The following words and terms, when used in this chapter, shall
have the following meanings, unless the contents clearly indicate
otherwise.
(1) Advanced practice registered nurse--A registered
nurse approved by the Texas Board of Nursing to practice as an advanced
practice nurse on the basis of completion of an advanced educational
program. The term includes an advanced nurse practitioner, a nurse
midwife, nurse anesthetist, clinical nurse specialist, and advanced
practice nurse, as defined by Texas Occupations Code Annotated, §301.152.
(2) Authorizing physician--A physician or physicians
licensed by the board who execute a standing delegation order or prescriptive
authority agreement.
(3) Controlled substance--A substance, including a
drug, an adulterant, and a dilutant, listed in Schedules I through
V or Penalty Groups 1, 1-A, or 2 through 4 as described under the
Texas Health and Safety Code, Chapter 481 (Texas Controlled Substances
Act). The term includes the aggregate weight of any mixture, solution,
or other substance containing a controlled substance.
(4) Dangerous drug--A device or a drug that is unsafe
for self medication and that is not included in the Texas Health and
Safety Code, Schedules I-V or Penalty Groups I-IV of Chapter 481 (Texas
Controlled Substances Act). The term includes a device or a drug that
bears or is required to bear the legend: "Caution: federal law prohibits
dispensing without prescription".
(5) Device--Means an instrument, apparatus, implement,
machine, contrivance, implant, in vitro reagent, or other similar
or related article, including a component part or accessory, that
is required under federal or state law to be ordered or prescribed
by a practitioner, as defined by §551.003 of the Occupations
Code.
(6) Facility based practice site--A hospital, as defined
by §157.051(6) of the Act and this chapter, or a licensed long-term
care facility. A facility-based practice does not include a freestanding
clinic, center or other medical practice associated with or owned
or operated by, a hospital or licensed long-term care facility.
(7) Health professional shortage area (HPSA)--
(A) an urban or rural area of this state that:
(i) is not required to conform to the geographic boundaries
of a political subdivision but is a rational area for the delivery
of health services;
(ii) the secretary of health and human services determines
has a health professional shortage; and
(iii) is not reasonably accessible to an adequately
served area;
(B) a population group that the secretary of health
and human services determines has a health professional shortage;
or
(C) a public or nonprofit private medical facility
or other facility that the secretary of health and human services
determines has a health professional shortage, as described by 42
U.S.C. §254e(a)(1).
(8) Hospital--A facility that:
(A) is:
(i) a general hospital or a special hospital, as those
terms are defined by §241.003, Health and Safety Code, including
a hospital maintained or operated by the state; or
(ii) a mental hospital licensed under Chapter 577,
Health and Safety Code; and
(B) has an organized medical staff.
(9) Medication order--An order from a practitioner
or a practitioner's designated agent for administration of a drug
or device, as defined by §551.003 of the Occupations Code, or
an order from a practitioner to dispense a drug to a patient in a
hospital for immediate administration while the patient is in the
hospital or for emergency use on the patient's release from the hospital,
as defined by Texas Health and Safety Code, §481.002.
(10) Nonprescription drug--A nonnarcotic drug or device
that may be sold without a prescription and that is labeled and packaged
in compliance with state and Federal Law, as defined by §551.003(25)
of the Occupations Code.
(11) Physician Assistant--A person who is licensed
as a physician assistant by the Texas Physician Assistant Board.
(12) Physician group practice--An entity through which
two or more physicians deliver health care to the public through the
practice of medicine on a regular basis and that is:
(A) owned and operated by two or more physicians; or
(B) a freestanding clinic, center, or office of a nonprofit
health organization certified by the board under §162.001(b)
of the Act (relating to Regulation by Board of Certain Nonprofit Health
Corporations), that complies with the requirements of Chapter 162
of the Act.
(13) Physician's orders--The instructions of a physician
for the care of an individual patient.
(14) Practice serving a medically underserved population--Refers
to the following:
(A) a practice in a health professional shortage area;
(B) a clinic designated as a rural health clinic under
42 U.S.C. §1395x(aa);
(C) a public health clinic or a family planning clinic
under contract with the Health and Human Services Commission or the
Department of State Health Services;
(D) a clinic designated as a federally qualified health
center under 42 U.S.C. §1396d(l)(2)(B);
(E) a county, state, or federal correctional facility;
(F) a practice:
(i) that either:
(I) is located in an area in which the Department of
State Health Services determines there is an insufficient number of
physicians providing services to eligible clients of federally, state,
or locally funded health care programs; or
(II) is a practice that the Department of State Health
Services determines serves a disproportionate number of clients eligible
to participate in federally, state, or locally funded health care
programs; and
(ii) for which the Department of State Health Services
publishes notice of the department's determination in the Texas Register
and provides an opportunity for public comment in the manner provided
for a proposed rule under Chapter 2001, Government Code; or
(G) a practice at which a physician was delegating
prescriptive authority to an advanced practice registered nurse or
physician assistant on or before March 1, 2013, based on the practice
qualifying as a site serving a medically underserved population.
(15) Prescribe or order a drug or device--Prescribing
or ordering a drug or device, including the issuing of a prescription
drug order or medication order.
(16) Prescription drug--Means:
(A) a substance for which federal or state law requires
a prescription before the substance may be legally dispensed to the
public;
(B) a drug or device that under federal law is required,
before being dispensed or delivered, to be labeled with the statement:
(i) "Caution: federal law prohibits dispensing without
prescription" or "Rx only" or another legend that complies with federal
law; or
(ii) "Caution: federal law restricts this drug to use
by or on the order of a licensed veterinarian"; or
(C) a drug or device that is required by federal or
state statute or regulation to be dispensed on prescription or that
is restricted to use by a practitioner only.
(17) Prescriptive authority agreement--An agreement
entered into by a physician and an advanced practice registered nurse
or physician assistant through which the physician delegates to the
advanced practice registered nurse or physician assistant the act
of prescribing or ordering a drug or device. Prescriptive authority
agreements are required for the delegation of the act of prescribing
or ordering a drug or device in all practice settings, with the exception
of a facility-based practice, pursuant to §157.054 of the Act.
(18) Protocols--Written authorization delegating authority
to initiate medical aspects of patient care, including delegation
of the act of prescribing or ordering a drug or device at a facility-based
practice. The term protocols is separate and distinct from prescriptive
authority agreements as defined under the Act and this chapter. However,
prescriptive authority agreements may reference or include the terms
of a protocol(s). The protocols must be agreed upon and signed by
the physician, the physician assistant and/or advanced practice registered
nurse, reviewed and signed at least annually, maintained on site,
and must contain a list of the types or categories of dangerous drugs
and controlled substances available for prescription, limitations
on the number of dosage units and refills permitted, and instructions
to be given the patient for follow-up monitoring or contain a list
of the types or categories of dangerous drugs and controlled substances
that may not be prescribed. Protocols shall be defined to promote
the exercise of professional judgment by the advanced practice registered
nurse and physician assistant commensurate with their education and
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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