Tenn. Comp. R. & Regs. 1000-04-.09 - PREREQUISITES TO PRESCRIBING OR DISPENSING MEDICATIONS
(1) Except as provided in paragraph (2), it
shall be a prima facie violation of T.C.A. §
63-7-115(a) (1) (C) and
(F) for an Advanced Practice Nurse, having
proper authority to prescribe, to prescribe or dispense any drug to any
individual, whether in person or by electronic means or over the Internet or
over telephone lines, unless the Advanced Practice Nurse with proper authority
to prescribe or the A.P.N's licensed supervisee and pursuant to appropriate
protocols or orders, has completed and appropriately documented, for the person
to whom a prescription is to be issued or drugs dispensed, all of the
following:
(a) Performed an appropriate
history and physical examination; and
(b) Made a diagnosis based upon the
examinations and all diagnostic and laboratory tests consistent with good
health care; and
(c) Formulated a
therapeutic plan, and discussed it, along with the basis for it and the risks
and benefits of various treatments options, a part of which might be the
prescription or dispensed drug, with the patient; and
(d) Insured availability of the Advanced
Practice Nurse with proper authority to prescribe, or coverage for the patient
for appropriate follow-up care.
(2) An Advanced Practice Nurse having proper
authority to prescribe, or the A.P.N's licensed supervisee and pursuant to
appropriate protocols or orders, may prescribe or dispense drugs for a person
not in compliance with paragraph (1) consistent with sound judgment, examples
of which are as follows:
(a) In admission
orders for a newly hospitalized patient; or
(b) For a patient of a physician or of an
Advanced Practice Nurse with proper authority to prescribe for whom the
prescriber is taking calls or for whom the prescriber has verified the
appropriateness of the medication; or
(c) For continuation medications on a
short-term basis for a new patient prior to the patient's first appointment;
or
(d) For established patients
who, based on sound practices, the Advanced Practice Nurse having proper
authority to prescribe, believes do not require a new physical examination
before issuing new prescriptions.
(3) Except as provided in paragraph (2), it
shall be a prima facie violation of T.C.A. §
63-7-115(a) (1) (C) and
(F) for an Advanced Practice Nurse having
proper authority to prescribe, or the A.P.N's licensed supervisee and pursuant
to appropriate protocols or orders, to prescribe or dispense any drug to any
individual for whom the Advanced Practice Nurse with proper authority to
prescribe, or the A.P.N's licensed supervisee and pursuant to appropriate
protocols or orders, has not complied with the provisions of this rule based
solely on answers to a set of questions regardless of whether the prescription
is issued directly to the person or electronically over the Internet or
telephone lines.
(4) Advanced
Practice Nurses having proper authority to prescribe, who elect to dispense
medication for remuneration must comply with all Federal Regulations ( 21 CFR
1304 through 1308) for the dispensing of controlled substances.
(5) Non-controlled drugs are to be dispensed
in an appropriate container labeled with at least, the following:
(a) Patient's name.
(b) Date.
(c) Complete directions for usage.
(d) The name and address of the Advanced
Practice Nurse having proper authority to prescribe.
(e) A unique number, or the name and strength
of the medication.
(6)
Whenever dispensing takes place, appropriate records shall be maintained. A
separate log must be maintained for controlled substances dispensing.
(7) Whenever prescribing takes place, written
or electronic prescription orders shall be prepared pursuant to T.C.A. §
63-7-123(b)
(3).
(8) It is not the intention of this Rule to
interfere with the individual Advanced Practice Nurses, having proper authority
to prescribe, and their appropriate use of professional samples, nor is it to
interfere in any way with the rights of Advanced Practice Nurses, who have
proper authority to prescribe, to directly administer drugs or medications to
any patient.
Notes
Authority: T.C.A. §§ 4-5-202, 4-5-204, 53-11-301, 63-7-115, 63-7-123, 63-7-126, and 63-7-207.
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