Medication Prescribing Practices of CRNPs in Mental Health Programs and Mental Retardation Programs BY:
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1 OFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES and OFFICE OF DEVELOPMENTAL PROGRAMS ISSUE DATE: March 27, 2010 EFFECTIVE DATE: March 27, 2010 NUMBER: OMHSAS SUBJECT: Medication Prescribing Practices of CRNPs in Mental Health Programs and Mental Retardation Programs BY: BY: Joan L. Erney Deputy Secretary Department of Public Welfare Office of Mental Health and Substance Abuse Services Kevin Casey Deputy Secretary Department of Public Welfare Office of Developmental Programs SCOPE: Administrative Entity Directors or Administrators Behavioral Health Managed Care Organizations County Mental Health/Mental Retardation Administrators Directors or Administrators of facilities licensed under the following 55 Pa.Code Chapters: Chapter 1153 (relating to outpatient psychiatric services) Chapter 2380 (relating to adult training facilities) Chapter 5200 (relating to psychiatric outpatient clinics) Chapter 5210 (relating to partial hospitalization) Chapter 6400 (relating to community homes for individuals with mental retardation) Chapter 6500 (relating to family living homes) PURPOSE:
2 The purpose of this bulletin is to communicate that, subject to certain conditions, medications may be prescribed by a Certified Registered Nurse Practitioner (CRNP) for individuals who receive services in a facility licensed under 55 Pa.Code Chapters: 2380, 5200, 5210, 6400 and DISCUSSION: Licensing regulations of the Department of Public Welfare (DPW) limit authority to prescribe medication to a physician for an individual who receives services in a facility licensed under 55 Pa.Code Chapters 2380, 5200, 5210, 6400 and In addition, Medical Assistance conditions of participation for outpatient psychiatric facilities require that medications be prescribed by a licensed physician. (55 Pa.Code Chapter (10) (relating to participation requirements)). These Department regulations are more restrictive than other provisions of state law, which do not limit prescriptive authority to licensed physicians. Under current state law, a CRNP is permitted to prescribe certain medications if granted prescriptive authority by the State Board of Nursing and acting within the scope of a collaborative agreement with a physician. See The Professional Nursing Law (63 P.S ; 49 Pa.Code Chapters 18 and 21, Subchapters C (relating to Certified Registered Nurse Practitioners)). GUIDELINE: The guideline is contained in Annex A to this bulletin. EFFECTIVE DATE: 2
3 This statement of policy is effective immediately upon publication in the Pennsylvania Bulletin. CONTACT PERSON: For questions related to this bulletin regarding facilities licensed under Chapters 5200 and 5210 by the Office of Mental Health and Substance Abuse Services (OMHSAS), please contact OMHSAS at For questions related to this bulletin regarding facilities licensed under Chapters 2380, 6400 or 6500 by the Office of Developmental Programs (ODP), please contact the appropriate Regional Licensing Administrator in ODP. Harriet Dichter Acting Secretary of Public Welfare 3
4 ANNEX A STATEMENT OF POLICY DEPARTMENT OF PUBLIC WELFARE OFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES OFFICE OF DEVELOPMENTAL PROGRAMS [55 Pa.Code Chapter 1153] Outpatient Psychiatric Services a. Medication prescription - statement of policy. Medications may be prescribed by a Certified Registered Nurse Practitioner in outpatient psychiatric clinics and outpatient partial hospitalization facilities as authorized under 49 Pa.Code Chapter 18, Subchapter C (relating to Certified Registered Nurse Practitioners) and Chapter 21, Subchapter C (relating to Certified Registered Nurse Practitioners). [55 Pa.Code Chapter 2380] Adult Training Facilities a. Labeling of medications statement of policy. Prescriptions for medications may be written by a Certified Registered Nurse Practitioner as authorized under 49 Pa.Code Chapter 18, Subchapter C (relating to Certified Registered Nurse Practitioners) and Chapter 21, Subchapter C (relating to Certified Registered Nurse Practitioners). The label on the original container shall include the name of the prescribing practitioner a. Medication log statement of policy. 4
5 The medication log must identify the prescribing Certified Registered Nurse Practitioner when a medication was prescribed by a Certified Nurse Practitioner as authorized under 49 Pa.Code Chapter 18, Subchapter C (relating to Certified Registered Nurse Practitioners) and Chapter 21, Subchapter C (relating to Certified Registered Nurse Practitioners) a. Adverse reaction statement of policy. Notification of an adverse reaction to a medication may be made to the prescribing Certified Registered Nurse Practitioner when the medication was prescribed by a Certified Nurse Practitioner as authorized under 49 Pa.Code Chapter 18, Subchapter C (relating to Certified Registered Nurse Practitioners) and Chapter 21, Subchapter C (relating to Certified Registered Nurse Practitioners). [55 Pa.Code Chapter 5200] Psychiatric Outpatient Clinics a. Medication prescription- statement of policy. Prescriptions for medications may be written by and dispensed on the order of a Certified Registered Nurse Practitioner in outpatient psychiatric clinics as authorized under 49 Pa.Code Chapter 18, Subchapter C (relating to Certified Registered Nurse Practitioners) and Chapter 21, Subchapter C (relating to Certified Registered Nurse Practitioners). 5
6 [55 Pa.Code Chapter 5210] Partial Hospitalization a. Medication prescription- statement of policy. Prescriptions for medications may be written by and dispensed on the order of a Certified Registered Nurse Practitioner in partial hospitalization facilities as authorized under 49 Pa.Code Chapter 18, Subchapter C (relating to Certified Registered Nurse Practitioners) and Chapter 21, Subchapter C (relating to Certified Registered Nurse Practitioners). [55 Pa.Code Chapter 6400] Community Homes for Individuals with Mental Retardation a. Labeling of medication statement of policy. Prescriptions for medications may be written by a Certified Registered Nurse Practitioner as authorized under 49 Pa.Code Chapter 18, Subchapter C (relating to Certified Registered Nurse Practitioners) and Chapter 21, Subchapter C (relating to Certified Registered Nurse Practitioners). The label on the original container shall include the name of the prescribing practitioner a. Use of prescription medication statement of policy. The review of documentation, including the reason for prescribing the medication, the need to continue the medication and the necessary dosage, may 6
7 be conducted by a Certified Registered Nurse Practitioner as authorized under 49 Pa.Code Chapter 18, Subchapter C (relating to Certified Registered Nurse Practitioners) and Chapter 21, Subchapter C (relating to Certified Registered Nurse Practitioners) when the medication was prescribed by a Certified Registered Nurse Practitioner a. Medication log statement of policy. The medication log must identify the prescribing Certified Registered Nurse Practitioner when a medication was prescribed by a Certified Nurse Practitioner as authorized under 49 Pa.Code Chapter 18, Subchapter C (relating to Certified Registered Nurse Practitioners) and Chapter 21, Subchapter C (relating to Certified Registered Nurse Practitioners) a. Adverse reaction statement of policy. Notification of an adverse reaction to a medication may be made to the prescribing Certified Registered Nurse Practitioner when the medication was prescribed by a Certified Nurse Practitioner as authorized under 49 Pa.Code Chapter 18, Subchapter C (relating to Certified Registered Nurse Practitioners) and Chapter 21, Subchapter C (relating to Certified Registered Nurse Practitioners). [55 Pa.Code Chapter 6500] Family Living Homes 7
8 a. Labeling of medication statement of policy. Prescriptions for medications may be written by a Certified Registered Nurse Practitioner as authorized under 49 Pa.Code Chapter 18, Subchapter C (relating to Certified Registered Nurse Practitioners) and Chapter 21, Subchapter C (relating to Certified Registered Nurse Practitioners). The label on the original container shall include the name of the prescribing practitioner a. Use of prescription medications statement of policy. The review of documentation, including the reason for prescribing the medication, the need to continue the medication and the necessary dosage, may be conducted by a Certified Registered Nurse Practitioner as authorized under 49 Pa.Code Chapter 18, Subchapter C (relating to Certified Registered Nurse Practitioners) and Chapter 21, Subchapter C (relating to Certified Registered Nurse Practitioners) when the medication was prescribed by a Certified Registered Nurse Practitioner a. Medication log statement of policy. The medication log must identify the prescribing Certified Registered Nurse Practitioner when a medication was prescribed by a Certified Nurse Practitioner as authorized under 49 Pa.Code Chapter 18, Subchapter C (relating to Certified Registered Nurse Practitioners) and Chapter 21, Subchapter C (relating to Certified Registered Nurse Practitioners). 8
9 a. Adverse reaction statement of policy. Notification of an adverse reaction to a medication may be made to the prescribing Certified Registered Nurse Practitioner when the medication was prescribed by a Certified Nurse Practitioner as authorized under 49 Pa.Code Chapter 18, Subchapter C (relating to Certified Registered Nurse Practitioners) and Chapter 21, Subchapter C (relating to Certified Registered Nurse Practitioners). 9
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