Further Information on SB 110

Information regarding Senate Bill (SB) 110 continues to emerge. Please see the following missive from the Ohio Board of Nursing:

SB 110, passed by the 131st General Assembly, authorizes CTP [Certificate to Prescribe] holders to delegate non-controlled drug administration under specified circumstances to unlicensed persons. Please click on the links below to access the statute and the Legislative Services Commission (LSC) Analysis for further details.

Effective October 15, 2015, APRNs [Advanced Practice Registered Nurses] holding prescriptive authority are authorized to delegate medication administration as specified in Sections 4723.48(C) and 4723.489, Ohio Revised Code (ORC). In doing so, APRNs must comply with standards of safe practice, including delegation, set forth in the law and rules, including Chapter 4723-13, Ohio Administrative Code (OAC). Please be aware that the new authorization in ORC Section 4723.48(C) supersedes rule language currently found in Chapter 4723-13, OAC, with respect to APRN prescribers, which previously limited the types of medication that could be delegated to an unlicensed person.

SB 110 authorizes the Board to adopt rules establishing standards and procedures for APRN delegation. The Board will convene a Board Committee on Practice meeting on January 20, 2016 at noon at the Board office to gather public input regarding the need for administrative rules.

If you have questions, please email practice@nursing.ohio.gov. To access the Ohio Revised Code and the Ohio Administrative Code, go to the Board website at www.nursing.ohio.gov.

https://www.legislature.ohio.gov/legislation/legislation-summary?id=GA131-SB-110

https://www.legislature.ohio.gov/legislation/legislation-documents?id=GA131-SB-110

Posted in On the Job, Scope of Practice, SB 110, medication administration, delegation | Tagged , , , , | 1 Comment

Supervision in an Office Setting

I recently received the following question:

I work in a medical specialty office. We have four CMAs (AAMA) and six nurses. Is it legal for a medical assistant to supervise a nurse in an office setting?

Here is my response:

Thank you for your question. It is my legal opinion that a medical assistant is permitted to supervise a registered nurse and a licensed practical/vocational nurse in regard to non-clinical matters–such as work schedule, office attire, compliance with government regulations, and administrative protocol. A medical assistant is not permitted to supervise an RN or an LP/VN in regard to clinical matters. This is due to the fact that clinical supervision of a nurse may require the medical assistant to exercise independent professional judgment, or to make clinical assessments, evaluations, or interpretations.

Posted in On the Job, Professional Identity, Scope of Practice, Clinical Assessment | Tagged , , , | 8 Comments

Ohio Passes Senate Bill 110

I am happy to report that the Ohio Legislature has passed Senate Bill (SB) 110, which has now been signed into law by Governor John Kasich. The bill becomes effective 90 days after signing.

This bill gives nurse practitioners (NPs) and physician assistants (PAs) the ability to delegate medication administration to unlicensed allied health professionals, such as medical assistants working under their supervision in outpatient settings.

See the following relevant passages from SB 110, the first from page 20 of the attached, which is the version that has passed both Houses of the Ohio legislature:

Sec. 4723.48. (A) A clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner seeking authority to prescribe drugs and therapeutic devices shall file with the board of nursing a written application for a certificate to prescribe. The board of nursing shall issue a certificate to prescribe to each applicant who meets the requirements specified in section 4723.482 or 4723.485 of the Revised Code. …

(C)(1) The holder of a certificate issued under this section may delegate to a person not otherwise authorized to administer drugs the authority to administer to a specified patient a drug, other than a controlled substance, listed in the formulary established in rules adopted under section 4723.50 of the Revised Code. The delegation shall be in accordance with division (C)(2) of this section and standards and procedures established in rules adopted under division (Q) of section 4723.07 of the Revised Code.

(2) Prior to delegating the authority, the certificate holder shall do both of the following:

(a) Assess the patient and determine that the drug is appropriate for the patient;

(b) Determine that the person to whom the authority will be delegated has met the conditions specified in division (D) of section 4723.489 of the Revised Code.

Note also the following on pages 22 and 23:

Sec. 4723.489. A person not otherwise authorized to administer drugs may administer a drug to a specified patient if all of the following conditions are met:

(A) The authority to administer the drug is delegated to the person by an advanced practice registered nurse who is a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner and holds a certificate to prescribe issued under section 4723.48 of the Revised Code.

(B) The drug is listed in the formulary established in rules adopted under section 4723.50 of the Revised Code but is not a controlled substance and is not to be administered intravenously.

(C) The drug is to be administered at a location other than a hospital inpatient care unit, as defined in section 3727.50 of the Revised Code; a hospital emergency department or a freestanding emergency department; or an ambulatory surgical facility, as defined in section 3702.30 of the Revised Code.

(D) The person has successfully completed education based on a recognized body of knowledge concerning drug administration and demonstrates to the person’s employer the knowledge, skills, and ability to administer the drug safely.

(E) The person’s employer has given the advanced practice registered nurse access to documentation, in written or electronic form, showing that the person has met the conditions specified in division (D) of this section.Sub. S. B. No. 110 131st G.A. 23

(F) The advanced practice registered nurse is physically present at the location where the drug is administered.

Note the following from pages 36 and 37:

Sec. 4730.203. (A) Acting pursuant to a supervision agreement, a physician assistant may Sub. S. B. No. 110 131st G.A. 37

delegate performance of a task to implement a patient’s plan of care or, if the conditions in division (C) of this section are met, may delegate administration of a drug. Subject to division (D) of section 4730.03 of the Revised Code, delegation may be to any person. The physician assistant must be physically present at the location where the task is performed or the drug administered.

(B) Prior to delegating a task or administration of a drug, a physician assistant shall determine that the task or drug is appropriate for the patient and the person to whom the delegation is to be made may safely perform the task or administer the drug.

(C) A physician assistant may delegate administration of a drug only if all of the following conditions are met:

(1) The physician assistant has been granted physician-delegated prescriptive authority.

(2) The drug is included in the formulary established under division (A) of section 4730.39 of the Revised Code.

(3) The drug is not a controlled substance.

(4) The drug will not be administered intravenously.

(5) The drug will not be administered in a hospital inpatient care unit, as defined in section 3727.50 of the Revised Code; a hospital emergency department; a freestanding emergency department; or an ambulatory surgical facility licensed under section 3702.30 of the Revised Code.

(D) A person not otherwise authorized to administer a drug or perform a specific task may do so in accordance with a physician assistant’s delegation under this section.

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Medical Assistants as Home Health Aides

Because of the great versatility of medical assistants, questions have arisen about whether medical assistants—especially CMAs (AAMA)—are permitted to work as home health aides (HHAs).

Most states have laws defining what qualifications an individual must have in order to work as a home health aide.  These laws also assign responsibility for the HHA program to an existing state agency, such as the department of health.  CMAs (AAMA) would have the opportunity to ask this agency whether their education in a CAAHEP or ABHES accredited medical assisting program, and their demonstration of didactic knowledge by passing the CMA (AAMA) Certification Examination, would meet or exceed the requirements of the home health aide law.  If the agency accepts the CMA (AAMA) credential in lieu of home health aide training, the CMA (AAMA) would then be able to work as an HHA.

Posted in Certification and the CMA (AAMA) Credential, On the Job, Professional Identity, Scope of Practice | Tagged , , , , , , , , , | Leave a comment

Medical Assistants as Scribes

Recently I received the following first-time question:

Is it illegal for a medical assistant to also function as the physician’s scribe? The office manager told me that a new law states that a medical assistant either can function as a scribe or as a medical assistant, but cannot assume both roles.

I am not aware of any state or federal laws that forbid a medical assistant from also functioning as the physician’s scribe. Medical assistants who have graduated from a CAAHEP or ABHES accredited medical assisting program and who hold a current CMA (AAMA) credential should be knowledgeable in scribing for the physician or other provider.

Posted in Certification and the CMA (AAMA) Credential, On the Job, Professional Identity, Scope of Practice | Tagged , , , , , | 9 Comments