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Public Health Nursing Physician Approved Protocols
GENERAL POLICY STATEMENT
The Oklahoma Nursing Practice Act, 59 O.S. § 567.3, states, "The practice of nursing means the performance of services provided for purposes of nursing diagnosis and treatment of human responses to actual or potential health problems consistent with educational preparation..... This practice includes execution of the medical regime including the administration of medications and treatments prepared by any person authorized by state law to so prescribe."
"Physician approved protocols" are commonly used in institutions providing health care services. A physician approved protocol is a medical function, task, or act that has been delegated to another individual, most commonly a nurse, by a licensed physician in accordance with the Oklahoma Medical and Surgical Licensure and Supervision Act, the Oklahoma Osteopathic Medicine Act, and the Oklahoma Public Health Code. Because of the accepted usage of the legal basis of approved protocols, it is both necessary and proper that public health nurses should have physician approved protocols to authorize them to administer a treatment or medication when a physician is not present. It is the policy of the Oklahoma State Department of Health (OSDH), in accordance with Oklahoma Public Health Code, 63 O.S. §§ 1-101 et seq., that the physician approved protocols will be evidence-based and consistent with nationally recognized and published clinical practice guidelines. They represent medically delegated functions from authorized public health medical directors.
The criteria listed below will be followed in the utilization of these physician approved protocols.
1. All physician approved protocols are reviewed annually by the Nursing Service Clinical Director, subject area experts within the agency, including program physician consultants. The orders will be signed annually by the OSDH State Health Officer, the Community & Family Health Services Medical Director and the County Health Department (CHD) Medical Director and remain in effect until superseded.
2. Specific orders received by telephone or verbally, from a person licensed to prescribe treatment, must be countersigned by that person (within 7 days after the order is received). This task can be accomplished using ODH Form # 303M.
3. The District Nurse Manager or designee is responsible for having valid current physician approved protocols for all public health nursing services provided through the health department.
4. Each nurse is individually responsible for his/her actions and should be knowledgeable of all physician approved protocols. Any nurse acting beyond the approved protocols would be practicing beyond the scope of his/her employment.
5. A file should be used to maintain the original copies of the physician approved protocol signature pages that have been signed by the medical director for each county. If the CHD medical director makes major changes in a particular protocol, the actual page of the protocol must be signed and dated by the physician and a copy of the amended protocol must be sent to Nursing Service within seven days of signature. The original of this page should also be maintained in this file.
6. Photocopies of this signature page should be placed within all county sites working under physician approved protocols. All original physician signature pages must remain in the county until a new signature page is signed for new orders. Within 30 days of being superseded, all original signature pages and the original page(s) of any order that has been changed by the CHD medical director must be assembled for each county and forwarded to Nursing Service for archival storage. For further information regarding this process contact Nursing Services.
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