FEBRUARY 2002 STATE BOARD NEWS
(STATE SECTION ONLY)
NURSING BOARD TO BEGIN LICENSING APN PRESCRIBERS
Shortly after you receive this
newsletter, the Board of Nursing will begin licensing a large number of additional
Advanced Practice Nurses (APNs) to prescribe.
As you know, there have been about
350 APNs prescribing under a trial program for the last few years. As a result of HB 241 from the 123rd
General Assembly, which was signed by the Governor on February 15, 2000, the
trial program will be phased out over the next year and any APN who meets the
proper criteria will be able to be licensed to prescribe by the Board of
Nursing. In addition to the number of
prescribing APNs greatly increasing, the rules governing their prescribing have
also changed from the rules in place for the trial program. This article will attempt to outline the
major changes, but it will certainly not be able to cover all of the possible
contingencies that may occur during the implementation of the new program.
Please also keep in mind that the
collaborating physician may add additional limitations on the APN’s scope of
prescribing privileges beyond the limitations placed by the master
formulary. It is the responsibility of
both the physician and the APN to see that these additional limitations are
followed.
Any questions that may come up
regarding APN prescribing can be directed to the Board of Nursing office
(614-466-3947) or to the Board of Pharmacy office. In addition, the Board of Nursing has assured us that they will
maintain both the list of the APNs authorized to prescribe as well as a copy of
the master formulary for APN prescribing on their Web page (www.state.oh.us/nur)
under the “Advanced Practice” box. This
should help you verify the licensure status of any APN prescription that you
may receive.
Major Points To Remember
With The New APN Law
1. An APN must be licensed to prescribe by
the Board of Nursing and have a special prescribing license issued in addition
to his/her APN license. Just because a
person is licensed as an APN does not necessarily mean that person may
prescribe.
2. Any APN who prescribes is to be considered
the prescriber of record for purposes of the pharmacy recordkeeping
requirements. It is not appropriate or
legal to list the collaborating physician as the prescriber.
3. Prescriptions may be issued by an APN in
the same manner as those issued by a physician, including oral, fax,
board-approved electronic transmission, and handwritten prescriptions.
4. The prescribing APN is subject to the same
restrictions that exist for the collaborating physician. If the collaborating physician happens to be
a podiatrist, the APN may not prescribe outside of the limits placed on the
podiatrist for prescribing. In
addition, if the collaborating physician has had limits placed on his/her
license by the Medical Board or DEA (e.g., limits on controlled substance
prescribing), then those same limits will apply to the APN, regardless of the
content of the formulary with the collaborating physician.
5. Any APN who wishes to prescribe controlled
substances must be registered with the DEA as a mid-level practitioner. This means that the DEA number assigned will
begin with the letter “M”, unlike physicians whose DEA number begins with the
letter “A” or "B". This is
the DEA number that is required to be maintained to meet the recordkeeping
requirements. The physician’s DEA number
is not the appropriate number to be maintained in your pharmacy computer
system as the prescriber identification.
6. Controlled substances in Schedules III-V
that are included in the APN’s formulary may now be prescribed as needed for a
legitimate medical purpose. There will no
longer be the 72-hour, one time restriction that applied during the trial
program.
7. Controlled substances in Schedule II may
ONLY be prescribed ONE TIME for NO MORE than a 24-hour period to a
TERMINALLY-ILL patient who has previously been prescribed the CII substance by
the collaborating physician. (Note -
Since a podiatrist should not be prescribing opiates for treatment of terminal
cancer pain, this also means that an APN whose collaborating physician is a
podiatrist may not write any CII prescriptions.) Other than for this reason, Schedule II substances MAY NOT be
prescribed by any APN. In particular,
please note that NO APN may write for methylphenidate, Adderall, or any other
CII stimulant for any reason.
8. The master formulary that will be listed
on the Nursing Board’s Web page will be an exclusionary one rather than the
listing of approved drugs that exists for the trial program. In other words, it may specify that the APN
may prescribe all antihypertensives except certain drugs; it may specify that
the APN may prescribe all oral vitamins, but no intravenous vitamins; etc.
9. The APN may now possess and supply
patients with NON-CONTROLLED drug samples of prescription drugs included on
his/her formulary as long as the quantity provided to the patient is limited to
a 72-hour supply (or smallest available size) and the sample is supplied free
of charge.
10. Other than the samples described above, the
ONLY prescription drugs that may be personally supplied to patients by an APN
are drugs listed as antibiotics, antifungals, scabicides, contraceptives, and
prenatal vitamins that are included in his/her formulary AND are furnished ONLY
from a licensed location operated by the Board of Health, a federally-funded
comprehensive primary care clinic, or a nonprofit health care clinic or
program. In other words, unlike the
trial program, an APN who is located somewhere other than those sites listed
above may NOT personally supply any prescription drugs other than samples of
prescription drugs that are included in his/her formulary.
11. The Board of
Nursing’s rules require that all prescribing APNs must list their prescribing
license number on each prescription written.
Again, please note that these APNs
who are licensed by the Board of Nursing are legally entitled to prescribe
certain drugs to their patients.
Prescriptions issued by these individuals are valid prescriptions and
may be filled by pharmacists in the same manner that prescriptions issued by
physicians are filled.
If you have any questions about
the legitimacy of an APN prescription or the procedures to be followed when
presented with such a prescription, please take the steps necessary to enable
you to make an informed decision on whether or not to fill the prescription. In these instances - as with all
prescriptions - please always act in the best interest of the patient as you
make your decisions.
DISCIPLINARY ACTIONS
Anyone having a question regarding
the license status of a particular practitioner, nurse, pharmacist, pharmacy intern,
or dangerous drug distributor in Ohio should contact the appropriate licensing
board. The Web sites listed below may
include disciplinary actions for their respective licensees.
State Dental Board--614/466-2580, www.state.oh.us/den/
State Medical Board--614/466-3934, www.state.oh.us/med/
State Nursing Board--614/466-3947, www.state.oh.us/nur/
State Optometry Board--614/466-5115, www.state.oh.us/opt/
State Pharmacy Board--614/466-4143, www.state.oh.us/pharmacy/
State Veterinary Medical Board--614/644-5281, www.state.oh.us/ovmlb/
Drug Enforcement Administration--800/230-6844; www.deadiversion.usdoj.gov/
STATE PHARMACY BOARD:
Due to
space limitations with this newsletter, recent Pharmacy Board disciplinary
actions will not be listed until the next issue. All actions may be seen in the Board's meeting minutes, which are
posted on the Internet at the Board's home page (see address above), then click
on the Board Minutes box. If you have any questions, please feel free to contact the Board
office directly.
STATE MEDICAL BOARD:
A document
of legal actions taken by the Medical Board may be accessed on the Internet at
the Medical Board's Home page (see address above) then click on Monthly Formal Actions. If you would like a more detailed history of
a legal action for an individual practitioner, go Back to the Medical Board's Home page, click on the Licensee Profile & Status tag, then
follow the instructions. Please contact
the Medical Board if you have questions.