Important Legislative Announcemet
Legislative Update, February 3, 2012
The bill to remove the "in life threatening situations only" restriction for ordering radiographic imaging tests (MRI, CT etc.) has been drafted and will be introduced on Monday, February 6. It will be Senate Bill 386. It is sponsored by Senator Johnny Grant (R) Milledgeville and co- sponsored by Senate Health And Human Resources Chairman Renee Unterman (R) Buford.
Removing this barrier to APRN Practice is our number one legislative priority for this session. The draft of the bill will be available online by Monday afternoon at http://www.senate.ga.gov/en-US/default.aspx Type in 386 in the box at the top left of the page.
1) Contact Senators Unterman and Grant and thank from for their support of Advanced Practice Nursing:
121-E State Capitol
Atlanta, GA 30334
Phone: (404) 463-1368
Fax: (404) 651-6767
110-A State Capitol
Atlanta, GA 30334
Phone: (404) 656-0082
Fax: (404) 463-2279
2)PLEASE CONTACT YOUR STATE SENATOR AND ASK THEM TO SUPPORT SB386 and consider signing on as a co- sponsor. You can go to www.votesmart.org to identify your state Senator
3) Contact the members of the Senate Health and Human Servispces Committee and ask them to support SB 386. Their contact information is at the following link: http://www.senate.ga.gov/committees/en-US/SenateCommitteesList.aspx Highlight the Health and Human Services Committee
4) I need as many examples that you can send me of how this restriction has interfered with your ability to provide timely, quality care. Include the type of practice site (hospital, rural clinic, etc.) and of course, no patient identifying information. Send to firstname.lastname@example.org. I NEED TO THESE BY FEBRUARY 8.
An issue brief is attached.
Revision of Statute Related to the ordering of Radiographic Imaging tests by APRN’s Statement of the Issue: O.C.G.A 43-34 26 provides for the delegation of medical acts utilizing a Nurse Protocol Agreement between an APRN and a supervising physician. The requirements for a Nurse Protocol agreement and the review thereof are governed by rules and regulations promulgated by the Georgia Board of Medical Examiners. In this statute “Nurse Protocol Agreement” and “Order” are defined as follows. The specific language related to this issue is highlighted.
(10) "Nurse protocol agreement" means a written document mutually agreed upon and signed by an advanced practice registered nurse and a physician, by which document the physician delegates to that advanced practice registered nurse the authority to perform certain medical acts pursuant to this Code section, and which acts may include, without being limited to, the ordering of drugs, medical devices, medical treatments, diagnostic studies, or in life-threatening situations radiographic imaging tests. Such agreements shall conform to the provisions set forth in subsection (c) of this Code section.
(11) "Order" means to prescribe pursuant to a nurse protocol agreement which drug, medical device, medical treatment, diagnostic study, or in life-threatening situations radiographic imaging test is appropriate for a patient and to communicate the same in writing, orally, via facsimile, or electronically.
Consequences: This restriction is causing harmful unintended consequences thatnegatively impact both quality and timely access to care.
These issues include:
- Excessive designation of orders as STAT which leads to
- Increases in healthcare costs.
- Patients with less urgent and emergent issues are given the same priority in the scheduling of testingand interpretation as true emergent cases.
- Incomplete discharge planning resulting from the inability of APRN member of the team to order follow-up exams at time of discharge.
- Delay of follow-up exam ordering while signature is obtained, potentially resulting in prolonged hospitalization.
- Wasted time for both patients and providers if necessary imaging not completed and report not available at time of follow-up appointment.
- Delays in ordering and scheduling impact timely evaluation and treatment while a signature is sought.
- Especially significant when anytime the physician is not physically on site.
- A major issue in rural and underserved areas where there are more APRN run clinics and orders must be transmitted to the physician for signature and transmitted back before test can be scheduled.
- Inefficient use of support staff time and resources.
- Increased opportunity for error with multiple transfers of information.
- Timely results not delivered to the correct provider, due to confusion over who actually cared for the patient, potentially resulting in treatment delays for emergent medical issues.
- Increased incidence of undesirable practices not in conformance to rules, regulations and best practices due to the use of pre-signed orders.
- This restriction on ordering of radiographic imaging scans apply only to APRN’s and not to Physician Assistants, leading to further confusion and the necessity of duplicative processes for ordering in clinical sites where both of these provider groups practice.
Proposed solution and rationale: Amend O.C.G.A. 43-26-3 by removing the words “or in life threatening situations” from the statute related to radiologic imaging exams.
- O.C.G.A 43-26-3 already provides for regulation of delegation of medical acts through the Nurse Protocol Agreement, based on the physician assessment of the individual practitioner’s knowledge, training, and experience.
- As long as the language of concern is present in the statute, modification of rules and regulations to solve issues related to safety, access, and cost, cannot be accomplished.
- Georgia is the only state in the United States that has a statutory restriction specific to radiographic imaging tests.
- O.C.G.A.43-34-25 section c),already governs the requirements for a nurse protocol agreement, ensures physician involvement and review of APRN practice as noted below, including parameters for ordering radiographic imaging tests:
A nurse protocol agreement between a physician and an advanced practice registered nurse pursuant to this Code section shall:
- Be between an advanced practice registered nurse who is in a comparable specialty area or field as that of the delegating physician;
- Contain a provision for immediate consultation between the advanced practice registered nurse and the delegating physician; 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;
- Identify the parameters under which delegated acts may be performed by the advanced practice registered nurse, including without limitation the number of refills which may be ordered, the kinds of diagnostic studies which may be ordered,the extent to which radiographic image tests may be ordered, and the circumstances under which a prescription drug order may be executed. In the event the delegating physician authorizes the advanced practice registered nurse to order an X-ray, ultrasound, or radiographic imaging test, the nurse protocol agreement shall contain provisions whereby such X-ray, ultrasound, or radiographic imaging test shall be read and interpreted by a physician who is trained in the reading and interpretation of such tests; a report of such X-ray, ultrasound,or radiographic imaging test may be reviewed by the advanced practice registered nurse; and a copy of such report shall be forwarded to the delegating physician, except that such provision for an ultrasound shall not be required for an advanced practice registered nurse acting within his or her scope of practice as authorized by Code Sections 43-26-3 and 43-26-5;
- Require documentation either in writing or by electronic means or other medium by the advanced practice registered nurse of those acts performed by the advanced practice registered nurse which are specific to the medical acts authorized by the delegating physician;
- Include a schedule for periodic review by the delegating physician of patient records. Such patient records review may be achieved with a sampling of such records as determined by the delegating physician;
There is clearly internal conflict and inconsistency within this statute between the definition of a Nurse Protocol agreement (a) (10) and an Order (a) (11) and (c) (3) which states that the extent to which radiographic imaging tests may be ordered is determined by the Nurse Protocol Agreement.
It is clear that the Nurse Protocol Agreement was intended as the mechanism to regulate the delegation of medical acts, including the “extent to which radiographic imaging tests” may be ordered.
No safety, quality or cost data was found to support the “in life threatening emergencies” restriction of APRN ordering this singular medical act.
There have been unintended negative consequences due to this restriction.
There is no evidence from other states to support the contention that removing Georgia’s statutory restriction would result in increased costs, inappropriate utilization of resources or increased liability to either the physician or radiologist.
The APRN’s of Georgia are therefore requesting that the words “or in life-threatening situations” be removed from statute O.C.G.A. 43-26-3.