Ohio § 4729.39

§ 4729.39.

(A) As used in this section: (1) “Certified nurse practitioner,” “certified nurse-midwife,” “clinical nurse specialist,”

and “standard care arrangement” have the same meanings as in section 4723.01 of the Revised Code . (2) “ Collaborating physician ” means a physician who has entered into a standard care arrangement with a clinical

nurse specialist, certified nurse-midwife, or certified nurse practitioner. (3) “ Physician ” means an individual authorized under Chapter 4731. of the Revised Code to practice

medicine and surgery or osteopathic medicine and surgery. (4) “ Physician assistant ” means an individual who is licensed to practice as a physician assistant under Chapter

4730. of the Revised Code, holds a valid prescriber number issued by the state medical

board, and has been granted physician-delegated prescriptive authority. (5) “ Supervising physician ” means a physician who has entered into a supervision agreement with a physician

assistant under section 4730.19 of the Revised Code . (B) Subject to division (C) of this section, one or more pharmacists may enter into a

consult agreement with one or more of the following practitioners: (1) Physicians; (2) Physician assistants, if entering into a consult agreement is authorized by one or

more supervising physicians; (3) Clinical nurse specialists, certified nurse-midwives, or certified nurse practitioners,

if entering into a consult agreement is authorized by one or more collaborating physicians. (C) Before entering into a consult agreement, all of the following conditions must be

met: (1) Each practitioner must have an ongoing practitioner-patient relationship with each

patient whose drug therapy is to be managed. (2) The diagnosis for which each patient has been prescribed drug therapy must be within

the scope of each practitioner's practice. (3) Each pharmacist must have training and experience related to the particular diagnosis

for which drug therapy is to be prescribed. (D) With respect to consult agreements, all of the following apply: (1) Under a consult agreement, a pharmacist is authorized to do both of the following,

but only to the extent specified in the agreement, this section, and the rules adopted

under this section: (a) Manage drug therapy for treatment of specified diagnoses or diseases for each patient

who is subject to the agreement, including all of the following: (i) Changing the duration of treatment for the current drug therapy; (ii) Adjusting a drug's strength, dose, dosage form, frequency of administration, or route

of administration; (iii) Discontinuing the use of a drug; (iv) Administering a drug; (v) Notwithstanding the definition of “licensed health professional authorized to prescribe

drugs” in section 4729.01 of the Revised Code , adding a drug to the patient's drug therapy. (b)(i) Order laboratory and diagnostic tests, including blood and urine tests, that are

related to the drug therapy being managed, and evaluate the results of the tests that

are ordered. (ii) A pharmacist's authority to evaluate test results under division (D)(1)(b)(i) of

this section does not authorize the pharmacist to make a diagnosis. (2)(a) A consult agreement, or the portion of the agreement that applies to a particular

patient, may be terminated by any of the following: (i) A pharmacist who entered into the agreement; (ii) A practitioner who entered into the agreement; (iii) A patient whose drug therapy is being managed; (iv) An individual who consented to the treatment on behalf of a patient or an individual

authorized to act on behalf of a patient. (b) The pharmacist or practitioner who receives the notice of a patient's termination

of the agreement shall provide written notice to every other pharmacist or practitioner

who is a party to the agreement.  A pharmacist or practitioner who terminates a consult agreement with regard to one

or more patients shall provide written notice to all other pharmacists and practitioners

who entered into the agreement and to each individual who consented to treatment under

the agreement.  The termination of a consult agreement with regard to one or more patients shall

be recorded by the pharmacist and practitioner in the medical records of each patient

to whom the termination applies. (3) A consult agreement shall be made in writing and shall include all of the following: (a) The diagnoses and diseases being managed under the agreement, including whether each

disease is primary or comorbid; (b) A description of the drugs or drug categories the agreement involves; (c) A description of the procedures, decision criteria, and plan the pharmacist is to

follow in acting under a consult agreement; (d) A description of how the pharmacist is to comply with divisions (D)(5) and (6) of

this section. (4) The content of a consult agreement shall be communicated to each patient whose drug

therapy is managed under the agreement. (5) A pharmacist acting under a consult agreement shall maintain a record of each action

taken for each patient whose drug therapy is managed under the agreement. (6) Communication between a pharmacist and practitioner acting under a consult agreement

shall take place at regular intervals specified by the primary practitioner acting

under the agreement.  The agreement may include a requirement that a pharmacist send a consult report

to each consulting practitioner. (7) A consult agreement is effective for two years and may be renewed if the conditions

specified in division (C) of this section continue to be met. (8) A consult agreement does not permit a pharmacist to manage drug therapy prescribed

by a practitioner who has not entered into the agreement. (E) The state board of pharmacy, state medical board, and board of nursing shall each

adopt rules as follows for its license holders establishing standards and procedures

for entering into a consult agreement and managing a patient's drug therapy under

a consult agreement: (1) The state board of pharmacy, in consultation with the state medical board and board

of nursing, shall adopt rules to be followed by pharmacists. (2) The state medical board, in consultation with the state board of pharmacy, shall

adopt rules to be followed by physicians and rules to be followed by physician assistants. (3) The board of nursing, in consultation with the state board of pharmacy and state

medical board, shall adopt rules to be followed by clinical nurse specialists, certified

nurse-midwives, and certified nurse practitioners. The boards shall specify in the rules any categories of drugs or types of diseases

for which a consult agreement may not be established.  Each board may adopt any other rules it considers necessary for the implementation

and administration of this section.  All rules adopted under this section shall be adopted in accordance with Chapter

119. of the Revised Code. (F)(1) Subject to division (F)(2) of this section, both of the following apply: (a) A pharmacist acting in accordance with a consult agreement regarding a practitioner's

change in a drug for a patient whose drug therapy the pharmacist is managing under

the agreement is not liable in damages in a tort or other civil action for injury

or loss to person or property allegedly arising from the change. (b) A practitioner acting in accordance with a consult agreement regarding a pharmacist's

change in a drug for a patient whose drug therapy the pharmacist is managing under

a consult agreement is not liable in damages in a tort or other civil action for injury

or loss to person or property allegedly arising from the change unless the practitioner

authorized the specific change. (2) Division (F)(1) of this section does not limit a practitioner's or pharmacist's liability

in damages in a tort or other civil action for injury or loss to person or property

allegedly arising from actions that are not related to the practitioner's or pharmacist's

change in a drug for a patient whose drug therapy is being managed under a consult

agreement.