FINAL BILL REPORT
SSB 5922
C 225 L 93
SYNOPSIS AS ENACTED
Brief Description: Regarding the use of controlled substances by advanced registered nurse practitioners, certified nurse anesthetists.
SPONSORS: Senate Committee on Health & Human Services (originally sponsored by Senators Snyder, Deccio, Vognild and Newhouse)
SENATE COMMITTEE ON HEALTH & HUMAN SERVICES
HOUSE COMMITTEE ON HEALTH CARE
BACKGROUND:
The state Board of Nursing may designate a registered nurse as an advanced registered nurse practitioner (ARNP) upon completion of advanced specialized training and certification by an approved national certification body. A Certified Registered Nurse Anesthetists (CRNA) is one type of ARNP specialty recognized by the Board.
The Board of Nursing is further authorized to grant registered nurses authority to prescribe legend drugs and schedule V controlled substances. Registered nurses, including ARNPs, are prohibited from prescribing schedule I through IV controlled substances. A registered nurse, however, may administer schedule II through IV controlled substances to patients if a physician or other authorized practitioner has ordered the use of the drug. Authorized practitioners include physicians, osteopathic physicians, podiatric physicians and dentists.
CRNAs administer anesthesia in a variety of health care settings including hospitals and outpatient surgical centers. Because of the shortage of anesthesiologists (physicians) CRNAs are widely used in rural hospitals to administer preoperative and postoperative anesthesia. There are cases where CRNAs have been selecting, ordering and administering schedule II through IV controlled substances as preoperative and postoperative anesthesia for patients without an order or signed prescription from an authorized practitioner.
In 1990, the Board of Pharmacy conducted an investigation at a rural hospital where a CRNA was selecting and ordering a schedule II controlled substance and forwarded the case to the Board of Nursing to investigate as a possible violation of prescribing prohibition in law. The Board of Nursing dismissed the case ruling that the CRNA had not prescribed the anesthesia since the drug was obtained and used on an inpatient basis. The Board of Pharmacy challenged this interpretation and concluded that the activity of selecting and ordering drugs is a prescribing activity and in violation of state law.
The Board of Pharmacy has announced that it intends to order its pharmacies to discontinue allowing CRNAs to obtain any schedule II through IV controlled substances without an order signed by an authorized practitioner. The shortage of anesthesiologists have many concerned that this action will severely reduce the availability of surgeries in many hospital and outpatient surgical centers.
SUMMARY:
Certified Registered Nurse Anesthetists (CRNA) are authorized to select, order or administer schedule II through IV controlled substances consistent within their Board of Nursing-recognized scope of practice. The authority is limited to administration of these drugs in hospitals, clinics, ambulatory surgical facilities or the offices of private physicians, dentists and podiatrists where diagnostic, operative, obstetrical or therapeutic procedures are involved. Facility-specific protocols concerning drug use must be observed and are defined to mean a statement of practice and documentation concerning categories of patients, medications, and operative procedures. A physician, osteopathic physician, dentist or podiatric physician must request the services of a CRNA. The act of selecting one of these drugs is defined as the decision-making process of choosing the drug, dosage, route and time of administration. Ordering is defined as the process of ordering individuals whose current statutory authority allows them to administer a drug, or to dispense, deliver or distribute the drug, to a patient pursuant to the instructions of a CRNA.
VOTES ON FINAL PASSAGE:
Senate 45 0
House 98 0 (House amended)
Senate 44 0 (Senate concurred)
EFFECTIVE:May 6, 1993