201 KAR 20:057 - Scope and standards of practice of advanced practice registered nurses
RELATES TO: KRS 218A.171, 218A.172, 218A.202, 218A.205(3)(a), (b), 314.011(7), (8), 314.039, 314.042, 314.091, 314.193(2), 314.195, 314.475
NECESSITY, FUNCTION, AND CONFORMITY: KRS 218A.205(3)(a) and (b) require the Board of Nursing, in consultation with the Kentucky Office of Drug Control Policy, to establish by administrative regulation mandatory prescribing and dispensing standards for licensees authorized to prescribe or dispense controlled substances, and in accordance with the Centers for Disease Control and Prevention (CDC) guidelines, to establish a prohibition on a practitioner issuing a prescription for a Schedule II controlled substance for more than a three (3) day supply if intended to treat pain as an acute medical condition, unless an exception applies. KRS 314.131(1) authorizes the board to promulgate administrative regulations necessary to enable it to carry into effect the provisions of KRS Chapter 314 and authorizes the board to require by administrative regulation that licensees and applicants utilize a specific method of submission of documents or information that is required to be provided to the board, including electronic submission. KRS 314.193(2) authorizes the board to promulgate administrative regulations establishing standards for the performance of advanced practice registered nursing to safeguard the public health and welfare. This administrative regulation establishes the scope and standards of practice for an advanced practice registered nurse.
Section 1. Definitions.
(1) "Collaboration" means the relationship
between the advanced practice registered nurse (APRN) and a physician in the
provision of prescription medication, including both autonomous and cooperative
decision-making, with the APRN and the physician contributing their respective
expertise.
(2) "Collaborative
Agreement for the Advanced Practice Registered Nurse's Prescriptive Authority
for Controlled Substances" or "CAPA-CS" means the written document pursuant to
KRS
314.042(11).
(3) "Collaborative Agreement for the Advanced
Practice Registered Nurse's Prescriptive Authority for Nonscheduled Legend
Drugs" or "CAPA-NS" means the written document pursuant to
KRS
314.042(8).
(4) "Good standing" is defined by
KRS
314.039.
(5) "Immediate family member" means a spouse,
parent, parent-in-law, stepparent, child, stepchild, son-in-law,
daughter-in-law, sibling, stepsibling, brother-in-law, sister-in-law,
grandparent, grandchild, spouse of grandparent or grandchild, or other person
residing in the same residence as the APRN.
(6) "KBML" means the Kentucky Board of
Medical Licensure.
(7) "PDMP" means
the electronic prescription drug monitoring program system for monitoring
scheduled controlled substances and medicinal cannabis currently in use in
Kentucky pursuant to KRS 218A.202, including the
Kentucky All Schedule Prescription Electronic Reporting (KASPER)
System.
Section 2.
(1) The practice of the APRN shall be in
accordance with the standards and functions established in scope and standards
of practice statements adopted by the board in subsection (2) of this
section.
(2) The following scope
and standards of practice statements shall be adopted:
(a) AACN Scope and Standards for Acute Care
Nurse Practitioner Practice;
(b)
AACN Scope and Standards for Acute Care Clinical Nurse Specialist
Practice;
(c) Neonatal Nursing:
Scope and Standards of Practice;
(d) Nursing: Scope and Standards of
Practice;
(e) Pediatric Nursing:
Scope and Standards of Practice;
(f) Psychiatric- Mental Health Nursing: Scope
and Standards of Practice;
(g)
Scope of Practice for Nurse Practitioners;
(h) Standards of Practice for Nurse
Practitioners;
(i) Scope of Nurse
Anesthesia Practice;
(j) Standards
for Nurse Anesthesia Practice;
(k)
Standards for Office Based Anesthesia Practice;
(l) Standards for the Practice of
Midwifery;
(m) Oncology Nursing
Scope and Standards of Practice;
(n) The Women's Health Nurse Practitioner:
Guidelines for Practice and Education;
(o) Definition of Midwifery and Scope of
Practice of Certified Nurse-Midwives and Certified Midwives; and
(p) Standards for Professional Nursing
Practice in the Care of Women and Newborns.
Section 3. CAPA-CS Practice Requirements for
APRNs
(1) In the performance of advanced
practice registered nursing, the APRN shall seek consultation or referral in
those situations outside the APRN's scope of practice.
(2) An APRN wishing to have a CAPA-CS in the
first year of the APRN's licensure shall be employed by a health care entity or
provider. If the employing provider is an APRN, the employing APRN shall have
been granted an exemption under Section 7 of this administrative
regulation.
(3) During term of the
CAPA-CS, the APRN and the collaborating physician shall meet in person or via
video conferencing, or by phone, if in person or video conferencing is not
feasible, to review the APRN's reverse PDMP report. The review may include
information from the patient's medical record that relates to the condition or
conditions being treated with controlled substances by the APRN.
(a) Both the APRN and the physician shall
maintain a record of:
1. The meeting
date;
2. A summary of the
discussions; and
3. Any
recommendations made that shall be made in writing.
(b) The record shall be maintained by both
parties for a period of one (1) year past the expiration of the APRN
CAPA-CS.
(c) The APRN's meeting
records shall be subject to audit by the board and the physician's records
shall be subject to audit by the KBML. The sole purpose of the audit shall be
to document that the collaboration meetings have taken place to verify
compliance with this section.
(4) In the first year of the CAPA-CS, the
APRN and a physician shall meet at least quarterly.
(5) In the ensuing three (3) years of the
CAPA-CS, the APRN and the physician shall meet at least biannually.
Section 4. Advanced practice
registered nursing shall include prescribing and administering medications, as
well as ordering treatments, devices, diagnostic tests, and performing certain
procedures that shall be consistent with the scope and standards of practice of
the APRN.
Section 5. Advanced
practice registered nursing shall not preclude the practice by the APRN of
registered nursing practice as defined by
KRS
314.011(6).
Section 6.
(1)
(a) A
CAPA-NS and a CAPA-CS shall include the:
1.
Name;
2. Practice
address;
3. Phone number;
4. License number of both the APRN and each
physician who is a party to the agreement; and
5. Population focus and area of practice of
the APRN and each physician.
(b) An APRN shall use a CAPA-NS Agreement
Form.
(c) An APRN shall use the
Standardized CAPA-CS Agreement Form.
(2)
(a) To
notify the board of the existence of a CAPA-NS pursuant to
KRS
314.042(8)(b), the APRN
shall submit an online notification as established in paragraph (e) of this
subsection.
(b) To notify the board
that the requirements of
KRS
314.042(9) have been met and
that the APRN will be prescribing nonscheduled legend drugs without a CAPA-NS,
the APRN shall submit an online notification as established in paragraph (e) of
this subsection.
(c) To notify the
board of the existence of a CAPA-CS pursuant to
KRS
314.042(11)(b), the APRN
shall submit an online notification as established in paragraph (e) of this
subsection.
(d) To notify the board
that the requirements of
KRS
314.042(14) have been met
and request that the APRN be exempt from prescribing scheduled legend drugs
under a CAPA-CS, the APRN shall complete the request for APRN exemption from
CAPA-CS prescriptive authority and pay the listed fee in
201 KAR 20:240, Section 3(1)(e).
Each submitted request shall be subject to the fee, regardless of whether the
board grants the exemption after making a determination under Section 7 of this
administrative regulation.
(e) Each
notification, recission, and exemption request shall be submitted by the APRN
to the board via the online KBN Nurse Portal at
www.kbn.ky.gov, and shall include
the information and documentation required by subsection (1) of this section
and this subsection.
(f) Upon
request by the board, the APRN shall furnish to the board a copy of the
executed CAPA-NS Agreement Form or Standardized CAPA-CS Agreement
Form.
(3) For purposes of
the CAPA-NS and the CAPA-CS, in determining whether the APRN and the
collaborating physician are qualified in the same or a similar specialty, the
board shall consider the facts of each particular situation and the scope of
the APRN's and the physician's actual practice.
(4) An APRN with controlled substance
prescriptive authority, shall:
(a) Obtain a
United States Drug Enforcement Administration (DEA) Controlled Substance
Registration Certificate and shall report the APRN's Kentucky DEA number, and
any change in the status of a certificate by providing a copy of each
registration certificate to the board within thirty (30) days of
issuance.
(b) Register for a master
account with the PDMP, within thirty (30) days of obtaining a DEA Controlled
Substance Registration Certificate, and prior to prescribing controlled
substances. A copy of the PDMP master account registration certificate shall be
submitted to the board via the online KBN Nurse Portal within thirty (30) days
of receipt of confirmation of registration by the PDMP.
(5) An APRN shall report any changes to a
CAPA-NS or a CAPA-CS to the board within thirty (30) days.
(6) If an APRN's CAPA-NS or CAPA-CS ends
unexpectedly for reasons outside the APRN's control such as being ended by the
physician without notice, the physician's license becoming no longer valid in
Kentucky, or the death of a physician, the APRN may continue to prescribe for
thirty (30) days, after documenting in each patient's medical record the
applicant's professional determination that the continued prescribing is
justified based on the individual facts applicable to the patient's diagnosis
and treatment. This thirty (30) day grace period shall not be extended or occur
successively.
(7) An APRN with a
CAPA-NS or a CAPA-CS shall report a practice address to the board. A change to
the practice address shall be reported to the board within thirty (30)
days.
(8) All documents and
information required to be reported to the board by this section shall be
reported by uploading the document or information through the board's Web site,
https://kbn.ky.gov. The board shall not
accept documents or information sent in any other format.
Section 7. CAPA-CS Exemption Review Request.
(1) An APRN who wishes to request a CAPA-CS
exemption pursuant to
KRS
314.042(14) shall:
(a) Complete a CAPA-CS exemption review
request on the board's Web site as required in Section 6(8) of this
administrative regulation;
(b)
Submit the fee required by
201 KAR 20:240, Section 3(1)(e);
and
(c) Comply with the
requirements established in
KRS
314.042(14) and this
administrative regulation.
(2) Upon receipt of the CAPA-CS exemption
review request, the board shall verify the following:
(a) The APRN has had four (4) years of
controlled substance prescribing authority;
(b) The APRN's license is in good
standing;
(c) The APRN has
maintained a DEA registration and a current registration certificate is on file
with the board;
(d) The APRN has
maintained a PDMP registration and a current registration is on file with the
board;
(e) That a current
Notification of a CAPA-CS for the APRN is on record with the board;
and
(f) The APRN has an active
account with the PDMP.
(3) Upon receipt of the CAPA-CS exemption
review request, the board shall:
(a) Perform a
criminal background check for any unreported misdemeanor or felony convictions
in Kentucky; and
(b) Perform a
check of the coordinated licensure information system specified in
KRS
314.475 for any unreported disciplinary
actions in another state.
(4) The APRN submitting the request shall
cooperate with supplemental requests for documentation before the board makes a
determination that the APRN's license is in good standing pursuant to
KRS
314.042(14).
(5) An APRN wishing to practice in Kentucky
through licensure by endorsement may request an exemption under this section.
(a) An APRN wishing to practice in Kentucky
through licensure by endorsement is exempt from the CAPA-CS requirement if the
APRN:
1. Has met the prescribing requirements
for controlled substances in a state that grants such prescribing authority to
APRNs;
2. Has had authority to
prescribe controlled substances for at least four (4) years; and
3. Has a license in good standing.
(b) An APRN wishing to practice in
Kentucky through licensure by endorsement who has had the authority to
prescribe controlled substances for less than four (4) years and wishes to
continue to prescribe controlled substances shall enter into a CAPA-CS with a
physician licensed in Kentucky and comply with the provisions of
KRS
314.042(11), until the
requirements of this section are met.
(6) If the board determines that the APRN is
eligible for the exemption after a review and determination of the exemption
request under this section, the board shall notify the APRN in writing that the
CAPA-CS is no longer required. The board shall not require the APRN to maintain
a CAPA-CS as a condition to prescribe controlled substances unless the board
imposes the requirement as part of an action instituted under
KRS
314.091(1).
(7) If the board denies the exemption
request, the denial shall be in writing and shall state the reasons for the
denial. The requestor may request a hearing pursuant to KRS Chapter 13B within
twenty (20) days of receiving written notification of the denial. If a hearing
is requested and the order of the board is adverse to the advance practice
registered nurse, the board may impose costs pursuant to
201 KAR 20:162, Section
7.
(8) The APRN nurse shall not
prescribe controlled substances without a CAPA-CS until the board has completed
its review and has notified the APRN in writing that the APRN is exempt from
the CAPA-CS requirement.
Section
8. Prescribing Medications without Prescriptive Authority.
Prescribing nonscheduled legend drugs without a CAPA-NS or prescribing
controlled substances without a CAPA-CS shall constitute a violation of
KRS
314.091(1), unless:
(1) In the case of nonscheduled legend drugs,
the CAPA-NS has been discontinued pursuant to
KRS
314.042(9) or if the
prescribing occurred within the grace period established in Section 6(6) of
this administrative regulation; or
(2) In the case of controlled substances, the
APRN was granted an CAPA-CS exemption by the board under
KRS
314.042(14)(e) prior to the
date the medications were prescribed.
Section 9. The board may make an unannounced
visit to an APRN's practice to determine if it is consistent with the
requirements established by KRS Chapter 314 and 201 KAR Chapter 20. Patient and
prescribing records shall be made available for immediate inspection.
Section 10. Prescribing Standards for
Controlled Substances.
(1)
(a) This section shall apply to APRNs with
controlled substance prescriptive authority. It also applies to the utilization
of the PDMP.
(b) The APRN shall
practice according to the applicable scope and standards of practice for the
APRN's role and population focus. This section does not alter the prescribing
limits established in
KRS
314.011(8).
(2) Prior to the initial prescribing of a
controlled substance to a patient, the APRN shall:
(a) Obtain the patient's medical history,
including history of substance use, and conduct an examination of the patient
and document the information in the patient's medical record. An APRN certified
in psychiatric-mental health shall obtain a medical and psychiatric history,
perform a mental health assessment, and document the information in the
patient's medical record;
(b) Query
the PDMP for the twelve (12) month period immediately preceding the request for
available data on the patient and maintain all PDMP report identification
numbers and the date of issuance of each PDMP report in the patient's
record;
(c) Develop a written
treatment plan stating the objectives of the treatment and further diagnostic
examinations required; and
(d)
Discuss with the patient, the patient's parent if the patient is an
unemancipated minor child, or the patient's legal guardian or health care
surrogate:
1. The risks and benefits of the
use of controlled substances, including the risk of tolerance and drug
dependence;
2. That the controlled
substance shall be discontinued once the condition requiring its use has
resolved; and
3. Document that the
discussion occurred and obtain written consent for the treatment.
(3) The treatment plan
shall include an exit strategy, if appropriate, including potential
discontinuation of the use of controlled substances.
(4) For subsequent or continuing long-term
prescriptions of a controlled substance for the same medical complaint, the
APRN shall:
(a) Update the patient's medical
history and document the information in the patient's medical record;
(b) Modify and document changes to the
treatment plan as clinically appropriate; and
(c) Discuss the risks and benefits of any new
controlled substances prescribed, including the risk of tolerance and drug
dependence with the patient, the patient's parent if the patient is an
unemancipated minor child, or the patient's legal guardian or health care
surrogate.
(5) During the
course of treatment, the APRN shall query the PDMP no less than once every
three (3) months for the twelve (12) month period immediately preceding the
request for available data on the patient. The APRN shall maintain in the
patient's record all PDMP report identification numbers and the date of
issuance of each PDMP report or a copy or saved image of the PDMP report. If
neither an identification number nor an image can be saved to the patient's
record as a result of technical limitations of the APRN's electronic health
record system, the APRN shall make a concurrent note in the patient's record
documenting the date and time that the APRN reviewed the patient's PDMP
report.
(6) These requirements may
be satisfied by other licensed practitioners in a single group practice if:
(a) Each licensed practitioner involved has
lawful access to the patient's medical record;
(b) Each licensed practitioner performing an
action to meet these requirements is acting within the scope of practice of his
or her profession; and
(c) There is
adequate documentation in the patient's medical record reflecting the actions
of each practitioner.
(7)
If prescribing a controlled substance for the treatment of chronic, non-cancer
pain, the APRN, in addition to the requirements of this section, shall obtain a
baseline drug screen and further random drug screens if the APRN:
(a) Finds a drug screen clinically
appropriate; or
(b) Believes that
it is appropriate to determine whether the controlled substance is being taken
by the patient.
(8) If
prescribing a controlled substance for the treatment of a mental health
condition, the APRN shall meet the requirements of this section and
KRS
314.011(8)(a) and
(b).
(9) Prior to prescribing a controlled
substance for a patient in the emergency department of a hospital that is not
an emergency situation, the APRN shall:
(a)
Obtain the patient's medical history, conduct an examination of the patient,
and document the information in the patient's medical record. An APRN certified
in psychiatric - mental health shall obtain a medical and psychiatric history,
perform a mental health assessment, and document the information in the
patient's medical record;
(b) Query
the PDMP for the twelve (12) month period immediately preceding the request for
available data on the patient and document the data in the patient's
record;
(c) Develop a written
treatment plan stating the objectives of the treatment and further diagnostic
examinations required; and
(d)
Discuss the risks and benefits of the use of controlled substances with the
patient, the patient's parent if the patient is an unemancipated minor child,
the patient's legal guardian, or health care surrogate, including the risks of
tolerance and drug dependence, and document that the discussion occurred and
that the patient consented to that treatment.
(10) For each patient for whom an APRN
prescribes a controlled substance, the APRN shall keep accurate, readily
accessible, and complete medical records, which include:
(a) Medical history and physical or mental
health examination;
(b) Diagnostic,
therapeutic, and laboratory results;
(c) Evaluations and consultations;
(d) Treatment objectives;
(e) Discussion of risk, benefits, and
limitations of treatments;
(f)
Treatments;
(g) Medications,
including date, type, dosage, and quantity prescribed;
(h) Instructions and agreements;
(i) Periodic reviews of the patient's file;
and
(j) All PDMP report
identification numbers and the date of issuance of each PDMP report.
(11) The requirement to query the
PDMP shall not apply to:
(a) An APRN
prescribing or administering a controlled substance immediately prior to,
during, or within the fourteen (14) days following an operative or invasive
procedure or a delivery if the prescribing or administering is medically
related to the operative or invasive procedure of the delivery and the
medication usage does not extend beyond the fourteen (14) days;
(b) An APRN prescribing or administering a
controlled substance necessary to treat a patient in an emergency situation;
or
(c) An APRN prescribing a
controlled substance:
1. For administration in
a hospital or long-term-care facility with an institutional account, or an APRN
in a hospital or facility without an institutional account, if the hospital,
long-term-care facility, or licensee queries the PDMP for all available data on
the patient or resident for the twelve (12) month period immediately preceding
the query within twelve (12) hours of the patient's or resident's admission and
places a copy of the query in the patient's or resident's medical records
during the duration of the patient's stay at the facility;
2. As part of the patient's hospice or
end-of-life treatment;
3. For the
treatment of pain associated with cancer or with the treatment of
cancer;
4. To assist a patient with
submitting to a diagnostic test or procedure;
5. Within seven (7) days of an initial
prescription pursuant to subsection (1) of this section if the prescriber:
a. Substitutes a controlled substance for the
initial prescribing;
b. Cancels any
refills for the initial prescription; and
c. Requires the patient to dispose of any
remaining unconsumed medication;
6. Within ninety (90) days of an initial
prescription pursuant to subsection (1) of this section if the prescribing is
done by another licensee in the same practice or in an existing coverage
arrangement, if done for the same patient for the same condition;
7. To a research subject enrolled in a
research protocol approved by an institutional review board that has an active
federal-wide assurance number from the United States Department of Health and
Human Services, Office for Human Research Protections if the research involves
single, double, or triple blind drug administration or is additionally covered
by a certificate of confidentiality from the National Institutes of
Health;
8. During the effective
period of any disaster or situation with mass casualties that have a direct
impact on the APRN's practice;
9.
As part of the administering or ordering of controlled substances to prisoners
in a state, county, or municipal correctional facility;
10. That is a Schedule IV controlled
substance for no longer than three (3) days for an established patient to
assist the patient in responding to the anxiety of a nonrecurring event;
or
11. That is classified as a
Schedule V controlled substance.
(12) In accordance with
21 C.F.R.
1306.12(b)(1)(iv) - (v),
federal regulation 21 C.F.R.
1306.12(b) concerning the
issuance of multiple prescriptions for Schedule II controlled substances shall
not apply to APRNs in this state.
(13) No less than once every six (6) months,
an APRN who holds a DEA Controlled Substance Registration Certificate shall
review a reverse PDMP report for the preceding six (6) months to determine if
the information contained in the PDMP is correct. If the information is
incorrect, the APRN shall comply with
902 KAR 55:110 and take the
necessary steps to seek correction of the information, by:
(a) First contacting the reporting
pharmacy;
(b) Contacting law
enforcement if suspected fraudulent activity; or
(c) Contacting the Drug Enforcement
Professional Practices Branch, Office of Inspector General, Cabinet for Health
and Family Services.
(14)
An APRN shall not issue a prescription for hydrocodone combination products for
more than a three (3) day supply if the prescription is intended to treat pain
as an acute medical condition, except if:
(a)
The APRN, in his or her professional judgment, believes that more than a three
(3) day supply of hydrocodone combination products is medically necessary to
treat the patient's pain as an acute medical condition and the APRN adequately
documents the acute medical condition and lack of alternative treatment options
that justifies deviation from the three (3) day supply limit on the patient's
medical records;
(b) The
prescription for hydrocodone combination products is prescribed to treat
chronic pain;
(c) The prescription
for hydrocodone combination products is prescribed to treat pain associated
with a valid cancer diagnosis;
(d)
The prescription for hydrocodone combination products is prescribed to treat
pain while the patient is receiving hospice or end-of-life treatment;
(e) The prescription for hydrocodone
combination products is prescribed as part of a narcotic treatment program
licensed by the Cabinet for Health and Family Services;
(f) The prescription for hydrocodone
combination products is prescribed to treat pain following a major surgery,
which is any operative or invasive procedure or a delivery, or the treatment of
significant trauma; or
(g)
Hydrocodone combination products are administered directly to an ultimate user
in an inpatient setting.
(15) Prescriptions written for hydrocodone
combination products pursuant to subsection (14)(a) through (g) of this section
shall not exceed thirty (30) days without any refill.
(16) An APRN may prescribe electronically.
Electronic prescription shall be as established in
KRS
218A.171.
(17) For any prescription for a controlled
substance, the prescribing APRN shall discuss with the patient the effect the
patient's medical condition and medication may have on the patient's ability to
safely operate a vehicle in any mode of transportation.
Section 11. Immediate Family Member and
Self-prescribing or Administering Medications.
(1) An APRN shall not self-prescribe or
administer controlled substances.
(2) An APRN shall not prescribe or administer
controlled substances to his or her immediate family member except as
established in subsections (3) and (4) of this section.
(3) An APRN may prescribe or administer
controlled substances to an immediate family member:
(a) In an emergency situation;
(b) For a single episode of an acute illness
through one (1) prescribed course of medication; or
(c) In an isolated setting, if no other
qualified practitioner is available.
(4)
(a) An
APRN who prescribes or administers controlled substances for an immediate
family member pursuant to subsections (3)(a) or (b) of this section shall
document all relevant information and notify the appropriate
provider.
(b) An APRN who
prescribes or administers controlled substances for an immediate family member
pursuant to subsection (3)(c) of this section shall maintain a
provider-practitioner relationship and appropriate patient records.
Section 12.
Incorporation by Reference.
(1) The following
material is incorporate by reference:
(a)
"AACN Scope and Standards for Acute Care Nurse Practitioner Practice", 2017
Edition, American Association of Critical-Care Nurses;
(b) "AACN Scope and Standards for Acute Care
Clinical Nurse Specialist Practice", 2014 Edition, American Association of
Critical-Care Nurses;
(c) "Neonatal
Nursing: Scope and Standards of Practice", 2013 Edition, American Nurses
Association/ National Association of Neonatal Nurses;
(d) "Nursing: Scope and Standards of
Practice", 2015 Edition, American Nurses Association;
(e) "Pediatric Nursing: Scope and Standards
of Practice", 2015 Edition, American Nurses Association/ Society of Pediatric
Nursing/ National Association of Pediatric Nurse Practitioners;
(f) "Psychiatric-Mental Health Nursing: Scope
and Standards of Practice", 2014, American Nurses Association/ American
Psychiatric Nursing Association;
(g) "Scope of Practice for Nurse
Practitioners", 2019 Edition, American Association of Nurse
Practitioners;
(h) "Standards of
Practice for Nurse Practitioners", 2019 Edition, American Association of Nurse
Practitioners;
(i) "Scope of Nurse
Anesthesia Practice", 2013 Edition, American Association of Nurse
Anesthetists;
(j) "Standards for
Nurse Anesthesia Practice", 2019 Edition, American Association of Nurse
Anesthetists;
(k) "Standards for
Office Based Anesthesia Practice", 2019 Edition, American Association of Nurse
Anesthetists;
(l) "Standards for
the Practice of Midwifery", 2011 Edition, American College of Nurse
Midwives;
(m) "Oncology Nursing
Scope and Standards of Practice", 2019 Edition, Oncology Nursing
Society;
(n) "The Women's Health
Nurse Practitioner: Guidelines for Practice and Education", 2014 Edition,
Association of Women's Health, Obstetric and Neonatal Nurses/Nurse
Practitioners in Women's Health;
(o) "Definition of Midwifery and Scope of
Practice of Certified Nurse-Midwives and Certified Midwives", 2012 Edition,
American College of Nurse Midwives;
(p) "Standards for Professional Nursing
Practice in the Care of Women and Newborns", 2019 Edition, Association of
Women's Health, Obstetric and Neonatal Nurses;
(q) "Standardized CAPA-CS Agreement Form",
_9/2023; and
(r) "CAPA-NS Agreement
Form", 9/2023.
(2) This
material may be inspected, copied, or obtained, subject to applicable copyright
law, at the Kentucky Board of Nursing, 312 Whittington Parkway, Suite 300,
Louisville, Kentucky 40222, Monday through Friday, 8 a.m. to 4:30 p.m. This
material is also available on the board's Web site at
https://kbn.ky.gov/document-library/Pages/default.aspx.
Notes
STATUTORY AUTHORITY: KRS 218A.205(3)(a), (b), 314.042, 314.131(1), 314.193(2)
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
RELATES TO: KRS 218A.171, 218A.172, 218A.202, 218A.205(3)(a), (b), 314.011(7), (8), 314.039, 314.042, 314.091, 314.193(2), 314.195, 314.475
NECESSITY, FUNCTION, AND CONFORMITY: KRS 218A.205(3)(a) and (b) require the Board of Nursing, in consultation with the Kentucky Office of Drug Control Policy, to establish by administrative regulation mandatory prescribing and dispensing standards for licensees authorized to prescribe or dispense controlled substances, and in accordance with the Centers for Disease Control and Prevention (CDC) guidelines, to establish a prohibition on a practitioner issuing a prescription for a Schedule II controlled substance for more than a three (3) day supply if intended to treat pain as an acute medical condition, unless an exception applies. KRS 314.131(1) authorizes the board to promulgate administrative regulations necessary to enable it to carry into effect the provisions of KRS Chapter 314 and authorizes the board to require by administrative regulation that licensees and applicants utilize a specific method of submission of documents or information that is required to be provided to the board, including electronic submission. KRS 314.193(2) authorizes the board to promulgate administrative regulations establishing standards for the performance of advanced practice registered nursing to safeguard the public health and welfare. This administrative regulation establishes the scope and standards of practice for an advanced practice registered nurse.
Section 1. Definitions.
(1) "Collaboration" means the relationship between the advanced practice registered nurse (APRN) and a physician in the provision of prescription medication, including both autonomous and cooperative decision-making, with the APRN and the physician contributing their respective expertise.
(2) "Collaborative Agreement for the Advanced Practice Registered Nurse's Prescriptive Authority for Controlled Substances" or "CAPA-CS" means the written document pursuant to KRS 314.042(11).
(3) "Collaborative Agreement for the Advanced Practice Registered Nurse's Prescriptive Authority for Nonscheduled Legend Drugs" or "CAPA-NS" means the written document pursuant to KRS 314.042(8).
(4) "Good standing" is defined by KRS 314.039.
(5) "Immediate family member" means a spouse, parent, parent-in-law, stepparent, child, stepchild, son-in-law, daughter-in-law, sibling, stepsibling, brother-in-law, sister-in-law, grandparent, grandchild, spouse of grandparent or grandchild, or other person residing in the same residence as the APRN.
(6) "KBML" means the Kentucky Board of Medical Licensure.
(7) "PDMP" means the electronic prescription drug monitoring program system for monitoring scheduled controlled substances and medicinal cannabis currently in use in Kentucky pursuant to KRS 218A.202, including the Kentucky All Schedule Prescription Electronic Reporting (KASPER) System.
Section 2.
(1) The practice of the APRN shall be in accordance with the standards and functions established in scope and standards of practice statements adopted by the board in subsection (2) of this section.
(2) The following scope and standards of practice statements shall be adopted:
(a) AACN Scope and Standards for Acute Care Nurse Practitioner Practice;
(b) AACN Scope and Standards for Acute Care Clinical Nurse Specialist Practice;
(c) Neonatal Nursing: Scope and Standards of Practice;
(d) Nursing: Scope and Standards of Practice;
(e) Pediatric Nursing: Scope and Standards of Practice;
(f) Psychiatric- Mental Health Nursing: Scope and Standards of Practice;
(g) Scope of Practice for Nurse Practitioners;
(h) Standards of Practice for Nurse Practitioners;
(i) Scope of Nurse Anesthesia Practice;
(j) Standards for Nurse Anesthesia Practice;
(k) Standards for Office Based Anesthesia Practice;
(l) Standards for the Practice of Midwifery;
(m) Oncology Nursing Scope and Standards of Practice;
(n) The Women's Health Nurse Practitioner: Guidelines for Practice and Education;
(o) Definition of Midwifery and Scope of Practice of Certified Nurse-Midwives and Certified Midwives; and
(p) Standards for Professional Nursing Practice in the Care of Women and Newborns.
Section 3. CAPA-CS Practice Requirements for APRNs
(1) In the performance of advanced practice registered nursing, the APRN shall seek consultation or referral in those situations outside the APRN's scope of practice.
(2) An APRN wishing to have a CAPA-CS in the first year of the APRN's licensure shall be employed by a health care entity or provider. If the employing provider is an APRN, the employing APRN shall have been granted an exemption under Section 7 of this administrative regulation.
(3) During term of the CAPA-CS, the APRN and the collaborating physician shall meet in person or via video conferencing, or by phone, if in person or video conferencing is not feasible, to review the APRN's reverse PDMP report. The review may include information from the patient's medical record that relates to the condition or conditions being treated with controlled substances by the APRN.
(a) Both the APRN and the physician shall maintain a record of:
1. The meeting date;
2. A summary of the discussions; and
3. Any recommendations made that shall be made in writing.
(b) The record shall be maintained by both parties for a period of one (1) year past the expiration of the APRN CAPA-CS.
(c) The APRN's meeting records shall be subject to audit by the board and the physician's records shall be subject to audit by the KBML. The sole purpose of the audit shall be to document that the collaboration meetings have taken place to verify compliance with this section.
(4) In the first year of the CAPA-CS, the APRN and a physician shall meet at least quarterly.
(5) In the ensuing three (3) years of the CAPA-CS, the APRN and the physician shall meet at least biannually.
Section 4. Advanced practice registered nursing shall include prescribing and administering medications, as well as ordering treatments, devices, diagnostic tests, and performing certain procedures that shall be consistent with the scope and standards of practice of the APRN.
Section 5. Advanced practice registered nursing shall not preclude the practice by the APRN of registered nursing practice as defined by KRS 314.011(6).
Section 6.
(1)
(a) A CAPA-NS and a CAPA-CS shall include the:
1. Name;
2. Practice address;
3. Phone number;
4. License number of both the APRN and each physician who is a party to the agreement; and
5. Population focus and area of practice of the APRN and each physician.
(b) An APRN shall use a CAPA-NS Agreement Form.
(c) An APRN shall use the Standardized CAPA-CS Agreement Form.
(2)
(a) To notify the board of the existence of a CAPA-NS pursuant to KRS 314.042(8)(b), the APRN shall submit an online notification as established in paragraph (e) of this subsection.
(b) To notify the board that the requirements of KRS 314.042(9) have been met and that the APRN will be prescribing nonscheduled legend drugs without a CAPA-NS, the APRN shall submit an online notification as established in paragraph (e) of this subsection.
(c) To notify the board of the existence of a CAPA-CS pursuant to KRS 314.042(11)(b), the APRN shall submit an online notification as established in paragraph (e) of this subsection.
(d) To notify the board that the requirements of KRS 314.042(14) have been met and request that the APRN be exempt from prescribing scheduled legend drugs under a CAPA-CS, the APRN shall complete the request for APRN exemption from CAPA-CS prescriptive authority and pay the listed fee in 201 KAR 20:240, Section 3(1)(e). Each submitted request shall be subject to the fee, regardless of whether the board grants the exemption after making a determination under Section 7 of this administrative regulation.
(e) Each notification, recission, and exemption request shall be submitted by the APRN to the board via the online KBN Nurse Portal at www.kbn.ky.gov, and shall include the information and documentation required by subsection (1) of this section and this subsection.
(f) Upon request by the board, the APRN shall furnish to the board a copy of the executed CAPA-NS Agreement Form or Standardized CAPA-CS Agreement Form.
(3) For purposes of the CAPA-NS and the CAPA-CS, in determining whether the APRN and the collaborating physician are qualified in the same or a similar specialty, the board shall consider the facts of each particular situation and the scope of the APRN's and the physician's actual practice.
(4) An APRN with controlled substance prescriptive authority, shall:
(a) Obtain a United States Drug Enforcement Administration (DEA) Controlled Substance Registration Certificate and shall report the APRN's Kentucky DEA number, and any change in the status of a certificate by providing a copy of each registration certificate to the board within thirty (30) days of issuance.
(b) Register for a master account with the PDMP, within thirty (30) days of obtaining a DEA Controlled Substance Registration Certificate, and prior to prescribing controlled substances. A copy of the PDMP master account registration certificate shall be submitted to the board via the online KBN Nurse Portal within thirty (30) days of receipt of confirmation of registration by the PDMP.
(5) An APRN shall report any changes to a CAPA-NS or a CAPA-CS to the board within thirty (30) days.
(6) If an APRN's CAPA-NS or CAPA-CS ends unexpectedly for reasons outside the APRN's control such as being ended by the physician without notice, the physician's license becoming no longer valid in Kentucky, or the death of a physician, the APRN may continue to prescribe for thirty (30) days, after documenting in each patient's medical record the applicant's professional determination that the continued prescribing is justified based on the individual facts applicable to the patient's diagnosis and treatment. This thirty (30) day grace period shall not be extended or occur successively.
(7) An APRN with a CAPA-NS or a CAPA-CS shall report a practice address to the board. A change to the practice address shall be reported to the board within thirty (30) days.
(8) All documents and information required to be reported to the board by this section shall be reported by uploading the document or information through the board's Web site, https://kbn.ky.gov. The board shall not accept documents or information sent in any other format.
Section 7. CAPA-CS Exemption Review Request.
(1) An APRN who wishes to request a CAPA-CS exemption pursuant to KRS 314.042(14) shall:
(a) Complete a CAPA-CS exemption review request on the board's Web site as required in Section 6(8) of this administrative regulation;
(b) Submit the fee required by 201 KAR 20:240, Section 3(1)(e); and
(c) Comply with the requirements established in KRS 314.042(14) and this administrative regulation.
(2) Upon receipt of the CAPA-CS exemption review request, the board shall verify the following:
(a) The APRN has had four (4) years of controlled substance prescribing authority;
(b) The APRN's license is in good standing;
(c) The APRN has maintained a DEA registration and a current registration certificate is on file with the board;
(d) The APRN has maintained a PDMP registration and a current registration is on file with the board;
(e) That a current Notification of a CAPA-CS for the APRN is on record with the board; and
(f) The APRN has an active account with the PDMP.
(3) Upon receipt of the CAPA-CS exemption review request, the board shall:
(a) Perform a criminal background check for any unreported misdemeanor or felony convictions in Kentucky; and
(b) Perform a check of the coordinated licensure information system specified in KRS 314.475 for any unreported disciplinary actions in another state.
(4) The APRN submitting the request shall cooperate with supplemental requests for documentation before the board makes a determination that the APRN's license is in good standing pursuant to KRS 314.042(14).
(5) An APRN wishing to practice in Kentucky through licensure by endorsement may request an exemption under this section.
(a) An APRN wishing to practice in Kentucky through licensure by endorsement is exempt from the CAPA-CS requirement if the APRN:
1. Has met the prescribing requirements for controlled substances in a state that grants such prescribing authority to APRNs;
2. Has had authority to prescribe controlled substances for at least four (4) years; and
3. Has a license in good standing.
(b) An APRN wishing to practice in Kentucky through licensure by endorsement who has had the authority to prescribe controlled substances for less than four (4) years and wishes to continue to prescribe controlled substances shall enter into a CAPA-CS with a physician licensed in Kentucky and comply with the provisions of KRS 314.042(11), until the requirements of this section are met.
(6) If the board determines that the APRN is eligible for the exemption after a review and determination of the exemption request under this section, the board shall notify the APRN in writing that the CAPA-CS is no longer required. The board shall not require the APRN to maintain a CAPA-CS as a condition to prescribe controlled substances unless the board imposes the requirement as part of an action instituted under KRS 314.091(1).
(7) If the board denies the exemption request, the denial shall be in writing and shall state the reasons for the denial. The requestor may request a hearing pursuant to KRS Chapter 13B within twenty (20) days of receiving written notification of the denial. If a hearing is requested and the order of the board is adverse to the advance practice registered nurse, the board may impose costs pursuant to 201 KAR 20:162, Section 7.
(8) The APRN nurse shall not prescribe controlled substances without a CAPA-CS until the board has completed its review and has notified the APRN in writing that the APRN is exempt from the CAPA-CS requirement.
Section 8. Prescribing Medications without Prescriptive Authority. Prescribing nonscheduled legend drugs without a CAPA-NS or prescribing controlled substances without a CAPA-CS shall constitute a violation of KRS 314.091(1), unless:
(1) In the case of nonscheduled legend drugs, the CAPA-NS has been discontinued pursuant to KRS 314.042(9) or if the prescribing occurred within the grace period established in Section 6(6) of this administrative regulation; or
(2) In the case of controlled substances, the APRN was granted an CAPA-CS exemption by the board under KRS 314.042(14)(e) prior to the date the medications were prescribed.
Section 9. The board may make an unannounced visit to an APRN's practice to determine if it is consistent with the requirements established by KRS Chapter 314 and 201 KAR Chapter 20. Patient and prescribing records shall be made available for immediate inspection.
Section 10. Prescribing Standards for Controlled Substances.
(1)
(a) This section shall apply to APRNs with controlled substance prescriptive authority. It also applies to the utilization of the PDMP.
(b) The APRN shall practice according to the applicable scope and standards of practice for the APRN's role and population focus. This section does not alter the prescribing limits established in KRS 314.011(8).
(2) Prior to the initial prescribing of a controlled substance to a patient, the APRN shall:
(a) Obtain the patient's medical history, including history of substance use, and conduct an examination of the patient and document the information in the patient's medical record. An APRN certified in psychiatric-mental health shall obtain a medical and psychiatric history, perform a mental health assessment, and document the information in the patient's medical record;
(b) Query the PDMP for the twelve (12) month period immediately preceding the request for available data on the patient and maintain all PDMP report identification numbers and the date of issuance of each PDMP report in the patient's record;
(c) Develop a written treatment plan stating the objectives of the treatment and further diagnostic examinations required; and
(d) Discuss with the patient, the patient's parent if the patient is an unemancipated minor child, or the patient's legal guardian or health care surrogate:
1. The risks and benefits of the use of controlled substances, including the risk of tolerance and drug dependence;
2. That the controlled substance shall be discontinued once the condition requiring its use has resolved; and
3. Document that the discussion occurred and obtain written consent for the treatment.
(3) The treatment plan shall include an exit strategy, if appropriate, including potential discontinuation of the use of controlled substances.
(4) For subsequent or continuing long-term prescriptions of a controlled substance for the same medical complaint, the APRN shall:
(a) Update the patient's medical history and document the information in the patient's medical record;
(b) Modify and document changes to the treatment plan as clinically appropriate; and
(c) Discuss the risks and benefits of any new controlled substances prescribed, including the risk of tolerance and drug dependence with the patient, the patient's parent if the patient is an unemancipated minor child, or the patient's legal guardian or health care surrogate.
(5) During the course of treatment, the APRN shall query the PDMP no less than once every three (3) months for the twelve (12) month period immediately preceding the request for available data on the patient. The APRN shall maintain in the patient's record all PDMP report identification numbers and the date of issuance of each PDMP report or a copy or saved image of the PDMP report. If neither an identification number nor an image can be saved to the patient's record as a result of technical limitations of the APRN's electronic health record system, the APRN shall make a concurrent note in the patient's record documenting the date and time that the APRN reviewed the patient's PDMP report.
(6) These requirements may be satisfied by other licensed practitioners in a single group practice if:
(a) Each licensed practitioner involved has lawful access to the patient's medical record;
(b) Each licensed practitioner performing an action to meet these requirements is acting within the scope of practice of his or her profession; and
(c) There is adequate documentation in the patient's medical record reflecting the actions of each practitioner.
(7) If prescribing a controlled substance for the treatment of chronic, non-cancer pain, the APRN, in addition to the requirements of this section, shall obtain a baseline drug screen and further random drug screens if the APRN:
(a) Finds a drug screen clinically appropriate; or
(b) Believes that it is appropriate to determine whether the controlled substance is being taken by the patient.
(8) If prescribing a controlled substance for the treatment of a mental health condition, the APRN shall meet the requirements of this section and KRS 314.011(8)(a) and (b).
(9) Prior to prescribing a controlled substance for a patient in the emergency department of a hospital that is not an emergency situation, the APRN shall:
(a) Obtain the patient's medical history, conduct an examination of the patient, and document the information in the patient's medical record. An APRN certified in psychiatric - mental health shall obtain a medical and psychiatric history, perform a mental health assessment, and document the information in the patient's medical record;
(b) Query the PDMP for the twelve (12) month period immediately preceding the request for available data on the patient and document the data in the patient's record;
(c) Develop a written treatment plan stating the objectives of the treatment and further diagnostic examinations required; and
(d) Discuss the risks and benefits of the use of controlled substances with the patient, the patient's parent if the patient is an unemancipated minor child, the patient's legal guardian, or health care surrogate, including the risks of tolerance and drug dependence, and document that the discussion occurred and that the patient consented to that treatment.
(10) For each patient for whom an APRN prescribes a controlled substance, the APRN shall keep accurate, readily accessible, and complete medical records, which include:
(a) Medical history and physical or mental health examination;
(b) Diagnostic, therapeutic, and laboratory results;
(c) Evaluations and consultations;
(d) Treatment objectives;
(e) Discussion of risk, benefits, and limitations of treatments;
(f) Treatments;
(g) Medications, including date, type, dosage, and quantity prescribed;
(h) Instructions and agreements;
(i) Periodic reviews of the patient's file; and
(j) All PDMP report identification numbers and the date of issuance of each PDMP report.
(11) The requirement to query the PDMP shall not apply to:
(a) An APRN prescribing or administering a controlled substance immediately prior to, during, or within the fourteen (14) days following an operative or invasive procedure or a delivery if the prescribing or administering is medically related to the operative or invasive procedure of the delivery and the medication usage does not extend beyond the fourteen (14) days;
(b) An APRN prescribing or administering a controlled substance necessary to treat a patient in an emergency situation; or
(c) An APRN prescribing a controlled substance:
1. For administration in a hospital or long-term-care facility with an institutional account, or an APRN in a hospital or facility without an institutional account, if the hospital, long-term-care facility, or licensee queries the PDMP for all available data on the patient or resident for the twelve (12) month period immediately preceding the query within twelve (12) hours of the patient's or resident's admission and places a copy of the query in the patient's or resident's medical records during the duration of the patient's stay at the facility;
2. As part of the patient's hospice or end-of-life treatment;
3. For the treatment of pain associated with cancer or with the treatment of cancer;
4. To assist a patient with submitting to a diagnostic test or procedure;
5. Within seven (7) days of an initial prescription pursuant to subsection (1) of this section if the prescriber:
a. Substitutes a controlled substance for the initial prescribing;
b. Cancels any refills for the initial prescription; and
c. Requires the patient to dispose of any remaining unconsumed medication;
6. Within ninety (90) days of an initial prescription pursuant to subsection (1) of this section if the prescribing is done by another licensee in the same practice or in an existing coverage arrangement, if done for the same patient for the same condition;
7. To a research subject enrolled in a research protocol approved by an institutional review board that has an active federal-wide assurance number from the United States Department of Health and Human Services, Office for Human Research Protections if the research involves single, double, or triple blind drug administration or is additionally covered by a certificate of confidentiality from the National Institutes of Health;
8. During the effective period of any disaster or situation with mass casualties that have a direct impact on the APRN's practice;
9. As part of the administering or ordering of controlled substances to prisoners in a state, county, or municipal correctional facility;
10. That is a Schedule IV controlled substance for no longer than three (3) days for an established patient to assist the patient in responding to the anxiety of a nonrecurring event; or
11. That is classified as a Schedule V controlled substance.
(12) In accordance with 21 C.F.R. 1306.12(b)(1)(iv) - (v), federal regulation 21 C.F.R. 1306.12(b) concerning the issuance of multiple prescriptions for Schedule II controlled substances shall not apply to APRNs in this state.
(13) No less than once every six (6) months, an APRN who holds a DEA Controlled Substance Registration Certificate shall review a reverse PDMP report for the preceding six (6) months to determine if the information contained in the PDMP is correct. If the information is incorrect, the APRN shall comply with 902 KAR 55:110 and take the necessary steps to seek correction of the information, by:
(a) First contacting the reporting pharmacy;
(b) Contacting law enforcement if suspected fraudulent activity; or
(c) Contacting the Drug Enforcement Professional Practices Branch, Office of Inspector General, Cabinet for Health and Family Services.
(14) An APRN shall not issue a prescription for hydrocodone combination products for more than a three (3) day supply if the prescription is intended to treat pain as an acute medical condition, except if:
(a) The APRN, in his or her professional judgment, believes that more than a three (3) day supply of hydrocodone combination products is medically necessary to treat the patient's pain as an acute medical condition and the APRN adequately documents the acute medical condition and lack of alternative treatment options that justifies deviation from the three (3) day supply limit on the patient's medical records;
(b) The prescription for hydrocodone combination products is prescribed to treat chronic pain;
(c) The prescription for hydrocodone combination products is prescribed to treat pain associated with a valid cancer diagnosis;
(d) The prescription for hydrocodone combination products is prescribed to treat pain while the patient is receiving hospice or end-of-life treatment;
(e) The prescription for hydrocodone combination products is prescribed as part of a narcotic treatment program licensed by the Cabinet for Health and Family Services;
(f) The prescription for hydrocodone combination products is prescribed to treat pain following a major surgery, which is any operative or invasive procedure or a delivery, or the treatment of significant trauma; or
(g) Hydrocodone combination products are administered directly to an ultimate user in an inpatient setting.
(15) Prescriptions written for hydrocodone combination products pursuant to subsection (14)(a) through (g) of this section shall not exceed thirty (30) days without any refill.
(16) An APRN may prescribe electronically. Electronic prescription shall be as established in KRS 218A.171.
(17) For any prescription for a controlled substance, the prescribing APRN shall discuss with the patient the effect the patient's medical condition and medication may have on the patient's ability to safely operate a vehicle in any mode of transportation.
Section 11. Immediate Family Member and Self-prescribing or Administering Medications.
(1) An APRN shall not self-prescribe or administer controlled substances.
(2) An APRN shall not prescribe or administer controlled substances to his or her immediate family member except as established in subsections (3) and (4) of this section.
(3) An APRN may prescribe or administer controlled substances to an immediate family member:
(a) In an emergency situation;
(b) For a single episode of an acute illness through one (1) prescribed course of medication; or
(c) In an isolated setting, if no other qualified practitioner is available.
(4)
(a) An APRN who prescribes or administers controlled substances for an immediate family member pursuant to subsections (3)(a) or (b) of this section shall document all relevant information and notify the appropriate provider.
(b) An APRN who prescribes or administers controlled substances for an immediate family member pursuant to subsection (3)(c) of this section shall maintain a provider-practitioner relationship and appropriate patient records.
Section 12. Incorporation by Reference.
(1) The following material is incorporate by reference:
(a) "AACN Scope and Standards for Acute Care Nurse Practitioner Practice", 2017 Edition, American Association of Critical-Care Nurses;
(b) "AACN Scope and Standards for Acute Care Clinical Nurse Specialist Practice", 2014 Edition, American Association of Critical-Care Nurses;
(c) "Neonatal Nursing: Scope and Standards of Practice", 2013 Edition, American Nurses Association/ National Association of Neonatal Nurses;
(d) "Nursing: Scope and Standards of Practice", 2015 Edition, American Nurses Association;
(e) "Pediatric Nursing: Scope and Standards of Practice", 2015 Edition, American Nurses Association/ Society of Pediatric Nursing/ National Association of Pediatric Nurse Practitioners;
(f) "Psychiatric-Mental Health Nursing: Scope and Standards of Practice", 2014, American Nurses Association/ American Psychiatric Nursing Association;
(g) "Scope of Practice for Nurse Practitioners", 2019 Edition, American Association of Nurse Practitioners;
(h) "Standards of Practice for Nurse Practitioners", 2019 Edition, American Association of Nurse Practitioners;
(i) "Scope of Nurse Anesthesia Practice", 2013 Edition, American Association of Nurse Anesthetists;
(j) "Standards for Nurse Anesthesia Practice", 2019 Edition, American Association of Nurse Anesthetists;
(k) "Standards for Office Based Anesthesia Practice", 2019 Edition, American Association of Nurse Anesthetists;
(l) "Standards for the Practice of Midwifery", 2011 Edition, American College of Nurse Midwives;
(m) "Oncology Nursing Scope and Standards of Practice", 2019 Edition, Oncology Nursing Society;
(n) "The Women's Health Nurse Practitioner: Guidelines for Practice and Education", 2014 Edition, Association of Women's Health, Obstetric and Neonatal Nurses/Nurse Practitioners in Women's Health;
(o) "Definition of Midwifery and Scope of Practice of Certified Nurse-Midwives and Certified Midwives", 2012 Edition, American College of Nurse Midwives;
(p) "Standards for Professional Nursing Practice in the Care of Women and Newborns", 2019 Edition, Association of Women's Health, Obstetric and Neonatal Nurses;
(q) "Standardized CAPA-CS Agreement Form", _9/2023; and
(r) "CAPA-NS Agreement Form", 9/2023.
(2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Kentucky Board of Nursing, 312 Whittington Parkway, Suite 300, Louisville, Kentucky 40222, Monday through Friday, 8 a.m. to 4:30 p.m. This material is also available on the board's Web site at https://kbn.ky.gov/document-library/Pages/default.aspx.
Notes
STATUTORY AUTHORITY: KRS 218A.205(3)(a), (b), 314.042, 314.131(1), 314.193(2)