In July, the Ohio Board of Nursing adopted a newly revised APN Formulary as it does from time to time. A change to the concepts of “Physician Initiated” and “Physician Consult” designations will likely require any APN with prescriptive authority to revise his or her Standard Care Arrangement. Previously, the APN Formulary identified certain drugs that could be prescribed by APNs but that were required to be initiated by the APN’s collaborating physician (Physician Initiated or “PI”) and other drugs that required the APN to obtain a consultation with the collaborating physician prior to prescription (Physician Consult or ”PC”). The APN Formulary previously identified which drugs were in which category. This has been changed; the new APN Formulary now merely lists those drugs required to be either Physician Initiated or Physician Consult, but the APN Formulary does not specify which – that distinction is now required to be in each APN’s Standard Care Arrangement. The July 2009 APN Formulary states:
NOTE: Please note the Physician Initiated (PI) and Physician Consult (PC) categories have been merged into a single category. You will need to update your standard care arrangement accordingly. The CTP holder’s standard care arrangement must specify whether a drug or drug category listed on the Formulary as PI or PC will require the collaborating physician to personally examine the patient (PI) or if the drug may be prescribed with consultation (PC). This determination should be consistent with the individual CTP holder’s scope of practice and the practice specialty of the collaborating physician. The definitions of Physician Initiated and Physician Consult are unchanged. (Emphasis in original.)
The APN Formulary further provides: “Drugs/categories listed as PI/PC on the Formulary must be referenced in the SCA with the collaborating physician” (emphasis added).
This requires immediate attention by APNs working with the drugs listed as PI/PC on the APN Formulary. Those APNs need to update their Standard Care Arrangements. APNs with prescriptive authority should review the July 2009 APN Formulary and the list of the drugs that are identified as PI/PC. If the APN prescribes any of these drugs, the APN needs to revise their Standard Care Arrangements to identify which process – PI or PC – is required for each drug. The new APN Formulary states that this information must be provided in the APN’s Standard Care Arrangement.