Advanced Practice Nurse (APN) CRNP Check Sheet (Functions & Procedures and Additional Duties)

Transcription

1 Advanced Practice Nurse (APN) CRNP Check Sheet (Functions & Procedures and Additional Duties) Name/Caregiver : Prescriptive Privileges: YES NO ACNP ANP FNP GNP NNP ACPNP PNP WHNP Acute Care Adult Family Geriatric Neonatal Acute Care Pediatrics Pediatric Women s Health Adult Pediatric Certifications: Approval Date: Collaborative Practice Physician: Specialty/Location Backup MDs: Core Privileges can be performed upon: 1) Completing a CRNP program, 2) Successfully passing the appropriate certifying examination, 3) State Licensure; and 4)Collaborating MD Approval by: The Advance Practice Nurse and Physician Assistant Oversight Committee for UAB Hospital, Highlands, and The Kirklin Clinic. The Medical & Dental Staff Credentialing Committee at Callahan Eye Foundation Hospital. CERTIFIED REGISTERED NURSE PRACTITIONER PROTOCOL -ABN last revised Apr 2009 The certified nurse practitioner (CRNP) may work in any setting consistent with the collaborating physician's areas of practice and function within the CRNP's specialty scope of practice. The CRNP's scope of practice shall be defined as those functions and procedures for which the CRNP is qualified by formal education, clinical training, area of certification and experience to perform. The following represents the functions which may be performed by the CRNP and do not require individual request or designated approval as Additional Duties in the collaborative practice agreement:: o Perform complete, detailed and accurate health histories, review patient records, develop comprehensive medical and nursing status reports, and order laboratory, radiological and diagnostic studies appropriate for complaint, age, race, sex and physical condition of the patient. o Perform comprehensive physical examinations and assessments, including bimanual pelvic examination and record pertinent data in appropriate medical records. o Formulate medical and nursing diagnoses and institute therapy or referrals of patients to the appropriate health care facilities, agencies, other resources of the community or physician. o Plan and initiate a therapeutic regimen which includes ordering legend drugs, medical devices, nutrition and supportive services. o Institute emergency measures and emergency treatment or appropriate stabilization measures in situations such as cardiac arrest, shock, hemorrhage, convulsions, poisoning, allergic reactions and emergency obstetric delivery. o Arrange inpatient admissions and discharges at the direction of the collaborating physician; write admission orders for inpatients as directed by the physician and subsequent orders in accordance with established protocols and institutional policies; issue diagnostic and therapeutic orders including orders for legend drugs; perform rounds and record appropriate patient progress notes; compile detailed narrative and case summaries; complete forms pertinent to patients' medical records. o Interpret and analyze patient data to determine patient status, patient management and treatment. o o Provide instructions and guidance regarding health care and health care promotion to patients/family/ significant others. In addition to functions/procedures within the scope of RN practice, perform or assist with laboratory procedures and technical procedures, which include but are not limited to the following: *Wet mount microscopy and interpretation of vaginal swabs *Debridement of wounds *Microscopic urinalysis *Foreign body removal *Aspiration, incision and drainage of superficial lesions *Biopsy of superficial lesions *Cast application/removal *Suturing of superficial lacerations *Initial x-ray interpretation, with subsequent required physician interpretation *Management and removal of arterial and central venous lines

2 Arterial Lines, Insertion of & Radial Artery Catheterization (ABN# 7 & 92) - Allowed generally with documented training ACNP, ACPNP, ANP, FNP, GNP, NNP, OB/GYN, PNP, WHP - Femoral Catheterization Not Approved Arthrocentesis, Injection of Shoulder, Elbow, Knee & Ankle: Greater Trochanteric Bursa (Excludes Injection of Hip Joint) (ABN# 10) - ACNP, ANP, FMP, & GNP Allowed with documented training. 4/96 a) Physician requests approval from ABME to supervise training of CRNP. If approved: b) CRNP and Physician submit application to add the procedure to the CRNP s protocol. c) Documentation of instructions and d) Supervised practice, using ABN/ABME form for documentation. Submit to ABN. e) Joint Committee review of documented practice prior to final recommendation for approval. Audiometry / Audiogram, Interpretation of (ABN# 11) - Physician over-read understood, ACNP, ACPNP, ANP, FNP, GNP, PNP Baclofen Intrathecal Pump, Refill (ABN# 128) - Allowed for specified CRNP as indicated. BCA Application to Condyloma (ABN# 12)- Allowed for specified CRNP areas as indicated) Bimanual Pelvic Exam (ABN# 13)- (Allowed for specified CRNP areas as indicated) approved for all NP specialities Bone Marrow Aspiration / Biopsy (Iliac Crest) (ABN# 15)- (Allowed with documented training) ACPNP Casting / Splinting (ABN# 18) - (Generally approved for all except for OB/GYN & PNP allow for specified CRNP s) Cervical Biopsy (ABN# 19) WHNP only, Use of Pipelle only at direction of MD: MD immediately available; interprets results. Cervical Biopsy With Colposcopy (ABN# 20) - WHNP only, Use of Pipelle only at direction of MD: MD immediately available; interprets results. Cervical Cap Fitting (ABN# 21) - Allow for specific CRNP, or areas as indicated - OB/GYN & WHP; approved for WHNP specialities Chest Tube Insertion / Thoracostomy -(ABN# 22) ACNP, ACPNP, NNP, no to others Chest Tube / Pleural Cath Insertion (ABN# 23) - approved for NNP specialties. Chest Tube / Pleural Cath Removal (ABN# 133) - Allowed generally with document Training; approved for ACNP, ACPNP, NNP specialties Colposcopy, Colposcopically-directed Cervical Biopsy and Endocervical Curettage (ABN# 148) - WHNP Allowed with Documented training a) Documentation of ASCCP circullum and admission to monitorship. b) CRNP and Physician submit application to add the procedure to the protocol prior to starting ASCCP mentored practice. c) Completion of ASCCP monitorship then JC review for final approval. Cryotherapy of Non-Pigmented Superficial Lesions (ABN# 136) - ACPNP, FNP only Allowed under special circumstances only. Document formal training and MD immediately available. Central Venous line (CVL) insertion at jugular site is permissible (ABN# 29, 53, 69 & 137) - Requires application with protocol, review by the Joint Committee and approval by Board of Nursing and Board of Medical Examiners prior to performing. Contact the Board of Nursing for parameters. Specific Site & Limitations. Allow for special circumstances only: ACNP, ACPNP, ANP, & FNP. Critical care or ER setting. Document education & Training. *Insertion of Central line, Subclavian & Femoral (NOT PERMITTED) Page 2 of 6

3 Percutaneous Catheter Insertion & Removal (Per-Q cath CV line) (ABN# 84) - RN Scope of Practice; UAB Policy requires completion of special training Diaphragm Fitting -(ABN# 30) - Allowed for specified CRNP areas as indicated; ANP, FNP, OB/GYN, WHP, approved for WHNP specialties Ductal Lavage, Breast, For Random Screening (ABN# 129) - FNP - Allowed for specific CRNP s as indicated Echocardiography, Technical Component (ABN# 139) - ACNP & ANP - Allowed generally with documented training. Endometrial Biopsy /Sampling Pipelle (ABN# 36) - Allow under special circumstances. Document formal training & MD immediately available; WHP & Use of Pipelle at direction of MD, evidence of MD review pre-op indications & post-results, & MD available to assist for FNP with documented training) approved for WHNP specialties. Endotracheal Intubation (ABN# 37) - RN Scope of Practice per ABN, Emergency Only; UAB Policy will not allow except for NNP s Epicardial Pacing Wires, Removal (ABN# 147) - ACNP, ANP, FNP Allowed under special circumstances; Jan 2006 Documentation of organized instruction and supervised practice, in collaboration with cardiac surgeon, and a MD must be immediately available. Exchange Transfusion (Partial & Double Lumen) (ABN# 39) - NNP, Allowed for specified CRNP) External cardiac pacing (ABN# 40) - ACNP, Others Joint Committee Review Femoral Vein Cannulation (or Catheterization) In Hemodialysis Setting (ABN# 41) - RN s In Dialysis settings only; ANP & FNP are allowed with documented Training for Dialysis settings ABN Decision for RN. Note: This procedure has not been requested since 2000) Flexible Sigmoidoscopy (ABN# 42) - Allowed generally with documented training, supervision, certification & available backup; Not allowed for NNP, PNP Graded Exercise Testing (GXT) Treadmill / Thallium Scans (ABN# 44) - RN Scope of Practice. MD Immediately available. Separate Rx approval required for CRNP prescribing radioactive agents Hemapheresis - Hemopoietic Stem Cell Collection Leukophoresis (ABN# 45) - Allow with documented training for Oncology practice, Not allowed for WHP Initial EKG Interpretation - 12 Lead (ABN# 47) - Allowed for ACNP, Others JC Review Initiation & maintenance of ventilatory support & breathing (non-elective emergency situation) (ABN# 49) - Allow under special circumstances only; A CNP, ACPNP, ANP, FNP, & PNP Initiation of Total Parenteral Nutrition (ABN# 50) - NNP with Documented Training & MD review. Allow under special circumstances only; Case-by-Case review by Joint Committee. Document training & MD review Insertion of Intrauterine Devices (ABN# 56) - Allowed for specified CRNP or areas as indicated - OB/GYN, WHP & approved for WHNP specialities 7/18/07 Joint Meeting. Page 3 of 6

4 Intrathecal Admin of Chemotherapy Via Omaya Reservoir (ABN# 63) - Allow generally with documented training; Oncology -- ACNP, ANP, & PNP; Others Joint Committee Review Intrauterine Insemination (ABN# 64) - Allowed for specified CRNP FNP, OB/GYN, WHP; approved for WHNP specialties. Intraosseous Catheter Insertion (ABN# 65) - Allow under special circumstances. Document formal training & MD immediately available. Approved if in trauma practice & appropriate training. PALS/NALS; select RN s and ACNP, ANP, FNP, & PNP Liquid Nitrogen Treatment - Superficial Lesions (ABN# 70) - Allow under special circumstances only; ANP, FNP, GNP, OB/GYN, WHP. Lumbar Puncture (ABN# 71) - Allowed for specified CRNP- ACNP, ACPNP, ANP, NNP, PNP allowed with documentation; Others Joint Committee review with documentation of competency) approved for NNP specialties. Microscopic Urinalysis (ABN# 73) - approved for all NP specialties. Nasal Cautery With Silver Nitrate Application for Epistaxis (ABN# 140) - FNP - Allowed with Documented training Nasal Packing, Anterior for Control of Epistaxis (ABN# 141) - FNP 11/2005 Allowed with Documented training Needle Aspiration of Brest Mass (ABN# 74) NOT ALLOWED But Approved for CRNP at UAB 01/03 Needle Decompression Of Tension Pneumothorax (Thoracostomy) (ABN# 76) - Allowed for specified CRNP ACNP, ANP, FNP & NNP; Aeromedical Trama practice with appropriate training ; ACNP approved for all NNP specialties. Needle Insertion / Transtracheal Jet Insufflations (ABN# 77) - Allowed for specified CRNP ACNP, ANP, & FNP; Trauma practice with appropriate Norplant Insertion (ABN# 78) - Allowed for specified CRNP ANP, FNP & OB/GYN, & WHP Norplant Removal (ABN# 79) - Allowed under specific Circumstances, Documented formal training & MD immediately available - ANP, FNP & OB/GYN, & WHP Paracervical Block (ABN# 83) - Case by Case consideration for PNP & WHP Pelvic Floor Rehab with Electrical Stim & Biofeedback (ABN# 127) - Allowed with documented training; not for NNP Podophyllin or Trichloroacetic Acid Application warts (ABN# 89) Allowed for specified CRNP ACNP, ANP, FNP, GNP, OB/GYN, PNP, WHP; approved for WHNP specialties. Pulmonary Spirometry, Interpretation of (ABN# 90) - Allow generally with documented training; ACNP, ANP, FNP, GNP, & PNP Punch Biopsies (Simple Skin Biopsy) (ABN# 91) - Allowed for specified CRNP ANP, FNP, GNP, OB/GYN, & WHP; approved for WHNP specialties Random Fine Needle Aspiration of Breast (ABN# 132) - FNP Allowed under special circumstances. Document formal training and MD immediately available. Page 4 of 6

5 Removal of Benign Lesions After Physician Evaluation (ABN# 131) - Allowed under special circumstances. Document formal training and MD immediately available.) Removal Of Extra Digits And Skin Tags (ABN# 95 & 130) - Allowed for specified CRNP NNP Allowed under special circumstances. Document formal training and MD immediately available. Approved for NNP specialties Removal of Toenails (ABN# 96) - Allow under special circumstances, To Joint Committee - ACNP, ANP, FNP, & GNP Saline Infusion Hysterosonography - (ABN# 123) - Allow for specified CRNP or areas as indicated - FNP, WHP, Physician Review of all records. Sclerotherapy of Telangiectasis with Hypertonic Saline (ABN# 142) - Allowed with documented training. Physician evaluation prior to treatment Shave Biopsy of Superficial Lesions (ABN# 134) -(FNP Allow under special circumstances. Document formal training and MD immediately available. Suprapubic Urine (Bladder) Aspiration (ABN# 104) - NNP only; approved for NNP specialties. Tattooing Of Nipple Areolar Complex (ABN# 106) RN with special training in micropigmentation TAC Application To Condyloma (See Podophyllin or Trichloroacetic Acid Warts) (ABN# 12 & 89) - Allowed for specified CRNP or areas as indicated Trigger Point Injection (ABN# 113) - Allowed for specified CRNP s - ACNP, ANP, FNP, & GNP - 100% MD review Tympanogram With Interpretation and Treatment (ABN# 125) - Generally allowed for the identified NP speciality Ultra Sonography, (OB) Ultrasound Limited & Level I (ABN# 114) - OB/GYN, WHP, 100% MD review; Others Joint Committee Review Ultrasound - Pelvic & OB/GYN (ABN# 126) - WHP Allowed with documented training. Requires specific training in sonography Ultra-Violet Therapy, Maintenance & Direction (ABN# 135) - FNP Allowed under special circumstances. Documented formal training and MD immediately available Umbilical Artery And Vein Catheterization (ABN# 116) - approved for NNP specialties. Vagal Nerve Stimulator, Interrogation With and Without Voltage Adjustment (ABN# 122) - Allowed generally with documented training. As directed by physician with physician review in all cases Wet Mount Microscopy and Interpretation of vaginal swab for bacteria, yeast and trichomonas (ABN# 119) - approved for all NP specialties Needle Aspiration of Breast Mass (ABN# 74) - NOT ALLOWED But Approved for UAB 01/03 Others Approved: Page 5 of 6

6 Certifications: (Example: ACLS, PALS, NALS, ER, etc.) Please List specific certifications Procedures Not Allowed (Source: ABN Website) The following procedures are not authorized for the practice of Certified Registered Nurse Practitioners and Certified Nurse Midwives. Disallowed procedures are reviewed annually by the Joint Committee of Advanced Practice Nursing of the Alabama Board of Nursing and the Alabama Board of Medical Examiners. Administration of Anesthetics - peripheral block-(abn# 2) Complex Suturing -(ABN# 27) Cryotherapy / Cryosurgery-(ABN# 28 ) (Unspecified procedures) Central Line insertion at subclavian and femoral sites. -(ABN# 146) Nasal Endoscopy-(ABN# 12) Paracentesis -(ABN# 82) Percutaneous Liver Biopsy (ABN# 85) Shave / Cautery Of Superficial Lesions -(ABN# 98) Sphenopalatine Ganglion Block with topical agent Nasal Approach -(ABN# 145) Swan-Ganz Placement -(ABN) Tympanostomy Tubes, Removal -(ABN# 123) Vacuum Assist Vaginal Delivery -(ABN# 117) Botox, Collagen and Restylane injection; Mesotherapy -(ABN ) Thoracentesis (ABN) Signature: Date: Certified Registered Nurse Practitioner Approval Signature: Signature: Date: Collaborating MD Note: This form is to be completed every 2 years as part of the re-credentialing process. Page 6 of 6