SCOPE: All Nurse Practitioners in the Emergency Room

EPIC

POLICY DESCRIPTION: Nurse Practitioner / CATEGORY:
APPROVED DATE: / REFERENCE NUMBER:
APPROVED BY: / REVISION DATE:
EFFECTIVE DATE: / PAGE:
WRITTEN DATE: / RETIRED:

SCOPE: All Nurse Practitioners in the Emergency Room

PURPOSE: To ensure all nurse practitioners follow the delegation of service agreement, which defines the working relationship, and delegation of duties between the supervising physician and the nurse practitioner as specified by division rule and shall include:

a) the prescribing of controlled substances:

b) the degree and means of supervision:

c) the frequency and mechanism of chart review

d) procedures addressing situations outside the scope of practice of the nurse

practitioner; and

e) procedures for providing backup for the nurse practitioner in emergency

situations.

POLICY:

1. A nurse practitioner may provide any medical service that is not prohibited

under the agreement or rules adopted under the agreement, and that are:

a) within their scope of protocol as defined by the licensing board of the

State of Utah;

b) within the scope of practice as allowed by hospital by-laws at the

hospital where they are practicing;

c) within the nurse practitioners skills and scope of competence;

d) within the usual scope of practice of the nurse practitioners supervising

physician;

e) provided under the supervision of a EPIC emergency physician and in

accordance with the State of Utah delegation of service agreement,

listed as:

-services with chart review by physician at later time

-only after consultation with supervising physician at time of service

-only under the direct supervision of an emergency physician.

2. A nurse practitioner, in accordance with a delegation of service agreement,

may prescribe or administer an appropriate controlled substance if:

a) the nurse practitioner holds a Utah controlled substance license and a

DEA registration;

b) the prescription or administration of the controlled substance is within

the prescriptive practice of the supervising physician and also within the

delegated prescribing stated in the delegation of services agreement;

c) the supervising physician cosigns all medical charts containing the

records of a prescription Schedule 2 or Schedule 3 controlled substance

made by the nurse practitioner.

3. Case review will be conducted on a daily and monthly basis.

a) A physician from each group will be required to cosign all nurse

practitioner charts on a daily basis.

b) The QA person for each group will do a monthly review on all charts

forwarded to them by the daily co-signature review. Issues identified

will be addressed with the nurse practitioner, discussed in the monthly

staff meeting if appropriate, and/or forwarded to the EPIC quality

assurance group for review.

4. Nurse practitioners will be required to participate in a supervised orientation

program, and receive appropriate training and continuing education in providing

emergency care.

5. A nurse practitioner shall, while practicing as a nurse practitioner, wear an

identification badge showing his/her license classification as a practicing

nurse practitioner.