07 AM 33
0581
NOT
GERMANE
Senators
Tolleson of the 20th, Adelman of the 42nd and Williams of the 19th offered the
following amendment:
Amend
HB 528 (LC 36 0793S) by inserting after
"sanctions;"
on line 11 of page 1 the following:
to
revise language relating to delegation of certain medical acts to advanced
practice registered nurses;
By
inserting between lines 23 and 24 of page 10 the following:
SECTION
1A.
Said
chapter is further amended by revising subsections (c) and (m) of Code Section
43-34-26.3, relating to delegation of certain medical acts to advanced practice
registered nurses, 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
shall be
deemed
may
be achieved with a sampling of such
records as determined by the delegating physician
and the
advanced practice registered nurse, except that such sampling of records of
patients who receive a prescription drug order for a controlled substance
pursuant to a nurse protocol agreement shall occur on at least a quarterly
basis;
(6)
Provide for 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
and the
advanced practice registered nurse 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;
and
(8)
Be available for review upon written request to the advanced practice registered
nurse by the Georgia Board of Nursing or to the
delegating
physician by the
board;
and. Within
30 days of entering into a nurse protocol agreement, an advanced practice
registered nurse and a delegating physician shall each provide written notice of
such agreement to his or her respective licensing board. The Georgia Board of
Nursing and the board may each create and maintain a roster of their respective
licensees who have entered into a nurse protocol agreement and may publish or
otherwise make available such roster to appropriate agencies or to others as
deemed appropriate by each such board.
(9)
Provide that a patient who receives a prescription drug order for any controlled
substance pursuant to a nurse protocol agreement shall be evaluated or examined
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."
"(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 shall be filed by the delegating
physician with the board 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.
Any
rules promulgated pursuant to this Code section shall be developed by a
committee appointed solely for such purpose. Such committee shall be composed
of three advanced practice registered nurses appointed by the Georgia Board of
Nursing and three physicians appointed by the board, all of whom shall have
experience working with an advanced practice registered nurse and with at least
one such physician practicing within or otherwise connected to the Division of
Public Health of the Department of Human Resources. The members of the
committee, who shall not be members of the board or the Georgia Board of
Nursing, shall serve without compensation, shall serve for terms designated by
their respective appointing boards, and shall serve at the pleasure of such
boards. The Georgia Board of Nursing shall designate one of its appointees to
be the chairperson of the committee during odd-numbered years and the board
shall designate one of its appointees to be the chairperson of the committee
during even-numbered years. The chairperson shall call all meetings of the
committee. Proposed rules and any amendments thereto developed by the committee
shall reflect strict adherence to the language contained in this Code section.
A majority vote of the committee shall be required to submit the initial
proposed rules and any amendments thereto to the board and the Georgia Board of
Nursing. The board and the Georgia Board of Nursing shall meet in a timely
manner after receipt of any such proposed rules or amendments thereto at which
time the board and the Georgia Board of Nursing shall vote to adopt the proposed
rules or amendments thereto of the committee as the rules of the board and the
Georgia Board of Nursing respectively. The initial rules adopted pursuant to
this subsection shall be adopted by the board and the Georgia Board of nursing
no later than December 31, 2007. Such initial rules and subsequent amendments
thereto shall supersede any other rules governing this Code section adopted by
the board or the Georgia Board of Nursing. Unless superseded by earlier action
of the board or the Georgia Board of Nursing, all rules governing this Code
section of the board or the Georgia Board of Nursing promulgated prior to July
1, 2007, shall be repealed on December 31,
2007."
By
striking "This"
on line 25 of page 10
and inserting in its place "Except as
otherwise provided,
this".
By
adding to the end of line 27 of page
4:
Section 1A of this Act shall become effective on July 1, 2007.
Section 1A of this Act shall become effective on July 1, 2007.