Collaborative Practice Arrangement Checklist

COLLABORATIVE PRACTICE ARRANGEMENT CHECKLIST

CP Rule: 20 CSR 2200-4.200 (Nursing) or 20 CSR 2150-5.100 (Healing Arts)

Written Collaborative Practice Arrangement (CPA) Between Physician And Registered Professional Nurse (RN) Who Is Not An Advanced Practice Nurse

NOTE:

-CPA refers to written agreements, written jointly agreed-upon protocols, or written standing orders for the delivery of health care services [See 334.104, RSMo].

-Collaborative Practice Rule does not apply if RN is not in a CPA with a physician.

-RN does not require a CPA with a physician nor require physician oversight to perform nursing acts that the RN has the specialized education, judgement, and skill to perform [See 335.016(9), RSMo].

-Collaborating physician and collaborating RN may want to use pertinent, reputable texts/literature to draft defensible, practice-related operational definitions for phrases/terms not defined in Rule.

-Exceptions to Rule:

    1. Collaborative Practice Rule does not extend to CPAs of RNs who are:
    2. hospital employees

      providing inpatient care

      within hospitals as defined pursuant to chapter 197, RSMo [See 334.104.3, RSMo].

    3. In the case of collaborating physicians and collaborating RNs practicing in association with public health clinics that provide specific (see list in rule) population-based health services, geographic areas, methods of treatment, and review of services occur as identified by the collaborating physicians and collaborating RNs in the CPA [(5)(A)].

Geographic Areas

  • Collaborating physician and collaborating RN are not so geographically distanced from one another as to create impediment to effective collaboration in delivery of health care services or adequate review of said services [(2)(A)]

Methods of Treatment

  • Methods of treatment and authority to administer or dispense drugs (i.e., medical acts) delegated in CPA to collaborating RN are within scope of practice of collaborating physician and collaborating RN and are consistent with each professionalís skill, training, education, and competence [(3)(A), (3)(C), & (3)(I)11.]
  • Collaborating physician considered level of skill, education, training, and competence of collaborating RN and ensure that delegated responsibilities in CPA are consistent with those levels [(3)(B)]
  • RNís guidelines for consultation and referral to collaborating physician or designated health care facility are specified in written CPA [(3)(D)]
  • Methods of treatment and authority to administer or dispense drugs (i.e., medical acts) delegated in CPA to collaborating RN are not being further delegated by collaborating RN to any other person with exception of individuals identified in 338.095, RSMo and 338.198, RSMo [(3)(E)][See also 335.016(8) & (9), RSMo]
  • Methods of treatment and authority to administer or dispense drugs (i.e., medical acts) delegated in CPA to collaborating RN are delivered only pursuant to written agreement, jointly agreed upon protocols, or standing orders that describe a specific sequence of orders, steps, or procedures to be followed in providing patient care in specified clinical situations [(3)(F)].

With such a CPA in place, the collaborating RN may:

-provide health care services for acute self-limited or well defined problems [(3)(J)];

-provide health care services for conditions other than acute self-limited or well defined problems [(3)(J)];

-provide care to well patients or to those with narrowly circumscribed conditions in public health clinics or community health settings that provide specific (see list in rule) population-based health services [(4)(E)];

-provide specific (see list in rule) population-based health services in association with public health clinics [(5)(A)]; and

-provide health care services for acutely or chronically ill or injured persons after diagnosis and initiation of treatment by the collaborating physician or an advanced practice nurse in CPA with physician (e.g., provide continuing or ongoing care) [(2)(B), (2)(C), (3)(J), & (4)(C)]

  • CPA specifies collaborating professionalsí awareness of content and agreement to follow terms and is signed and dated by the collaborating physician and collaborating RN before implementation [(3)(H)]
  • CPA and any subsequent written notice of its termination are maintained by collaborating physician and collaborating RN for minimum of eight (8) years after termination of CPA [(3)(H)]
  • Collaborating physician and collaborating RN review and revise written CPA as needed [(3)(H)]
  • Collaborating physician ensures appropriate administering, dispensing, and control of drugs utilized pursuant to CPA in accordance with all state/federal laws [(3)(I)1.]
  • Methods of treatment and authority to administer or dispense drugs (i.e., medical acts) delegated in CPA to collaborating RN are in accordance with all state/federal laws (packaging, labeling, storage, inventory) [(3)(I)2.,3.,4., & 5.]
  • Retrievable dispensing logs, which include all information required by state/federal laws, are maintained for all prescription drugs dispensed [(3)(I)6.]
  • RN does not prescribe drugs (whether in or not in CPA) [(3)(I)8.][See also 335.016 (9), RSMo & 195.070.6, RSMo]
  • Administering or dispensing of a controlled substance by a RN in a CPA only occurs on a case-by-case basis following verbal consultation between collaborating physician, or other physician designated in CPA, and collaborating RN, with consultation and physician directions recorded by collaborating RN in patient chart and appropriate dispensing log and cosigned by collaborating physician following record review [(3)(I)9.]
  • RN in CPA only dispenses starter doses of medication to cover seventy-two (72) hours or less (does not apply to samples) [(3)(I)10.] [See also 338.010, RSMo & 20 CSR 2150.5.020]

-entity exceptions to above include: Title X family planning providers or publicly funded clinics in community health settings that dispense medications free of charge [(3)(I)10.]

  • RN in CPA to provide services for conditions other than acute self-limited or well defined problems requires collaborating physician, or other physician designated in the CPA, seeing patient (to evaluate and approve or formulate the plan of treatment) for new or significantly changed conditions within no more than two (2) weeks after that patient was seen by RN [(3)(J)]

  • RN in CPA shall not make a medical diagnosis of any condition [(3)(K)]

Review of Services

  • Collaborating physician, or other physician designated in CPA, is immediately available for consultation to collaborating RN at all times, either personally or via telecommunications [(4)(A)]
  • Collaborating physician reviews work, records, and practice of health care delivered pursuant to CPA at least once every two (2) weeks with such review documented by collaborating physician [(4)(B)]

-exception to this once every two (2) week review by collaborating physician are settings in which collaborating RNís health care is provided to well patients or to those with narrowly circumscribed conditions in public health clinics or community health settings that provide specific (see list in rule) population-based health services; review of these services occurs as needed and identified in written CPA [(4)(E)]

  • The process and documentation of whatever review is required is kept on file and maintained in the collaborative practice setting [(4)(F)]

Collaborating physician and collaborating RN determine and document in written CPA an appropriate process of review and management of abnormal test results [(4)(D)]