| (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 meetings between the APRN and the physician.
(d) The periodic 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;
(2) be documented; and
(3) take place at least once a month in a manner determined
by the physician and the APRN.
(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.
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