Tennessee § 63-7-123 - Certified nurse practitioners — Drug prescriptions — Temporary certificate — Rules and regulations.

§ 63-7-123. Certified nurse practitioners — Drug prescriptions — Temporary certificate — Rules and regulations.

The board shall issue a certificate of fitness to nurse practitioners who meet the qualifications, competencies, training, education and experience, pursuant to § 63-7-207(14), sufficient to prepare such persons to write and sign prescriptions and/or issue drugs within the limitations and provisions of § 63-1-132. A nurse who has been issued a certificate of fitness as a nurse practitioner pursuant to § 63-7-207 and this section shall file a notice with the board, containing the name of the nurse practitioner, the name of the licensed physician collaborating with the nurse practitioner who has control and responsibility for prescriptive services rendered by the nurse practitioner, and a copy of the formulary describing the categories of legend drugs to be prescribed and/or issued by the nurse practitioner. The nurse practitioner shall be responsible for updating this information. The nurse practitioner who holds a certificate of fitness shall be authorized to prescribe and/or issue controlled substances listed in Schedules II, III, IV, and V of title 39, chapter 17, part 4, upon joint adoption of physician collaboration rules concerning controlled substances pursuant to subsection (d). Notwithstanding subdivision (b)(2)(A), a nurse practitioner shall not prescribe Schedules II, III, and IV controlled substances unless such prescription is specifically authorized by the formulary or expressly approved after consultation with the collaborating physician before the initial issuance of the prescription or dispensing of the medication. A nurse practitioner who had been issued a certificate of fitness may only prescribe or issue a Schedule II or III opioid listed on the formulary for a maximum of a non-refillable, thirty-day course of treatment unless specifically approved after consultation with the collaborating physician before the initial issuance of the prescription or dispensing of the medication. This subdivision (b)(2)(C) shall not apply to prescriptions issued in a hospital, a nursing home licensed under title 68, or inpatient facilities licensed under title 33. Any prescription written and signed or drug issued by a nurse practitioner under collaboration with and the control of a collaborating physician shall be deemed to be that of the nurse practitioner. Every prescription issued by a nurse practitioner pursuant to this section shall be entered in the medical records of the patient and shall be written on a preprinted prescription pad bearing the name, address, and telephone number of the collaborating physician and of the nurse practitioner, and the nurse practitioner shall sign each prescription so written. Where the preprinted prescription pad contains the names of more than one (1) physician, the nurse practitioner shall indicate on the prescription which of those physicians is the nurse practitioner's primary collaborating physician by placing a checkmark beside or a circle around the name of that physician. Any handwritten prescription order for a drug prepared by a nurse practitioner who is authorized by law to prescribe a drug must be legible so that it is comprehensible by the pharmacist who fills the prescription. The handwritten prescription order must contain the name of the prescribing nurse practitioner, the name and strength of the drug prescribed, the quantity of the drug prescribed, handwritten in letters or in numerals, instructions for the proper use of the drug and the month and day that the prescription order was issued, recorded in letters or in numerals or a combination thereof. The prescribing nurse practitioner must sign the handwritten prescription order on the day it is issued, unless the prescription order is: Issued as a standing order in a hospital, a nursing home or an assisted care living facility as defined in § 68-11-201; or Prescribed by a nurse practitioner in the department of health or local health departments or dispensed by the department of health or a local health department as stipulated in § 63-10-205. Any typed or computer-generated prescription order for a drug issued by a nurse practitioner who is authorized by law to prescribe a drug must be legible so that it is comprehensible by the pharmacist who fills the prescription order. The typed or computer-generated prescription order must contain the name of the prescribing nurse practitioner, the name and strength of the drug prescribed, the quantity of the drug prescribed, recorded in letters or in numerals, instructions for the proper use of the drug and the month and day that the typed or computer-generated prescription order was issued, recorded in letters or in numerals or a combination thereof. The prescribing nurse practitioner must sign the typed or computer-generated prescription order on the day it is issued, unless the prescription order is: Issued as a standing order in a hospital, nursing home or an assisted care living facility as defined in § 68-11-201; or Prescribed by a nurse practitioner in the department of health or local health departments or dispensed by the department of health or a local health department as stipulated in § 63-10-205. Nothing in this section shall be construed to prevent a nurse practitioner from issuing a verbal prescription order. All handwritten, typed or computer-generated prescription orders must be issued on either tamper-resistant prescription paper or printed utilizing a technology that results in a tamper-resistant prescription that meets the current centers for medicare and medicaid service guidance to state medicaid directors regarding § 7002(b) of the United States Troop Readiness, Veterans' Care, Katrina Recovery and Iraq Accountability Appropriations Act of 2007, P.L. 110-28, and meets or exceeds specific TennCare requirements for tamper-resistant prescriptions. Subdivision (b)(3)(E)(i) shall not apply to prescriptions written for inpatients of a hospital, outpatients of a hospital where the doctor or other person authorized to write prescriptions writes the order into the hospital medical record and then the order is given directly to the hospital pharmacy and the patient never has the opportunity to handle the written order, a nursing home or an assisted care living facility as defined in § 68-11-201 or inpatients or residents of a mental health hospital or residential facility licensed under title 33 or individuals incarcerated in a local, state or federal correctional facility. [Deleted by 2018 amendment.] The nurse practitioner shall maintain a copy of the protocol the nurse practitioner is using at the nurse practitioner's practice location and shall make the protocol available upon request by the board of nursing, the board of medical examiners or authorized agents of either board. An advanced practice registered nurse with a certificate of fitness issued pursuant to this chapter, who provides services in a free clinic as defined in § 63-6-703 or engages in the voluntary provision of healthcare services as defined in § 63-6-703, may arrange for required personal review of the nurse's charts by a collaborating physician in the office or practice site of the physician or remotely via HIPAA-compliant electronic means rather than at the site of the clinic. For purposes of this subdivision (b)(5), “HIPAA-compliant” means that the entity has implemented technical policies and procedures for electronic information systems that meet the requirements of 45 CFR 164.312. An advanced practice registered nurse with a certificate of fitness issued pursuant to this chapter, who provides services in a community mental health center as defined in § 33-1-101, may arrange for the required personal review of the advanced practice registered nurse's charts by a collaborating physician, with the same authority to render prescriptive services that the nurse practitioner is authorized to render, in the office or practice site of the physician, or the required visit by a collaborating physician to any remote site, or both, via HIPAA-compliant electronic means rather than at the site of the clinic. For purposes of this subdivision (b)(6), “HIPAA-compliant” means that the entity has implemented technical policies and procedures for electronic information systems that meet the requirements of 45 C.F.R. § 164.312. The board may issue a temporary certificate of fitness to a registered nurse who: Is licensed to practice in Tennessee; Has a master's degree in a nursing clinical specialty area with preparation in specialized practitioner skills that includes three (3) quarter hours of pharmacology instruction or its equivalent; and Has applied for examination and/or is awaiting examination results for national certification as a first-time examinee in an appropriate nursing specialty area. Such temporary certificate shall remain valid until the examination results are obtained. The holder of a temporary certificate issued under this subsection (c) who has not received the results of the examination shall work only under the supervision and control of a certified nurse practitioner or physician. Any rules that purport to regulate the collaboration of nurse practitioners with physicians shall be jointly adopted by the board of medical examiners and the board of nursing. Acts 1980, ch. 851, § 4; T.C.A., § 63-760; Acts 1985, ch. 120, § 9; 1992, ch. 822, § 1; 1994, ch. 569, § 2; 1995, ch. 358, § 1; 1996, ch. 659, § 2; 1997, ch. 507, § 2; 1998, ch. 842, §§ 2, 3; 2003, ch. 259, § 1; 2004, ch. 678, § 9; 2005, ch. 12, § 4; 2008, ch. 1035, §§ 5, 9; 2010, ch. 795, §§ 6, 17; 2013, ch. 74, § 5; 2013, ch. 396, § 1; 2016, ch. 769, § 1; 2016, ch. 980, § 12; 2017, ch. 334, §§ 2-5; 2018, ch. 883, § 6; 2019, ch. 183, § 1. Compiler's Notes. Acts 1997, ch. 507, § 4 provides that nothing in (b)(2) shall apply to the practice of nurse anesthesia. Acts 2004, ch. 678, § 1 provided that the title of the act is and may be cited as the “Medication Error Reduction Act of 2004.” Acts 2004, ch. 678, § 2 provided that it is the intent of the general assembly to create a uniform standard that health care providers must follow in issuing written or electronic prescription orders. This standard is intended to reduce medication related errors, which represent a major source of medical errors in the health care system. The general assembly finds that reducing medical errors will result in greater safety for patients as well as cost savings for the health care system in this state. By adopting these standards, the general assembly intends to promote medical safety for all patients who are issued drug prescriptions in this state. Acts 2004, ch. 678, § 11 provided that nothing in the act shall be construed as limiting any practitioner's or pharmacist's ability to order the use of or distribute nonprescription drugs or devices otherwise in accordance with applicable law. Acts 2004, ch. 678, § 12 provided that nothing in the act shall be construed as limiting any professional nurse's ability to issue drugs in accordance with the provisions of § 63-7-124 . Acts 2004, ch. 678, § 13 provided that the department of health, division of health related boards and the board of pharmacy, are authorized to promulgate uniform rules to effect the purposes of this act in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. The power and duty to enforce those rules shall be vested in the various boards that regulate health care providers affected by the act, in accordance with § 63-1-122 [repealed]. Acts 2004, ch. 678, § 14 provided that the act shall not affect rights and duties that matured, penalties that were incurred, or proceedings that were begun before July 1, 2004. Acts 2010, ch. 795, § 8 provided that nothing in the act shall be construed as limiting any practitioner's or pharmacist's ability to order the use of or distribute non-prescription drugs or devices otherwise in accordance with applicable law. Acts 2010, ch. 795, § 9 provided that §§ 1-7 of the act shall not apply to prescriptions written for inpatients of a hospital, outpatients of a hospital where the physician or other person authorized to write prescriptions, writes the order into the hospital medical record and the patient or patient's agent or representative never has the opportunity to handle the written order, a nursing home, or an assisted care living facility as defined in § 68-11-201 or inpatients or residents of a mental health hospital or residential facility licensed under title 33 or individuals incarcerated in a local, state or federal correctional facility. Acts 2010, ch. 795, § 10 provided that nothing in the act shall be construed as limiting any professional nurse's ability to issue drugs in accordance with the provisions of § 63-7-124 . Acts 2010, ch. 795, § 11 provided that the department of health, division of health related boards and the board of pharmacy, are authorized to promulgate uniform rules to effect the purposes of the act in accordance with title 4, chapter 5. The power and duty to enforce those rules shall be vested in the various boards that regulate healthcare providers affected by the act, in accordance with § 63-1-122 [repealed]. Acts 2010, ch. 795, § 19 provided that the act shall not affect rights and duties that matured, penalties that were incurred, or proceedings that were begun before January 1, 2011. For the Preamble to the act relative to the relationship between physicians and advanced practice registered nurses, please refer to Acts 2017, ch. 334. Acts 2018, ch. 883, § 10 provided that the commissioner of health is authorized to promulgate rules to effectuate the purposes of the act. All rules must be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in Tennessee Code Annotated, Title 4, Chapter 5. Amendments. The 2017 amendment, in (b), substituted “collaborating physician” for “supervising physician” throughout, substituted “licensed physician collaborating with the nurse practitioner who has control” for “licensed physician having supervision, control” in (1), substituted “physician collaboration rules” for “physician supervisory rules” in (2)(A), and substituted “nurse practitioner under collaboration with and the control of a collaborating physician” for “nurse practitioner under the supervision and control of a supervising physician” in (3)(A); and substituted “regulate the collaboration of nurse practitioners with physicians” for “regulate the supervision of nurse practitioners by physicians” in (d). The 2018 amendment, effective January 1, 2019, deleted former (b)(3)(F) which read: “Any written, printed or computer-generated prescription order for a Schedule II controlled substance prepared by an advanced practice registered nurse who is authorized by law to prescribe a drug must be printed or typed as a separate prescription order. The written, printed or computer-generated prescription order must contain all information otherwise required by law. The prescribing advanced practice registered nurse must sign the written, printed or computer-generated prescription order on the day it is issued.” The 2019 amendment added (b)(6). Effective Dates. Acts 2017, ch. 334, § 15. July 1, 2017. Acts 2018, ch. 883, § 12. January 1, 2019; provided that for rulemaking purposes the act took effect May 3, 2018. Acts 2019, ch. 183, § 3. April 23, 2019. Cross-References. Certified nurse practitioners' prescription and drug authorization powers, § 63-7-207 . Issuance of oral contraceptives and drugs relating to sexually transmitted diseases, by professional nurse, § 63-7-124 . Law Reviews. Health Professionals' Access to Hospitals: A Retrospective and Prospective Analysis, 34 Vand. L. Rev. 1161 (1981). Defining the Opioid Crisis and the Limited Role of the Criminal Justice System Resolving It, 48 U. Mem. L. Rev. 1206 (Summer 2018). Attorney General Opinions. Prescriptions by nurse anesthetist, nurse midwife, or clinical nurse specialist; applicability of prescribing privileges to all categories of advanced practice nurse. OAG 10-22, 2010 Tenn. AG LEXIS 17 (3/1/10).