SECTION IV. - BOARD POLICY                 Prescriptive Authority for Physician Assistants
General

POLICY: It is the poli...
months prior to the application. The POS will also include a plan for future category 1 CME to maintain
          current ...
2.     List each medication to be used, by type, and the anticipated frequency of use.




2.     Describe the training an...
Effective Date: November 9, 1999
Revision date: February 10, 2004
Revision date: October 6, 2005

HISTORY: In 1995 the boa...
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SECTION IV. - BOARD POLICY Prescriptive Authority for ...

  1. 1. SECTION IV. - BOARD POLICY Prescriptive Authority for Physician Assistants General POLICY: It is the policy of the Board of Licensure in Medicine that the Board will not authorize blanket prescribing of scheduled substances from hospital emergency departments by physician assistants. It is the policy of the Board that Physician Assistants and Advanced Practice Nurses, working under delegation, when working in a hospital setting, may order and dispense schedule II drugs as authorized in their written Plan of Supervision, including emergency department analgesic starter packs (as defined by emergency department protocols). BOARD OF LICENSURE IN MEDICINE Guidelines for Granting PA Schedule II Prescription Authority September 9, 2003 The Board of Licensure in Medicine has accepted, with modifications, the recommendations of the Physician Assistant Advisory Committee dated June 3, 2003 regarding new guidelines which could be used in the evaluation of Physician Assistant (PA) requests for authorization to prescribe schedule II drugs. • The committee recommended that, following specific guidelines, the board should continue to judge individual requests to prescribe schedule II drugs according to specific need rather than give “blanket” authorization to all PA’s. It also concluded that application should be made using a proposed amendment to the Plan of Supervision (POS), with that document including relevant detail regarding what types of drugs may be prescribed, to whom, and in what circumstances. • The committee felt that based on the required curriculum of modern PA training, every PA should be presumed to be adequately trained and capable of managing schedule II pharmaceuticals within their practice. • Finally, the committee recommends that any PA and Primary Supervising Physician (PSP) who believe that the ability to prescribe schedule II drugs is essential to their practice should apply to the Board for authority to prescribe schedule II drugs according to details specified in the submitted POS. PLAN OF SUPERVISION GUIDELINES Guidelines for necessary detailed information to be included in the POS amendment submittal when schedule II drug prescription authority is being sought include the following. The submittal should be on the form prescribed by the Board. 1. A detailed description of the practice setting which will clearly demonstrate the need for the PA to prescribe schedule II drugs for the particular practice. a. PA’s may prescribe schedule II drugs for the treatment of acute and/or chronic pain syndromes and or behavioral/psychiatric conditions in which schedule II drugs are indicated. The POS should implement the Board’s Rule Chapter 11: Use of Controlled Substances in the Treatment of Pain”. b. This authority should exclude the use of narcotics for the treatment of narcotic addiction. 2. A specific list of the types of medication to indicate which drugs are commonly prescribed in the practice. This list should include, by drug type, an approximate frequency of prescription of the drugs to show the level of necessity of schedule II’s in the particular practice. 3. A detailed description of the PA’s current competence base derived from Continuing Medical Education (CME), other formal training, and knowledge from work with the supervising physician; and a detailed plan of education to maintain competence, to show knowledge of use and management of schedule II’s. Category 1 CME specific to the drug types proposed in the POS should have been completed within six (6)
  2. 2. months prior to the application. The POS will also include a plan for future category 1 CME to maintain current competency. 4. A counter signature attesting to agreement and support of the POS by the PSP. An onsite copy of the POS should include the signatures of all secondary supervising physicians with a clear delineation of schedule II prescribing supervision responsibilities. 5. The request for authority to prescribe schedule II drugs shall be renewed every two years from the time granted, unless interim changes are needed. REQUEST ACTION PROCESS The process for requesting, reviewing, and granting authority to prescribe schedule II drugs includes the following steps. 1. Requests for authorization to prescribe schedule II drugs should be submitted by the PA and the PSP by a letter of request, including a proposed POS detailing the need and practice structure to assure patient safety and appropriate treatment. 2. Any PA and PSP who believes that the ability to prescribe schedule II drugs is essential to their practice should be allowed authority to prescribe schedule II drugs according to details specified in the submitted POS. 3. PA’s will be bound by specific criteria established by the board regarding their POS agreement. Within the POS, specific guidelines will be documented in detail concerning when the prescribing of schedule II drugs are considered necessary within the practice. 4. If the board finds the criteria are sufficiently met within the POS, the board may grant the PA limited schedule II prescription authority as defined in the submitted POS. 5. Submit the application fee as specified in a published fee schedule. ATTACHMENT TO PLAN OF SUPERVISION Proposed Effective date: _________________ This proposed addition to our original Plan of Supervision intends to include the ability of the Physician Assistant (PA) to prescribe certain schedule II drugs under the following conditions: 1. Practice setting description (in detail, why is schedule II needed) a. acute or chronic pain b. psychiatric conditions, including Attention Deficit Hyperactivity Disorder (ADHD)
  3. 3. 2. List each medication to be used, by type, and the anticipated frequency of use. 2. Describe the training and knowledge base of the PA, the plan for continuing education related specifically to the drugs being proposed for use, and the plan for supervision/monitoring: 4. Every situation in which schedule II drugs are prescribed must be fully supervised/monitored Describe the plan for supervision/monitoring. This proposal is jointly agreed to and submitted by: PA-C Primary Supervising Physician Agrees and Supports __________________________________ __________________________________ Date: ______________________________ Date: ______________________________ (See also - SECTION I ADVISORY RULINGS PHYSICIAN ASSISTANTS ORDERING SCHEDULE II DRUGS)
  4. 4. Effective Date: November 9, 1999 Revision date: February 10, 2004 Revision date: October 6, 2005 HISTORY: In 1995 the board, responding to a letter of inquiry from Pen Bay Medical Center, stated in a letter interpreting chapters 2 and 3 of the board rules, that Physician Assistants and Nurse Practitioners (then jointly referred to as physician extenders) could order and administer schedule II narcotics to hospital inpatients under the assumption that access to a qualified physician was readily at hand and that supervision of the Extender’s actions were both supervised and carefully reviewed after the fact through quality assurance review processes. In 1999 the Board responding to a letter of inquiry by Maine Coast Memorial Hospital, added that a PA working in the Emergency Department could order and dispense schedule II analgesics, including the dispensing of medication “starter packs” so long as the contents of medication starter packs were delineated in Emergency Department protocols and included only enough medication to allow the patient sufficient time to seek a licensed physician for further diagnosis, treatment plan, and prescription of appropriate medications by a licensed physician. An increasing number of requests for special consideration by individual physician assistants and their supervising physicians has lead to the need for clear guidelines when considering specific requests. In October of 2003, The Board of Licensure in Medicine replaced its decision guidelines. The earlier version read: Schedule II prescribing shall be reviewed and authorized on a case by case basis as called for in Board Rules. In reviewing specific requests by Physicians Assistants and Advanced Practice Nurses working under delegation for the authority to prescribe schedule II drugs, the Board shall consider the following criteria in assessing the appropriateness of the request: 1. Travel distance or lack of access to a licensed physician by the patient or the PA.0. 2. Training and general competence of the Physician Assistant. 3. Specific training and supervision management by the supervising physician. 4. Clearly identified protocols in the written Plan of Supervision. 5. Other situation specific facts or particular needs that will improve patient access to critically needed medications, while assuring the protection of the health and safety of the public. On October 6, 2005 an editorial revision was made by staff. Item 5 under “Request Action Process” was added. It was not submitted for Board approval since it was merely an instructional statement on a form of a current standing expectation that a fee shall be submitted with the application.

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