0512, Occupations Code or §222.5 of this
chapter at other practice locations, including hospitals or long term
care facilities, provided that the delegation at those locations complies
with all of the requirements of §157.0512 and §222.5 of
this chapter.
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