07 LC 33
1876
House
Bill 676
By:
Representative Knox of the
24th
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Code Section 43-34-26.3 of the Official Code of Georgia Annotated,
relating to delegation of certain medical acts to advanced practice registered
nurses, so as to provide for on-site patient evaluation; to provide for
examination of all patients who receive a prescription drug order for a
controlled substance of more than a ten-day supply; to provide for approval by
the board of nurse protocol agreements; to provide for a fee; to revise a
provision relating to unlawful activity; to provide for related matters; to
repeal conflicting laws; and for other purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
Code
Section 43-34-26.3 of the Official Code of Georgia Annotated, relating to
delegation of certain medical acts to advanced practice registered nurses, is
amended by revising subsections (c), (m), and (n), as follows:
"(c)
A nurse protocol agreement between a physician and an advanced practice
registered nurse pursuant to this Code section shall:
(1)
Be between an advanced practice registered nurse who is in a comparable
specialty area or field as that of the delegating physician;
(2)
Contain a provision for immediate consultation between the advanced practice
registered nurse and the delegating physician; if the delegating physician is
not available, the delegating physician for purposes of consultation may
designate another physician who concurs with the terms of the nurse protocol
agreement;
(3)
Identify the parameters under which delegated acts may be performed by the
advanced practice registered nurse, including without limitation the number of
refills which may be ordered, the kinds of diagnostic studies which may be
ordered, the extent to which radiographic image tests may be ordered, and the
circumstances under which a prescription drug order may be executed. In the
event the delegating physician authorizes the advanced practice registered nurse
to order an X-ray, ultrasound, or radiographic imaging test, the nurse protocol
agreement shall contain provisions whereby such X-ray, ultrasound, or
radiographic imaging test shall be read and interpreted by a physician who is
trained in the reading and interpretation of such tests; a report of such X-ray,
ultrasound, or radiographic imaging test may be reviewed by the advanced
practice registered nurse; and a copy of such report shall be forwarded to the
delegating physician, except that such provision for an ultrasound shall not be
required for an advanced practice registered nurse acting within his or her
scope of practice as authorized by Code Sections 43-26-3 and
43-26-5.;
(4)
Require documentation either in writing or by electronic means or other medium
by the advanced practice registered nurse of those acts performed by the
advanced practice registered nurse which are specific to the medical acts
authorized by the delegating physician;
(5)
Include a schedule for periodic review by the delegating physician of patient
records. Such patient records review may be achieved with a sampling of such
records as determined by the delegating physician;
(6)
Provide for
on-site
patient
evaluation
or follow-up examination by the delegating
physician or other physician designated by the delegating physician pursuant to
paragraph (2) of this subsection, with the frequency of such
evaluation
or follow-up examination based on the
nature, extent, and scope of the delegated act or acts as determined by the
delegating physician in accordance with paragraph (3) of this subsection and
accepted standards of medical practice as determined by the board;
(7)
Be reviewed, revised, or updated annually by the delegating physician and the
advanced practice registered nurse;
(8)
Be available for review upon written request to the advanced practice registered
nurse by the Georgia Board of Nursing or to the physician by the board;
and
(9)
Provide that
a patient
who receives
100 percent of
all patients who receive a prescription
drug order for any controlled substance pursuant to a nurse protocol agreement
shall be
evaluated
or examined
on-site
by the delegating physician or other physician designated by the delegating
physician pursuant to paragraph (2) of this subsection on at least a quarterly
basis or at
a more frequent interval as determined by the
board;
provided, however, that this paragraph shall not apply to a patient who has
received a prescription drug order for a ten-day or less supply of a controlled
substance during the
quarter."
"(m)
The board shall have the authority to promulgate rules and regulations governing
a delegating physician in order to carry out the intents and purposes of this
Code section. Further, the board shall be authorized to:
(1)
Require that a nurse protocol agreement
and
registration form shall be filed by the
delegating physician with the board
for approval
and shall be accompanied by the required fee, which shall not be
refundable, within a reasonable time from
the date of execution;
(2)
Determine, after review of a filed nurse protocol agreement, if such nurse
protocol agreement fails to meet accepted standards of medical practice as
established by the board; and
(3)
Require the delegating physician to amend any such noncompliant nurse protocol
agreement in order to meet such accepted standards.
(n)
Except for practice settings identified in paragraph (7) of subsection (g) of
this Code section, it shall be unlawful for a physician to be
an
employee
employed by or
a consultant of an advanced practice
registered nurse, alone or in combination with others, if the physician is
required to supervise the employing advanced practice registered nurse. Such
conduct shall be subject to sanctions by the Georgia Board of Nursing as to the
advanced practice registered nurse and the board as to the
physician."
SECTION
2.
All
laws and parts of laws in conflict with this Act are repealed.