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| To amend sections 4723.07 and 4723.48 and to enact | 1 |
| section 4723.488 of the Revised Code to authorize | 2 |
| a person not otherwise authorized to do so to | 3 |
| administer certain drugs pursuant to delegation by | 4 |
| an advanced practice registered nurse who holds a | 5 |
| certificate to prescribe. | 6 |
| Section 1. That sections 4723.07 and 4723.48 be amended and | 7 |
| section 4723.488 of the Revised Code be enacted to read as | 8 |
| follows: | 9 |
| Sec. 4723.07. In accordance with Chapter 119. of the Revised | 10 |
| Code, the board of nursing shall adopt and may amend and rescind | 11 |
| rules that establish all of the following: | 12 |
| (A) Provisions for the board's government and control of its | 13 |
| actions and business affairs; | 14 |
| (B) Minimum standards for nursing education programs that | 15 |
| prepare graduates to be licensed under this chapter and procedures | 16 |
| for granting, renewing, and withdrawing approval of those | 17 |
| programs; | 18 |
| (C) Criteria that applicants for licensure must meet to be | 19 |
| eligible to take examinations for licensure; | 20 |
| (D) Standards and procedures for renewal of the licenses and | 21 |
| certificates issued by the board; | 22 |
| (E) Standards for approval of continuing nursing education | 23 |
| programs and courses for registered nurses, licensed practical | 24 |
| nurses, certified registered nurse anesthetists, clinical nurse | 25 |
| specialists, certified nurse-midwives, and certified nurse | 26 |
| practitioners. The standards may provide for approval of | 27 |
| continuing nursing education programs and courses that have been | 28 |
| approved by other state boards of nursing or by national | 29 |
| accreditation systems for nursing, including, but not limited to, | 30 |
| the American nurses' credentialing center and the national | 31 |
| association for practical nurse education and service. | 32 |
| (F) Standards that persons must meet to be authorized by the | 33 |
| board to approve continuing education programs and courses and a | 34 |
| schedule by which that authorization expires and may be renewed; | 35 |
| (G) Requirements, including continuing education | 36 |
| requirements, for reactivating inactive licenses or certificates, | 37 |
| and for reinstating licenses or certificates that have lapsed; | 38 |
| (H) Conditions that may be imposed for reinstatement of a | 39 |
| license or certificate following action taken under section | 40 |
| 3123.47, 4723.28, 4723.281, 4723.652, or 4723.86 of the Revised | 41 |
| Code resulting in a license or certificate suspension; | 42 |
| (I) Requirements for board approval of courses in medication | 43 |
| administration by licensed practical nurses; | 44 |
| (J) Criteria for evaluating the qualifications of an | 45 |
| applicant for a license to practice nursing as a registered nurse, | 46 |
| a license to practice nursing as a licensed practical nurse, or a | 47 |
| certificate of authority issued under division (B) of section | 48 |
| 4723.41 of the Revised Code for the purpose of issuing the license | 49 |
| or certificate by the board's endorsement of the applicant's | 50 |
| authority to practice issued by the licensing agency of another | 51 |
| state; | 52 |
| (K) Universal and standard precautions that shall be used by | 53 |
| each licensee or certificate holder. The rules shall define and | 54 |
| establish requirements for universal and standard precautions that | 55 |
| include the following: | 56 |
| (1) Appropriate use of hand washing; | 57 |
| (2) Disinfection and sterilization of equipment; | 58 |
| (3) Handling and disposal of needles and other sharp | 59 |
| instruments; | 60 |
| (4) Wearing and disposal of gloves and other protective | 61 |
| garments and devices. | 62 |
| (L) Standards and procedures for approving certificates of | 63 |
| authority to practice nursing as a certified registered nurse | 64 |
| anesthetist, clinical nurse specialist, certified nurse-midwife, | 65 |
| or certified nurse practitioner, and for renewal of those | 66 |
| certificates; | 67 |
| (M) Quality assurance standards for certified registered | 68 |
| nurse anesthetists, clinical nurse specialists, certified | 69 |
| nurse-midwives, or certified nurse practitioners; | 70 |
| (N) Additional criteria for the standard care arrangement | 71 |
| required by section 4723.431 of the Revised Code entered into by a | 72 |
| clinical nurse specialist, certified nurse-midwife, or certified | 73 |
| nurse practitioner and the nurse's collaborating physician or | 74 |
| podiatrist; | 75 |
| (O) Continuing education standards for clinical nurse | 76 |
| specialists who were issued a certificate of authority to practice | 77 |
| as a clinical nurse specialist under division (C) of section | 78 |
| 4723.41 of the Revised Code as that division existed at any time | 79 |
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before | 80 |
| (P) For purposes of division (B)(31) of section 4723.28 of | 81 |
| the Revised Code, the actions, omissions, or other circumstances | 82 |
| that constitute failure to establish and maintain professional | 83 |
| boundaries with a patient; | 84 |
| (Q) Standards and procedures for delegation under division | 85 |
| (C) of section 4723.48 of the Revised Code of the authority to | 86 |
| administer drugs. | 87 |
| The board may adopt other rules necessary to carry out the | 88 |
| provisions of this chapter. The rules shall be adopted in | 89 |
| accordance with Chapter 119. of the Revised Code. | 90 |
| Sec. 4723.48. (A) A clinical nurse specialist, certified | 91 |
| nurse-midwife, or certified nurse practitioner seeking authority | 92 |
| to prescribe drugs and therapeutic devices shall file with the | 93 |
| board of nursing a written application for a certificate to | 94 |
| prescribe. The board of nursing shall issue a certificate to | 95 |
| prescribe to each applicant who meets the requirements specified | 96 |
| in section 4723.482 or 4723.485 of the Revised Code. | 97 |
| Except as provided in division (B) of this section, the | 98 |
| initial certificate to prescribe that the board issues to an | 99 |
| applicant shall be issued as an externship certificate. Under an | 100 |
| externship certificate, the nurse may obtain experience in | 101 |
| prescribing drugs and therapeutic devices by participating in an | 102 |
| externship that evaluates the nurse's competence, knowledge, and | 103 |
| skill in pharmacokinetic principles and their clinical application | 104 |
| to the specialty being practiced. During the externship, the nurse | 105 |
| may prescribe drugs and therapeutic devices only when one or more | 106 |
| physicians are providing supervision in accordance with rules | 107 |
| adopted under section 4723.50 of the Revised Code. | 108 |
| After completing the externship, the holder of an externship | 109 |
| certificate may apply for a new certificate to prescribe. On | 110 |
| receipt of the new certificate, the nurse may prescribe drugs and | 111 |
| therapeutic devices in collaboration with one or more physicians | 112 |
| or podiatrists. | 113 |
| (B) In the case of an applicant who meets the requirements of | 114 |
| division (C) of section 4723.482 of the Revised Code, the initial | 115 |
| certificate to prescribe that the board issues to the applicant | 116 |
| under this section shall not be an externship certificate. The | 117 |
| applicant shall be issued a certificate to prescribe that permits | 118 |
| the recipient to prescribe drugs and therapeutic devices in | 119 |
| collaboration with one or more physicians or podiatrists. | 120 |
| (C)(1) The holder of a certificate issued under this section | 121 |
| may delegate to a person not otherwise authorized to administer | 122 |
| drugs the authority to administer a drug, other than a controlled | 123 |
| substance, listed in the formulary established under division | 124 |
| (B)(1) of section 4723.50 of the Revised Code to a specified | 125 |
| patient. The delegation shall be in accordance with division | 126 |
| (C)(2) of this section and standards and procedures established in | 127 |
| rules adopted under division (O) of section 4723.07 of the Revised | 128 |
| Code. | 129 |
| (2) Prior to delegating authority, the certificate holder | 130 |
| shall do both of the following: | 131 |
| (a) Assess the patient and determine that the drug is | 132 |
| appropriate for the patient; | 133 |
| (b) Determine that the person to whom the authority will be | 134 |
| delegated has met the conditions specified in division (D) of | 135 |
| section 4723.488 of the Revised Code. | 136 |
| Sec. 4723.488. A person not otherwise authorized to | 137 |
| administer drugs may administer a drug to a specified patient if | 138 |
| all of the following conditions are met: | 139 |
| (A) The authority to administer the drug is delegated to the | 140 |
| person by an advanced practice registered nurse who is a clinical | 141 |
| nurse specialist, certified nurse-midwife, or certified nurse | 142 |
| practitioner and holds a certificate to prescribe issued under | 143 |
| section 4723.48 of the Revised Code. | 144 |
| (B) The drug is listed in the formulary established under | 145 |
| division (B) of section 4723.50 of the Revised Code but is not a | 146 |
| controlled substance and is not to be administered intravenously. | 147 |
| (C) The drug is to be administered at a location other than a | 148 |
| hospital inpatient care unit, as defined in section 3727.50 of the | 149 |
| Revised Code; a hospital emergency department or a freestanding | 150 |
| emergency department; or an ambulatory surgical facility, as | 151 |
| defined in section 3702.30 of the Revised Code. | 152 |
| (D) The person has successfully completed education based on | 153 |
| a recognized body of knowledge concerning drug administration and | 154 |
| demonstrates to the person's employer the knowledge, skills, and | 155 |
| ability to administer the drug safely. | 156 |
| (E) The person's employer has given the advanced practice | 157 |
| registered nurse access to documentation, in written or electronic | 158 |
| form, showing that the person has met the conditions specified in | 159 |
| division (D) of this section. | 160 |
| (F) The advanced practice registered nurse is physically | 161 |
| present at the location where the drug is administered. | 162 |
| Section 2. That existing sections 4723.07 and 4723.48 of the | 163 |
| Revised Code are hereby repealed. | 164 |