Administrative Rule
Changes
The Board adopted several
comprehensive changes to the Nurse Practice Act at its June 18th meeting. Newly
revised regulations are posted on the Board’s
website at www.oregon.gov/OSBN.
As a reminder, draft regulations are posted for input and are heard at a minimum
of two Board meetings before adoption. Please use the website as a primary resource
for the latest information. The Board is also looking at the possibility of
offering a list serve option to sign up for updates related to CNS, CRNA, CNM
and NP issues and regulations.
Newly updated sections are:
- Division
21 – Rules Regarding the Standards for the Approval of Educational Programs
in Nursing Preparing Candidates for Licensure as Practical or Registered Nurses (complete
overview and revision)
- Division
45 – Standards and Scope of Practice for the Licensed Practical Nurse and
Registered Nurse (complete overview and revision)
- Division
56 – Rules Regarding Clinical Nurse Specialist and Nurse Practitioner Authority
to Prescribe and Dispense ( revision of specific sections removing the
Formulary requirement and clarifying standards for prescribing/dispensing)
Patient Records
The Board has recently
been contacted by a number of patients who are unable to locate their medical
records when care was provided by a Nurse Practitioner. The Nurse Practice Act
requires notification of the Board within 30 days of any change in practice
address or setting whether or not direct patient care is provided. (OAR 851-050-0010).
The Board and patients must be informed when a practice is closed regarding
where medical records are stored and how they may be accessed. Please see the
Board’s Patient
Abandonment policy for further details regarding notification and
discharge of patients from your care: http://www.oregon.gov/OSBN/pdfs/policies/abandon.pdf.
Additional regulations
regarding closure of practice and patient obligations may be found in the newly
revised Division 45.
Formulary Update
The requirement for Oregon
Nurse Prescribers to use a Board approved Formulary was officially removed from
regulations on June 18, 2009. The Board adopted a set of standards which defines
continuing expectations for prescribers including safety, congruence with scope
of practice, and FDA approval for drugs prescribed with the exception of Institutional
Review Board approved medical trials.
Clinical Nurse Specialists
and Nurse Practitioners with prescriptive authority may prescribe:
- Limited
Access Drugs - Sometimes known as “expanded access” drugs, these are approved
by the FDA for patient access before final FDA trials are completed. FDA approval
for limited or expanded access must already be granted for a Nurse Prescriber
or Clinical Nurse Specialist to prescribe, dispense, or procure these drugs.
- Over
the Counter Drugs - Occasionally a prescription is required in order for
an over the counter medication to be covered by insurance. This is acceptable
to the Board provided that the prescription is congruent with the diagnosis
or indication.
- Appliances
and Devices - Examples of appliances and devices include blood glucose
meters, CPAP devices, and breast pumps. Clinical Nurse Specialists without
prescriptive authority may order durable medical equipment (see Division 54
for specific rule language).
- Orphan
Drugs - These are drugs approved for rare diseases or conditions which
are not able to be mass marketed. According to the FDA “The orphan designation
process is the mechanism by which sponsors of drugs and biologics for rare
diseases may qualify for incentives
of the Orphan Drug Actsuch as tax credits and marketing exclusivity.”
- Investigational
Drugs Distributed through an Institutional Review Board (IRB)Approved
Medical Trial- The FDA’s Center for Drug Evaluation and Research (CDER) approves
applications for investigational new drugs. If a nurse prescriber is participating
in an IRB approved trial he or she may now be designated to prescribe, dispense,
and procure the drug if permitted by IRB, facility, and federal law or policy. See
more details regarding this process.
Please see Division 56
of the Nurse Practice Act for more specific detail regarding prescribing and
dispensing laws in Oregon.