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H.B. 139





Chief Sponsor: Paul Ray

Senate Sponsor: ____________

             7      LONG TITLE
             8      General Description:
             9          This bill allows an advanced practice registered nurse to prescribe a schedule II or III
             10      controlled substance without supervision by a consulting physician.
             11      Highlighted Provisions:
             12          This bill:
             13          .    allows an advanced practice registered nurse to prescribe a schedule II or III
             14      controlled substance without supervision by a consulting physician; and
             15          .    makes technical and conforming amendments.
             16      Money Appropriated in this Bill:
             17          None
             18      Other Special Clauses:
             19          None
             20      Utah Code Sections Affected:
             21      AMENDS:
             22           58-31b-102 , as last amended by Laws of Utah 2011, Chapter 366
             23           58-31b-502 , as last amended by Laws of Utah 2012, Chapter 234
             24           58-31d-103 , as last amended by Laws of Utah 2007, Chapter 57
             26      Be it enacted by the Legislature of the state of Utah:
             27          Section 1. Section 58-31b-102 is amended to read:

             28           58-31b-102. Definitions.
             29          In addition to the definitions in Section 58-1-102 , as used in this chapter:
             30          (1) "Administrative penalty" means a monetary fine or citation imposed by the division
             31      for acts or omissions determined to constitute unprofessional or unlawful conduct in
             32      accordance with a fine schedule established by rule and as a result of an adjudicative
             33      proceeding conducted in accordance with Title 63G, Chapter 4, Administrative Procedures Act.
             34          (2) "Applicant" means a person who applies for licensure or certification under this
             35      chapter by submitting a completed application for licensure or certification and the required
             36      fees to the department.
             37          (3) "Approved education program" means a nursing education program that meets the
             38      minimum standards for educational programs established under this chapter and by division
             39      rule in collaboration with the board.
             40          (4) "Board" means the Board of Nursing created in Section 58-31b-201 .
             41          [(5) "Consultation and referral plan" means a written plan jointly developed by an
             42      advanced practice registered nurse and a consulting physician that permits the advanced
             43      practice registered nurse to prescribe schedule II-III controlled substances in consultation with
             44      the consulting physician.]
             45          [(6) "Consulting physician" means a physician and surgeon or osteopathic physician
             46      and surgeon licensed in accordance with this title who has agreed to consult with an advanced
             47      practice registered nurse with a controlled substance license, a DEA registration number, and
             48      who will be prescribing schedule II-III controlled substances.]
             49          [(7)] (5) "Diagnosis" means the identification of and discrimination between physical
             50      and psychosocial signs and symptoms essential to the effective execution and management of
             51      health care.
             52          [(8)] (6) "Examinee" means a person who applies to take or does take any examination
             53      required under this chapter for licensure.
             54          [(9)] (7) "Licensee" means a person who is licensed or certified under this chapter.
             55          [(10)] (8) "Long-term care facility" means any of the following facilities licensed by
             56      the Department of Health pursuant to Title 26, Chapter 21, Health Care Facility Licensing and
             57      Inspection Act:
             58          (a) a nursing care facility;

             59          (b) a small health care facility;
             60          (c) an intermediate care facility for people with an intellectual disability;
             61          (d) an assisted living facility Type I or II; or
             62          (e) a designated swing bed unit in a general hospital.
             63          [(11)] (9) "Medication aide certified" means a certified nurse aide who:
             64          (a) has a minimum of 2,000 hours experience working as a certified nurse aide;
             65          (b) has received a minimum of 60 hours of classroom and 40 hours of practical training
             66      that is approved by the division in collaboration with the board, in administering routine
             67      medications to patients or residents of long-term care facilities; and
             68          (c) is certified by the division as a medication aide certified.
             69          [(12)] (10) (a) "Practice as a medication aide certified" means the limited practice of
             70      nursing under the supervision, as defined by the division by administrative rule, of a licensed
             71      nurse, involving routine patient care that requires minimal or limited specialized or general
             72      knowledge, judgment, and skill, to an individual who:
             73          (i) is ill, injured, infirm, has a physical, mental, developmental, or intellectual
             74      disability; and
             75          (ii) is in a regulated long-term care facility.
             76          (b) "Practice as a medication aide certified":
             77          (i) includes:
             78          (A) providing direct personal assistance or care; and
             79          (B) administering routine medications to patients in accordance with a formulary and
             80      protocols to be defined by the division by rule; and
             81          (ii) does not include assisting a resident of an assisted living facility, a long term care
             82      facility, or an intermediate care facility for people with an intellectual disability to self
             83      administer a medication, as regulated by the Department of Health by administrative rule.
             84          [(13)] (11) "Practice of advanced practice registered nursing" means the practice of
             85      nursing within the generally recognized scope and standards of advanced practice registered
             86      nursing as defined by rule and consistent with professionally recognized preparation and
             87      education standards of an advanced practice registered nurse by a person licensed under this
             88      chapter as an advanced practice registered nurse. Advanced practice registered nursing
             89      includes:

             90          (a) maintenance and promotion of health and prevention of disease;
             91          (b) diagnosis, treatment, correction, consultation, and referral for common health
             92      problems;
             93          (c) prescription or administration of prescription drugs or devices including:
             94          (i) local anesthesia; and
             95          (ii) schedule [IV-V] II-V controlled substances; [and] or
             96          [(iii) schedule II-III controlled substances in accordance with a consultation and
             97      referral plan; or]
             98          (d) the provision of preoperative, intraoperative, and postoperative anesthesia care and
             99      related services upon the request of a licensed health care professional by an advanced practice
             100      registered nurse specializing as a certified registered nurse anesthetist, including:
             101          (i) preanesthesia preparation and evaluation including:
             102          (A) performing a preanesthetic assessment of the patient;
             103          (B) ordering and evaluating appropriate lab and other studies to determine the health of
             104      the patient; and
             105          (C) selecting, ordering, or administering appropriate medications;
             106          (ii) anesthesia induction, maintenance, and emergence, including:
             107          (A) selecting and initiating the planned anesthetic technique;
             108          (B) selecting and administering anesthetics and adjunct drugs and fluids; and
             109          (C) administering general, regional, and local anesthesia;
             110          (iii) postanesthesia follow-up care, including:
             111          (A) evaluating the patient's response to anesthesia and implementing corrective
             112      actions; and
             113          (B) selecting, ordering, or administering the medications and studies listed in
             114      Subsection [(13)] (11)(d); and
             115          (iv) other related services within the scope of practice of a certified registered nurse
             116      anesthetist, including:
             117          (A) emergency airway management;
             118          (B) advanced cardiac life support; and
             119          (C) the establishment of peripheral, central, and arterial invasive lines; and
             120          (v) for purposes of Subsection [(13)] (11)(d), "upon the request of a licensed health

             121      care professional":
             122          (A) means a health care professional practicing within the scope of the health care
             123      professional's license, requests anesthesia services for a specific patient; and
             124          (B) does not require an advanced practice registered nurse specializing as a certified
             125      registered nurse anesthetist to [enter into a consultation and referral plan or] obtain additional
             126      authority to select, administer, or provide preoperative, intraoperative, or postoperative
             127      anesthesia care and services.
             128          [(14)] (12) "Practice of nursing" means assisting individuals or groups to maintain or
             129      attain optimal health, implementing a strategy of care to accomplish defined goals and
             130      evaluating responses to care and treatment. The practice of nursing requires substantial
             131      specialized or general knowledge, judgment, and skill based upon principles of the biological,
             132      physical, behavioral, and social sciences, and includes:
             133          (a) initiating and maintaining comfort measures;
             134          (b) promoting and supporting human functions and responses;
             135          (c) establishing an environment conducive to well-being;
             136          (d) providing health counseling and teaching;
             137          (e) collaborating with health care professionals on aspects of the health care regimen;
             138          (f) performing delegated procedures only within the education, knowledge, judgment,
             139      and skill of the licensee; and
             140          (g) delegating nurse interventions that may be performed by others and are not in
             141      conflict with this chapter.
             142          [(15)] (13) "Practice of practical nursing" means the performance of nursing acts in the
             143      generally recognized scope of practice of licensed practical nurses as defined by rule and as
             144      provided in this Subsection [(15)] (13) by a person licensed under this chapter as a licensed
             145      practical nurse and under the direction of a registered nurse, licensed physician, or other
             146      specified health care professional as defined by rule. Practical nursing acts include:
             147          (a) contributing to the assessment of the health status of individuals and groups;
             148          (b) participating in the development and modification of the strategy of care;
             149          (c) implementing appropriate aspects of the strategy of care;
             150          (d) maintaining safe and effective nursing care rendered to a patient directly or
             151      indirectly; and

             152          (e) participating in the evaluation of responses to interventions.
             153          [(16)] (14) "Practice of registered nursing" means performing acts of nursing as
             154      provided in this Subsection [(16)] (14) by a person licensed under this chapter as a registered
             155      nurse within the generally recognized scope of practice of registered nurses as defined by rule.
             156      Registered nursing acts include:
             157          (a) assessing the health status of individuals and groups;
             158          (b) identifying health care needs;
             159          (c) establishing goals to meet identified health care needs;
             160          (d) planning a strategy of care;
             161          (e) prescribing nursing interventions to implement the strategy of care;
             162          (f) implementing the strategy of care;
             163          (g) maintaining safe and effective nursing care that is rendered to a patient directly or
             164      indirectly;
             165          (h) evaluating responses to interventions;
             166          (i) teaching the theory and practice of nursing; and
             167          (j) managing and supervising the practice of nursing.
             168          [(17)] (15) "Routine medications":
             169          (a) means established medications administered to a medically stable individual as
             170      determined by a licensed health care practitioner or in consultation with a licensed medical
             171      practitioner; and
             172          (b) is limited to medications that are administered by the following routes:
             173          (i) oral;
             174          (ii) sublingual;
             175          (iii) buccal;
             176          (iv) eye;
             177          (v) ear;
             178          (vi) nasal;
             179          (vii) rectal;
             180          (viii) vaginal;
             181          (ix) skin ointments, topical including patches and transdermal;
             182          (x) premeasured medication delivered by aerosol/nebulizer; and

             183          (xi) medications delivered by metered hand-held inhalers.
             184          [(18)] (16) "Unlawful conduct" is as defined in Sections 58-1-501 and 58-31b-501 .
             185          [(19)] (17) "Unlicensed assistive personnel" means any unlicensed person, regardless
             186      of title, to whom tasks are delegated by a licensed nurse as permitted by rule and in accordance
             187      with the standards of the profession.
             188          [(20)] (18) "Unprofessional conduct" is as defined in Sections 58-1-501 and
             189      58-31b-502 and as may be further defined by rule.
             190          Section 2. Section 58-31b-502 is amended to read:
             191           58-31b-502. Unprofessional conduct.
             192          "Unprofessional conduct" includes:
             193          (1) failure to safeguard a patient's right to privacy as to the patient's person, condition,
             194      diagnosis, personal effects, or any other matter about which the licensee is privileged to know
             195      because of the licensee's or person with a certification's position or practice as a nurse or
             196      practice as a medication aide certified;
             197          (2) failure to provide nursing service or service as a medication aide certified in a
             198      manner that demonstrates respect for the patient's human dignity and unique personal character
             199      and needs without regard to the patient's race, religion, ethnic background, socioeconomic
             200      status, age, sex, or the nature of the patient's health problem;
             201          (3) engaging in sexual relations with a patient during any:
             202          (a) period when a generally recognized professional relationship exists between the
             203      person licensed or certified under this chapter and patient; or
             204          (b) extended period when a patient has reasonable cause to believe a professional
             205      relationship exists between the person licensed or certified under the provisions of this chapter
             206      and the patient;
             207          (4) (a) as a result of any circumstance under Subsection (3), exploiting or using
             208      information about a patient or exploiting the licensee's or the person with a certification's
             209      professional relationship between the licensee or holder of a certification under this chapter and
             210      the patient; or
             211          (b) exploiting the patient by use of the licensee's or person with a certification's
             212      knowledge of the patient obtained while acting as a nurse or a medication aide certified;
             213          (5) unlawfully obtaining, possessing, or using any prescription drug or illicit drug;

             214          (6) unauthorized taking or personal use of nursing supplies from an employer;
             215          (7) unauthorized taking or personal use of a patient's personal property;
             216          (8) knowingly entering into any medical record any false or misleading information or
             217      altering a medical record in any way for the purpose of concealing an act, omission, or record
             218      of events, medical condition, or any other circumstance related to the patient and the medical or
             219      nursing care provided;
             220          (9) unlawful or inappropriate delegation of nursing care;
             221          (10) failure to exercise appropriate supervision of persons providing patient care
             222      services under supervision of the licensed nurse;
             223          (11) employing or aiding and abetting the employment of an unqualified or unlicensed
             224      person to practice as a nurse;
             225          (12) failure to file or record any medical report as required by law, impeding or
             226      obstructing the filing or recording of such a report, or inducing another to fail to file or record
             227      such a report;
             228          (13) breach of a statutory, common law, regulatory, or ethical requirement of
             229      confidentiality with respect to a person who is a patient, unless ordered by a court;
             230          (14) failure to pay a penalty imposed by the division;
             231          [(15) prescribing a schedule II-III controlled substance without a consulting physician
             232      or outside of a consultation and referral plan;]
             233          [(16)] (15) violating Section 58-31b-801 ; and
             234          [(17)] (16) violating the dispensing requirements of Section 58-17b-309 or
             235      58-17b-309.5 , if applicable.
             236          Section 3. Section 58-31d-103 is amended to read:
             237           58-31d-103. Rulemaking authority -- Enabling provisions.
             238          (1) The division may adopt rules necessary to implement Section 58-31d-102 .
             239          (2) As used in Article VIII (1) of the Advanced Practice Registered Nurse Compact,
             240      "head of the licensing board" means the executive administrator of the Utah Board of Nursing.
             241          (3) For purposes of the Advanced Practice Registered Nurse Compact, "APRN" as
             242      defined in Article II (1) of the compact includes an individual who is:
             243          (a) licensed to practice under Subsection 58-31b-301 (2) as an advanced practice
             244      registered nurse; or

             245          (b) licensed to practice under Section 58-44a-301 as a certified nurse midwife.
             246          (4) An APRN practicing in this state under a multistate licensure privilege may only be
             247      granted prescriptive authority if that individual can document completion of graduate level
             248      course work in the following areas:
             249          (a) advanced health assessment;
             250          (b) pharmacotherapeutics; and
             251          (c) diagnosis and treatment.
             252          (5) (a) An APRN practicing in this state under a multistate privilege who seeks to
             253      obtain prescriptive authority must:
             254          (i) meet all the requirements of Subsection (4) and this Subsection (5); and
             255          (ii) be placed on a registry with the division.
             256          (b) To be placed on a registry under Subsection (5)(a)(ii), an APRN must:
             257          (i) submit a form prescribed by the division;
             258          (ii) pay a fee; and
             259          (iii) if prescribing a controlled substance:
             260          (A) obtain a controlled substance license as required under Section 58-37-6 ; and
             261          (B) if prescribing a Schedule II or III controlled substance as a nurse midwife, have a
             262      consultation and referral plan with a physician licensed in Utah as required under Subsection
             263      58-31b-102 (13)(c)(iii) or 58-44a-102 (8)(b)(iii)(C).

Legislative Review Note
    as of 2-10-14 5:47 PM

Office of Legislative Research and General Counsel

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