Welcome and thank you for your participation in our Atlanta Workshop THIS INITIATIVE IS BEING SUPPORTED BY A SPONSORSHIP FROM PFIZER

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1 Welcome and thank you for your participation in our Atlanta Workshop THIS INITIATIVE IS BEING SUPPORTED BY A SPONSORSHIP FROM PFIZER

2 Session 3 THIS INITIATIVE IS BEING SUPPORTED BY A SPONSORSHIP FROM PFIZER

3 Disclosure The Immunization Action Coalition has been responsible for all aspects of content development for the enclosed presentation and all other assets supporting the Take a Stand program. Any questions should be directed to the Immunization Action Coalition. Pfizer is supporting this initiative because it provides focus on the importance of adult immunization. Pfizer has had no role in the creation of content for this presentation or other assets supporting the Take a Stand program workshops and therefore accepts no responsibility for the content.

4 Session 3 State Law & Standing Orders: GEORGIA Alexandra Stewart, JD Associate Professor Milken Institute School of Public Health George Washington University

5 Overview Professions Practice Acts Indentified: Terms equivalent to Standing Orders Terms equivalent to Vaccination Elements of Immunization Practice Immunization Practice in GEORGIA Supervision Requirements Practice Settings Summary

6 Purpose Ensure supervising physicians understand: Immunization practice = medical practice All states have laws governing how physicians delegate medical tasks to health professionals Laws may address: The medical practice eligible for delegation Which professionals may participate Level of required supervision Where the practice may occur Broad variability among states No state authorizes all NPHPs to assess, prescribe and administer vaccines

7 State Law Review Reviewed all laws, regulations, case law, attorney s general advisory opinions governing: Medical Assistants Midwives Nurses Advanced Practice Nurse Nurse Practitioner Practical Nurse Registered Nurse Vocational Nurse Pharmacists Physician Assistants

8 Terms Equivalent to Standing Orders 1. Standardized Procedures 2. Written Guidelines 3. Collaboration: With collaboration Collaborative practice Collaborative practice agreement Collaborative authority Collaborating provider 4. Delegation Delegated authority Delegation order, agreement 5. Protocol Prescriber-approved protocol

9 GEORGIA law does not include the term standing orders Professional Clinical Nurse Specialist (psychiatric/mental health Certified Nurse Midwife Nurse Practitioner Equivalent Terms Nurse protocol agreement Medical Assistant Practical Nurse Registered Nurse Vocational Nurse Pharmacist Physician Assistant Protocol Protocol agreement (only under a RN who is a party to an influenza protocol agreement) Influenza vaccine protocol agreement (as long a the physician is registered with the vaccination registry) SILENT Influenza vaccine protocol agreement Delegation as contained in the job description

10 Immunization Terms Equivalent to Vaccination Diagnostic or therapeutic regimens/measures Drug or device by injection Nonscheduled legend drug/substance* Medication** Pharmacological agents Prescription drugs or devices Schedule VI controlled substances * LEGEND DRUGS are approved by the FDA and must be dispensed to the public only when a licenses physician or other licensed provider prescribes them. Legend drugs may be a controlled substance or a non-narcotic. SOURCE Legend Drug Law and Legal Definition. USLegal.com. Available at: ** MEDICATION includes drugs and pharmaceuticals and may be administered by injection or other methods.

11 Defining Vaccination in GEORGIA Law Professional Clinical Nurse Specialist (psychiatric/mental health Certified Nurse Midwife Nurse Practitioner Medical Assistant Practical Nurse Registered Nurse Pharmacist Vocational Nurse Physician Assistant Prescription drugs Controlled substances Term Subcutaneous and intramuscular injections Vaccination (case law) 1. Flu vaccine to patient <13 requires individual prescription 2. Pneumococcal vaccine to patient <18 requires individual prescription 3. May not administer any vaccine containing live attenuated virus to patient <13 4. May not administer meningitis vaccine to patient <18 SILENT Prescription or dangerous drugs (Prescription authority only)

12 State Law Review Immunization Practice includes: Assessment: Screening, examining, diagnosing, treating EXCLUDES: merely collecting or reporting data, interviewing or taking patient history Prescription: Oral, written or electronic EXCLUDES: simply transmitting a prescription issued by another provider Administration: Injection, oral, nasal EXCLUDES: Dispensing medication

13 Immunization Practice: GEORGIA Law Professional Assessment Prescription Administration Clinical Nurse Specialist psychiatric/mental health Certified Nurse Midwife Nurse Practitioner OWN AUTHORITY DELEGATED DELEGATED Medical Assistant SILENT SILENT DELEGATED Practical Nurse SILENT SILENT DELEGATED Registered Nurse OWN AUTHORITY SILENT DELEGATED Vocational Nurse SILENT SILENT SILENT Pharmacist SILENT SILENT DELEGATED Physician Assistant SILENT DELEGATED SILENT

14 Supervision Requirements Include Medical Assistant Direct, within close proximity of supervisor, undefined supervision, at physician s discretion Midwife Collaborative agreements with supervising physicians if midwife is an Advanced Practice Nurse Nurses in Advanced Practice Collaborative agreement with supervising physician/system governs entire practice

15 Supervision Requirements (cont.) Practical Nurse Direct, on-site supervision from physician, dentist, podiatrist, nurse in advanced practice, registered nurse, physician assistant Registered Nurse In collaboration with physician, dentist, podiatrist Vocational Nurse None listed Pharmacist Under own license or under delegated authority, protocol Physician Assistant With adequate physician supervision

16 Supervision Requirements: GEORGIA Law Professional Clinical Nurse Specialist psychiatric/mental health Certified Nurse Midwife Nurse Practitioner Medical Assistant Practical Nurse Registered Nurse Vocational Nurse Pharmacist Physician Assistant Provision Physician must be available for consultation and provide periodic review May administer injections: Under physician supervision, who is not required to remain on-site Physician assistants under job description and/or advanced practice nurses under protocol must remain on-site Registered nurse must provide direct, on-site supervision under flu protocol agreement Collaborate with other members of the health care team in the management of care SILENT SILENT May practice under personal direction or supervision of the supervising physician, who is not required to remain on-site

17 Permissible Practice Settings Medical Assistant Public, private ambulatory care setting, delegating physician s office, licensed clinics Midwife Public/private clinical settings, physician s offices Nurses in Advanced Practice (APN; CNS; NP) Public/private clinical settings, patient s home, schools, occupational health, community health settings Practical Nurse Public/private clinical settings, patient s home, schools, occupational health, community health settings

18 Permissible Practice Settings (cont.) Registered Nurse Public/private clinical settings, patient s home, schools, occupational health, community health settings Vocational Nurse Public/private clinical settings, patient s home, schools, occupational health, community health settings Pharmacist Hospitals, pharmacies, other health care facilities, jails Physician Assistant Clinical and community locations

19 Practice Settings in GEORGIA Law Professional Clinical Nurse Specialist psychiatric/mental health Certified Nurse Midwife Nurse Practitioner Medical Assistant Practical Nurse Registered Nurse Vocational Nurse Pharmacist Setting Hospital Department of Public Health County board of health, Community service board Free health clinic, Birthing center Any entity serving the uninsured/indigent Medicaid/Medicare School, College HMO Supervising physician s office SILENT Physician Assistant Public or private places where the supervising physician or alternate supervising physician regularly sees patients Patient s home, Nursing home Hospital, Ambulance

20 Delegation of Immunization Practice in GEORGIA Law Professional Clinical Nurse Specialist psychiatric/mental health Certified Nurse Midwife Nurse Practitioner Medical Assistant Practical Nurse Registered Nurse Pharmacist Physician Assistant Summary Assess patient status under their own authority. Prescribe and administer prescription drugs and controlled substances under nurse protocol agreements. Physicians must be available to consult and for periodic review. Administer injections and vaccinations under protocols and with supervision of physician who may be off-site, or physician assistant or advanced practice nurse who must remain on-site. Administer flu and meningitis vaccines based on patient s age under a protocol agreement with direct, on-site supervision of a registered nurse who has been authorized to supervise under a flu protocol agreement. Assess patient status under their own authority. Administer flu, pneumococcal, meningitis vaccines based on patient s age under flu vaccine protocol agreement with physicians who are registered with the registry. Administer flu, pneumococcal, meningitis vaccines based on patient s age under flu vaccine protocol agreement. Prescribe drugs under delegated authority contained in job description and adequate physician supervision

21 Comments????

22 Citations 1. Code of Ga (2015) Role of medical assistants clarified 2. Ga. Admin. Code (2015) Medical Assistants, Polysomnography Technologists, and Radiology Technologists 3. Kerr v. Ob/Gyn Assocs. Of Savannah, 723 S.E.2d 302, 303 (Ga. Ct. App. 2012) 4. Stultz v. Safety & Compliance Mgmt., Inc., 648 S.E.2d 129, 131 (Ga. Ct. App. 2007) 5. Code of Ga (2015) Definitions 6. Code of Ga (2015) Delegation of certain medical acts to advanced practice registered nurse; construction and limitations of such delegation; definitions; conditions of nurse protocol; issuance of prescription drug orders 7. Ga. Admin. Code (2015) Regulation of Protocol Use By Advanced Practice Registered Nurses as Authorized by O.C.G.A

23 Citations 8. Ga. Admin. Code (2015) Purpose, Definitions, Title, and Authority for Advanced Nursing Practice 9. Code of Ga (2015) Vaccine protocol agreements 10. Ga. Admin. Code (2015) Standards for Physician Assistant Practice 11. Code of Ga (2015) Definitions 12. Code of Ga (2015) Application for assistant; number of assistants; job descriptions; duties; receipt of samples; employment by nonpracticing physicians; delegated authority; temporary practice agreements; assistance during emergencies; pronouncement of death 13. Ga. Admin. Code (2015) Guidelines concerning Prescriptive Authority

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