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experience. The protocols used by a reasonable and prudent physician
exercising sound medical judgment need not describe the exact steps
that an advanced practice registered nurse or a physician assistant
must take with respect to each specific condition, disease, or symptom.
(19) Standing delegation order--Written instructions,
orders, rules, regulations, or procedures prepared by a physician
and designed for a patient population with specific diseases, disorders,
health problems, or sets of symptoms. Such written instructions, orders,
rules, regulations or procedures shall delineate under what set of
conditions and circumstances action should be instituted. These instructions,
orders, rules, regulations or procedures are to provide authority
for and a plan for use with patients presenting themselves prior to
being examined or evaluated by a physician to assure that such acts
are carried out correctly and are distinct from specific orders written
for a particular patient, and shall be limited in scope of authority
to be delegated as provided in §193.4 of this title (relating
to Scope of Standing Delegation Orders). As used in this chapter,
standing delegation orders do not refer to treatment programs ordered
by a physician following examination or evaluation by a physician,
nor to established procedures for providing of care by personnel under
direct, personal supervision of a physician who is directly supervising
or overseeing the delivery of medical or health care. As used in this
chapter, standing delegation orders are separate and distinct from
prescriptive authority agreements as defined in this chapter. Such
standing delegation orders should be developed and approved by the
physician who is responsible for the delivery of medical care covered
by the orders. Such standing delegation orders, at a minimum, should:
(A) include a written description of the method used
in developing and approving them and any revision thereof;
(B) be in writing, dated, and signed by the physician;
(C) specify which acts require a particular level of
training or licensure and under what circumstances they are to be
performed;
(D) state specific requirements which are to be followed
by persons acting under same in performing particular functions;
(E) specify any experience, training, and/or education
requirements for those persons who shall perform such orders;
(F) establish a method for initial and continuing evaluation
of the competence of those authorized to perform same;
(G) provide for a method of maintaining a written record
of those persons authorized to perform same;
(H) specify the scope of supervision required for performance
of same, for example, immediate supervision of a physician;
(I) set forth any specialized circumstances under which
a person performing same is to immediately communicate with the patient's
physician concerning the patient's condition;
(J) state limitations on setting, if any, in which
the plan is to be performed;
(K) specify patient record-keeping requirements which
shall, at a minimum, provide for accurate and detailed information
regarding each patient visit; personnel involved in treatment and
evaluation on each visit; drugs, or medications administered, prescribed
or provided; and such other information which is routinely noted on
patient charts and files by physicians in their offices; and
(L) provide for a method of periodic review, which
shall be at least annually, of such plan including the effective date
of initiation and the date of termination of the plan after which
date the physician shall issue a new plan.
(20) Standing medical orders--Orders, rules, regulations
or procedures prepared by a physician or approved by a physician or
the medical staff of an institution for patients which have been examined
or evaluated by a physician and which are used as a guide in preparation
for and carrying out medical or surgical procedures or both. These
orders, rules, regulations or procedures are authority and direction
for the performance for certain prescribed acts for patients by authorized
persons as distinguished from specific orders written for a particular
patient or delegation pursuant to a prescriptive authority agreement.
(21) Submit--The term used to indicate that a completed
item has been actually received and date-stamped by the Board along
with all required documentation and fees, if any.
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