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Public Health Nursing Guidelines And Physician Approved Orders 


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."  The Oklahoma Board of Nursing has no interpretative statement regarding this portion of the Act but the Board recommends that an institution have written guidelines that do not exceed the Nurse Practice Act for the use of approved orders.

"Physician approved orders and protocols" are commonly used in institutions providing health care services. An approved order or 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 orders and protocols, it is both necessary and proper that public health nurses should have approved orders and 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 orders and 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 and will be used in conjunction with the public health nurse guidelines

The criteria listed below will be followed in the utilization of these guidelines and physician approved orders and protocols.

1. All public health nursing guidelines and physician approved orders and protocols will be reviewed annually.  The orders will be signed annually by the OSDH Medical Director and the County Health Department Medical Director and remain in effect until superseded.

2. Specific orders and protocols 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 orders and protocols for all public health nursing services provided in the health department.

4. Each nurse is individually responsible for his/her actions and should be knowledgeable of all nursing guidelines and physician approved orders and protocols.  Any nurse acting beyond the approved orders and 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 order and protocol signature pages that have been signed by the medical director for each county.  If the physician makes major changes in a particular order or protocol, the actual page of the order must be signed and dated by the physician and a copy of the amended order 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 nursing guidelines and physician approved orders and 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 medical director/physician 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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