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Chapter 360-32 NURSE PROTOCOL AGREEMENTS PURSUANT TO O.C.G.A. SECTION 43-34-25

Rule 360-32-.01 [Repealed]

Rule 360-32-.02 [Repealed]

Rule 360-32-.03 Filing of Nurse Protocol Agreement with the Board

(1) The delegating physician shall file the nurse protocol agreement and a Board approved form with the Board for review and submits the requisite fee for review established in the Board's fee schedule. Fees are non-refundable.
(2) In addition to submitting the nurse protocol agreement to the Board for review, the delegating physician shall obtain from the APRN and submit to the Board current verification from the Georgia Board of Nursing that the APRN is approved to practice as an APRN and whether the APRN has had any disciplinary action taken against him or her by the Georgia Board of Nursing.
(3) If, after review, the Board determines that the nurse protocol agreement fails to meet accepted standards of medical practice, the delegating physician will be so notified and be required to amend the agreement in order to comply with such accepted standards.
(4) The delegating physician shall file with the Board amendments to nurse protocol agreements previously reviewed by the Board within 30 days of the date the amendment was executed.
(5) Nurse protocol agreements must be received by the Board within 30 days from the date of execution of the agreement.
(6) Incomplete protocols that have been on file with the Board for more than three months shall be deemed invalid. No further action will take place on the protocol requests that have been incomplete for more than three months and a new protocol and fee will be required.

Rule 360-32-.04 Limitations

(1) A physician whose medical license is restricted shall not enter into a nurse protocol agreement, unless the physician has received prior written approval from the Board.
(2) No physician shall delegate to an individual pursuant to the provisions of Code Section 43-34-25, unless the individual is fully approved by the Georgia Board of Nursing to practice as an APRN.
(3) No physician may enter into a nurse protocol agreement with an APRN whose specialty area or field is not comparable to the physician's specialty area or field.
(4) Unless specifically exempted by paragraphs (g), (g.1), or (g.2) of Code Section 43-34-25, a delegating physician may not enter into a nurse protocol agreement with more than four APRN's at any one time. A delegating physician meeting the provisions of Code section 43-34-25 (g.1) or (g.2) may enter into a nurse protocol agreement not with more than eight APRN's at any one time, but may only supervise up to four APRN's at any one time.
(5) Except for practice settings identified in paragraph (7) of subsection (g) of Code Section 43-34-25, a physician shall not be an employee of an APRN, alone or in combination with others, if the physician delegates to and/or is required to supervise the employing APRN.
(6) No delegating physician shall delegate to an APRN the ability to prescribe controlled substances for the delegating physician, for the members of the delegating physician's immediate family, for the APRN himself or herself, or for the APRN's immediate family. For purposes of this rule,"immediate family" shall include spouses, children, siblings and parents.

Rule 360-32-.05 Additional Requirements Regarding Physician Delegation to an APRN

(1) The delegating physician shall be available for immediate consultation with the advanced practice registered nurse. If the delegating physician is not available, the delegating physician for purposes of consultation may designate another physician who concurs with the terms of the nurse protocol agreement as provided in O.C.G.A. 43-34-25.
(2) The delegating physician shall document and maintain a record of onsite observation and review of medical records on a quarterly basis to monitor quality of care being provided to the patients.
(3) The delegating physician shall make certain that the medical acts provided by the APRN pursuant to the protocol agreement are:
(a) Commensurate with the education, training, experience and competence of the APRN:
1. A delegating physician shall therefore ensure that an APRN to whom he delegates prescriptive receives pharmacology training appropriate to the delegating physician's scope of practice at least annually. Documentation of such training shall be maintained by the physician and provided to the Board upon request.
2. A delegating physician who fails to comply with subparagraph (3)(a)1. of this rule by delegating prescriptive to an APRN who has not received pharmacology training appropriate to the delegating physician's scope of practice at least annually may be subject to disciplinary action.
(b) Within the scope of practice, specialty area or field and certification of the APRN;
(c) Within the comparable specialty area or field of the delegating physician; and
(d) Well documented in accurately maintained patient specific medical records.
(4) The delegating physician is responsible for all the medical acts performed by the APRN.
(5) A delegating physician shall notify the Board within ten (10) working days of the date of termination of a nurse protocol agreement with the delegating physician and APRN.
(6) In the event of the death or departure of a delegating physician, an APRN must notify the Board within 7 days. If a designated physician is available according to an approved protocol agreement, he or she may serve as the delegating physician for up to 60 days (from the date of death of departure) until a new protocol agreement is approved by the Board. In the event that there is no designated physician, the APRN will not have prescriptive authority until a new signed protocol agreement is submitted to the Board.
(7) The Board may request at any time to review the nurse protocol agreement and any supporting documentation. Failure to provide this written information to the Board within 30 days shall be a basis for and may result in disciplinary action. The Board may require changes in these documents if the Board determines that they do not comply with O.C.G.A. 43-34-25 and/or accepted standards of medical practice.

Rule 360-32-.06 Non-compliance

A delegating or other designated physician may be disciplined for failure to comply with this Chapter.

Rule 360-32-.07 Exemptions

Nothing in this rule shall be construed to require a physician to delegate prescriptive or prohibit a physician from utilizing the protocol granted under O.C.G.A. § 43-34-23.