CNAP 2009 Interim Update #2 /APN Legislative Day March 1 ,2010

Lynda Woolbert, Executive Director

Coalition for Nurses in Advanced Practice

December 10, 2009

APN Legislative Day

The Texas Legislature does not meet in regular session in 2010 but the Texas Capitol is still open for business, and Texas APNs will be there on March 1, 2010. This is the day we encourage APRNs and APRN students to come to Austin, learn about our issues and then discuss those issues with legislators and staff at the Capitol. Online registration will open in mid December. In the meantime, more details on the event are available on CNAPs Home Page or Click Here

Physicians Register Rx Delegation Now

The Texas Medical Board (TMB) adopted new rules implementing SB 532 on November 27, 2009. One of those provisions requires physicians who delegate prescriptive authority to register that delegation to the TMB.

All physicians who currently delegate prescriptive authority to an APRN must complete an APN Delegation Form and submit it to the TMB now. A link to that form is posted on the TMB Website . Download the form titled, APN Delegation of Prescriptive Authority

APRNs that have delegated prescriptive authority should inform their delegating physicians about this new requirement. The form requires both the physicians and APRNs signatures.

The form includes instructions and a summary of the changes created by SB 532. The instructions state that physicians are responsible for notifying the TMB when a physician delegates prescriptive authority, and when the physician terminates that authority. The same form is used for both. A different form will need to be used for each APRN to whom the physician delegates prescriptive authority. Alternate delegating physicians do not submit a form

The completed form may be mailed or faxed to the Texas Medical Board. The address and fax number are provided at the top of the instructions. Only submit the completed one-page registration form. Physicians must keep a copy for their records and it would be wise for APRNs to do the same.

The instructions are detailed and list the sites where a physician is limited to delegating to no more than four full time equivalents. (Remember, that limitation does not apply to hospital facility-based and medically underserved practices.) The TMB lists a phone number and email address should a physician have questions about completing the form or the physicians obligation to register as a delegating physician. For general information about prescriptive authority go to the Prescriptive Authority Page on CNAPs Website.

BON Proposes Rx Authority Rules

The November 27th issue of the Texas Register was important for APRNs with prescriptive authority. Not only did the Texas Medical Board adopt rules to implement SB 532, the Texas Board of Nursing (BON) proposed amendments to its prescriptive authority rules. In addition to making changes consistent with SB 532, the BON took advantage of this opportunity to change Advanced Practice Nurses to Advanced Practice Registered Nurses throughout Chapter 222 and to update the definition of APRN.

The rules also add information on prescribing for partners of patients that have STDs and off label prescribing. This is important for APNs who specialize in womens health since their scope of practice would not encompass treating men. Proposed Rule 222.4 states:

(E) An Advanced Practice Registered Nurse may prescribe medications for sexually transmitted diseases for partners of an established patient, if the advanced practice registered nurse assesses the patient and determines that the patient may have been infected with a sexually transmitted disease. Nothing in this subsection shall be construed to require the advanced practice registered nurse to issue prescriptions for partners of patients.

(F) Advanced Practice Registered Nurses may prescribe only those medications that are FDA approved unless done through protocol registration in a United States Institutional Review Board or Expanded Access authorized clinical trial. "Off label" use, or prescription of FDA-approved medications for uses other than that indicated by the FDA, is permitted when such practices are:

(1) within the current standard of care for treatment of the disease or condition, and

(2) supported by evidence-based research.

To review the proposed amendments,

Click Here. There is a lengthy and detailed preamble that outlines all the proposed changes with the reasoning for those changes. Anyone may comment on the proposed amendments until December 27, 2009. It is likely that the rules will be finally adopted after the BON meets on January 22nd. To view other recently revised rules proposed and adopted by the Board of Nursing, Click Here

Texas Health IT Summit

Health information technology (HIT) is a hot topic, especially since money is available for certain Medicare and Medicaid providers to implement electronic health records (EHR). Nurse practitioners and nurse-midwives that are high volume Medicaid providers (at least 30% Medicaid) are among the types of providers who may qualify for up to $64,000 distributed over a period of four to five years.

To help providers learn about EHRs and take advantage of these funding opportunities, the Texas Medical Foundation and the Texas Health Institute are hosting a conference on January 15 - 16, 2009. Preconference sessions on January 14th are available at an additional charge. This would be an excellent opportunity for APRNs to become leaders in HIT. For more information about the conference and to register, go to

www.texashealthitsummit.org. There is also more information about this program on the Federal Health Information Technology Website