Full Text of SB0318 96th General Assembly
SB0318enr 96TH GENERAL ASSEMBLY
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LRB096 08980 ASK 19119 b |
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| AN ACT concerning regulation.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Medical Practice Act of 1987 is amended by | 5 |
| changing Section 54.5 and by adding Section 54.2 as follows: | 6 |
| (225 ILCS 60/54.2 new) | 7 |
| (Section scheduled to be repealed on December 31, 2010) | 8 |
| Sec. 54.2. Physician delegation of authority. | 9 |
| (a) Nothing in this Act shall be construed to limit the | 10 |
| delegation of patient care tasks or duties by a physician, to a | 11 |
| licensed practical nurse, a registered professional nurse, or | 12 |
| other licensed person practicing within the scope of his or her | 13 |
| individual licensing Act. Delegation by a physician licensed to | 14 |
| practice medicine in all its branches to physician assistants | 15 |
| or advanced practice nurses is also addressed in Section 54.5 | 16 |
| of this Act. No physician may delegate any patient care task or | 17 |
| duty that is statutorily or by rule mandated to be performed by | 18 |
| a physician. | 19 |
| (b) In an office or practice setting and within a | 20 |
| physician-patient relationship, a physician may delegate | 21 |
| patient care tasks or duties to an unlicensed person who | 22 |
| possesses appropriate training and experience provided a | 23 |
| health care professional, who is practicing within the scope of |
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| such licensed professional's individual licensing Act, is on | 2 |
| site to provide assistance. | 3 |
| (c) Any such patient care task or duty delegated to a | 4 |
| licensed or unlicensed person must be within the scope of | 5 |
| practice, education, training, or experience of the delegating | 6 |
| physician and within the context of a physician-patient | 7 |
| relationship. | 8 |
| (d) Nothing in this Section shall be construed to affect | 9 |
| referrals for professional services required by law. | 10 |
| (e) The Department shall have the authority to promulgate | 11 |
| rules concerning a physician's delegation, including but not | 12 |
| limited to, the use of light emitting devices for patient care | 13 |
| or treatment.
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| (225 ILCS 60/54.5)
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| (Section scheduled to be repealed on December 31, 2010)
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| Sec. 54.5. Physician delegation of authority to physician | 17 |
| assistants and advanced practice nurses .
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| (a) Physicians licensed to practice medicine in all its
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| branches may delegate care and treatment responsibilities to a
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| physician assistant under guidelines in accordance with the
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| requirements of the Physician Assistant Practice Act of
1987. A | 22 |
| physician licensed to practice medicine in all its
branches may | 23 |
| enter into supervising physician agreements with
no more than 2 | 24 |
| physician assistants.
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| (b) A physician licensed to practice medicine in all its
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| branches in active clinical practice may collaborate with an | 2 |
| advanced practice
nurse in accordance with the requirements of | 3 |
| the Nurse Practice Act. Collaboration
is for the purpose of | 4 |
| providing medical consultation,
and no employment relationship | 5 |
| is required. A
written collaborative agreement shall
conform to | 6 |
| the requirements of Section 65-35 of the Nurse Practice Act. | 7 |
| The written collaborative agreement shall
be for
services the | 8 |
| collaborating physician generally provides to
his or her | 9 |
| patients in the normal course of clinical medical practice.
A | 10 |
| written collaborative agreement shall be adequate with respect | 11 |
| to collaboration
with advanced practice nurses if all of the | 12 |
| following apply:
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| (1) The agreement is written to promote the exercise of | 14 |
| professional judgment by the advanced practice nurse | 15 |
| commensurate with his or her education and experience. The | 16 |
| agreement need not describe the exact steps that an | 17 |
| advanced practice nurse must take with respect to each | 18 |
| specific condition, disease, or symptom, but must specify | 19 |
| those procedures that require a physician's presence as the | 20 |
| procedures are being performed.
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| (2) Practice guidelines and orders are developed and | 22 |
| approved jointly by the advanced practice nurse and | 23 |
| collaborating physician, as needed, based on the practice | 24 |
| of the practitioners. Such guidelines and orders and the | 25 |
| patient services provided thereunder are periodically | 26 |
| reviewed by the collaborating physician.
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| (3) The advance practice nurse provides services the | 2 |
| collaborating physician generally provides to his or her | 3 |
| patients in the normal course of clinical practice, except | 4 |
| as set forth in subsection (b-5) of this Section. With | 5 |
| respect to labor and delivery, the collaborating physician | 6 |
| must provide delivery services in order to participate with | 7 |
| a certified nurse midwife. | 8 |
| (4) The collaborating physician and advanced practice | 9 |
| nurse meet in person at least once a month to provide | 10 |
| collaboration and consultation. | 11 |
| (5) Methods of communication are available with the | 12 |
| collaborating physician in person or through | 13 |
| telecommunications for consultation, collaboration, and | 14 |
| referral as needed to address patient care needs. | 15 |
| (6) The agreement contains provisions detailing notice | 16 |
| for termination or change of status involving a written | 17 |
| collaborative agreement, except when such notice is given | 18 |
| for just cause.
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| (b-5) An anesthesiologist or physician licensed to | 20 |
| practice medicine in
all its branches may collaborate with a | 21 |
| certified registered nurse anesthetist
in accordance with | 22 |
| Section 65-35 of the Nurse Practice Act for the provision of | 23 |
| anesthesia services. With respect to the provision of | 24 |
| anesthesia services, the collaborating anesthesiologist or | 25 |
| physician shall have training and experience in the delivery of | 26 |
| anesthesia services consistent with Department rules. |
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| Collaboration shall be
adequate if:
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| (1) an anesthesiologist or a physician
participates in | 3 |
| the joint formulation and joint approval of orders or
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| guidelines and periodically reviews such orders and the | 5 |
| services provided
patients under such orders; and
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| (2) for anesthesia services, the anesthesiologist
or | 7 |
| physician participates through discussion of and agreement | 8 |
| with the
anesthesia plan and is physically present and | 9 |
| available on the premises during
the delivery of anesthesia | 10 |
| services for
diagnosis, consultation, and treatment of | 11 |
| emergency medical conditions.
Anesthesia services in a | 12 |
| hospital shall be conducted in accordance with
Section 10.7 | 13 |
| of the Hospital Licensing Act and in an ambulatory surgical
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| treatment center in accordance with Section 6.5 of the | 15 |
| Ambulatory Surgical
Treatment Center Act.
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| (b-10) The anesthesiologist or operating physician must | 17 |
| agree with the
anesthesia plan prior to the delivery of | 18 |
| services.
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| (c) The supervising physician shall have access to the
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| medical records of all patients attended by a physician
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| assistant. The collaborating physician shall have access to
the | 22 |
| medical records of all patients attended to by an
advanced | 23 |
| practice nurse.
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| (d) (Blank). Nothing in this Act
shall be construed to | 25 |
| limit the delegation of
tasks or duties by a physician licensed | 26 |
| to practice medicine
in all its branches to a licensed |
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| practical nurse, a registered professional
nurse, or other | 2 |
| persons.
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| (e) A physician shall not be liable for the acts or
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| omissions of a physician assistant or advanced practice
nurse | 5 |
| solely on the basis of having signed a
supervision agreement or | 6 |
| guidelines or a collaborative
agreement, an order, a standing | 7 |
| medical order, a
standing delegation order, or other order or | 8 |
| guideline
authorizing a physician assistant or advanced | 9 |
| practice
nurse to perform acts, unless the physician has
reason | 10 |
| to believe the physician assistant or advanced
practice nurse | 11 |
| lacked the competency to perform
the act or acts or commits | 12 |
| willful and wanton misconduct.
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| (Source: P.A. 95-639, eff. 10-5-07 .)
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| Section 10. The Nurse Practice Act is amended by changing | 15 |
| Section 65-35 as follows:
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| (225 ILCS 65/65-35)
(was 225 ILCS 65/15-15)
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| (Section scheduled to be repealed on January 1, 2018)
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| Sec. 65-35. Written collaborative
agreements. | 19 |
| (a) A written collaborative agreement is required for all | 20 |
| advanced practice nurses engaged in clinical practice, except | 21 |
| for advanced practice nurses who are authorized to practice in | 22 |
| a hospital or ambulatory surgical treatment center. | 23 |
| (a-5) If an advanced practice nurse engages in clinical | 24 |
| practice outside of a hospital or ambulatory surgical treatment |
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| center in which he or she is authorized to practice, the | 2 |
| advanced practice nurse must have a written collaborative | 3 |
| agreement.
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| (b) A written collaborative
agreement shall describe the | 5 |
| working relationship of the
advanced practice nurse with the | 6 |
| collaborating
physician or podiatrist and shall authorize the | 7 |
| categories of
care, treatment, or procedures to be performed by | 8 |
| the advanced
practice nurse. A collaborative agreement with a | 9 |
| dentist must be in accordance with subsection (c-10) of this | 10 |
| Section. Collaboration does not require an
employment | 11 |
| relationship between the collaborating physician
and advanced | 12 |
| practice nurse. Collaboration means
the relationship under
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| which an advanced practice nurse works with a collaborating
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| physician or podiatrist in an active clinical practice to | 15 |
| deliver health care services in
accordance with
(i) the | 16 |
| advanced practice nurse's training, education,
and experience | 17 |
| and (ii) collaboration and consultation as documented in a
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| jointly developed written collaborative
agreement.
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| The agreement shall be defined to promote the
exercise of | 20 |
| professional judgment by the advanced practice
nurse | 21 |
| commensurate with his or her education and
experience. The | 22 |
| services to be provided by the advanced
practice nurse shall be | 23 |
| services that the
collaborating physician or podiatrist is | 24 |
| authorized to and generally provides to his or her
patients in | 25 |
| the normal course of his or her clinical medical practice, | 26 |
| except as set forth in subsection (c-5) of this Section.
The |
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| agreement need not describe the exact steps that an advanced | 2 |
| practice
nurse must take with respect to each specific | 3 |
| condition, disease, or symptom
but must specify
which | 4 |
| authorized procedures require the presence of the | 5 |
| collaborating physician or podiatrist as
the procedures are | 6 |
| being performed. The collaborative
relationship under an | 7 |
| agreement shall not be
construed to require the personal | 8 |
| presence of a physician or podiatrist at
all times at the place | 9 |
| where services are rendered.
Methods of communication shall
be | 10 |
| available for consultation with the collaborating
physician or | 11 |
| podiatrist in person or by telecommunications in accordance | 12 |
| with
established written guidelines as set forth in the written
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| agreement.
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| (c) Collaboration and consultation under all collaboration | 15 |
| agreements
shall be adequate if a
collaborating physician or | 16 |
| podiatrist does each of the following:
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| (1) Participates in the joint formulation and joint | 18 |
| approval of orders or
guidelines with the advanced practice | 19 |
| nurse and he or she periodically reviews such orders and | 20 |
| the
services provided patients under such orders in | 21 |
| accordance with accepted
standards of medical practice and | 22 |
| advanced practice nursing practice.
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| (2) Meets in person with the advanced practice nurse at | 24 |
| least once a month to provide collaboration and
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| consultation. In the case of anesthesia services provided | 26 |
| by a certified registered nurse anesthetist, an |
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LRB096 08980 ASK 19119 b |
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| anesthesiologist, physician, dentist, or podiatrist must | 2 |
| participate through discussion of and agreement with the | 3 |
| anesthesia plan and remain physically present and | 4 |
| available on the premises during the delivery of anesthesia | 5 |
| services for diagnosis, consultation, and treatment of | 6 |
| emergency medical conditions.
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| (3) Is available through telecommunications for | 8 |
| consultation on medical
problems, complications, or | 9 |
| emergencies or patient referral. In the case of anesthesia | 10 |
| services provided by a certified registered nurse | 11 |
| anesthetist, an anesthesiologist, physician, dentist, or | 12 |
| podiatrist must participate through discussion of and | 13 |
| agreement with the anesthesia plan and remain physically | 14 |
| present and available on the premises during the delivery | 15 |
| of anesthesia services for diagnosis, consultation, and | 16 |
| treatment of emergency medical conditions.
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| The agreement must contain provisions detailing notice for | 18 |
| termination or change of status involving a written | 19 |
| collaborative agreement, except when such notice is given for | 20 |
| just cause. | 21 |
| (c-5) A certified registered nurse anesthetist, who | 22 |
| provides anesthesia services outside of a hospital or | 23 |
| ambulatory surgical treatment center shall enter into a written | 24 |
| collaborative agreement with an anesthesiologist or the | 25 |
| physician licensed to practice medicine in all its branches or | 26 |
| the podiatrist performing the procedure. Outside of a hospital |
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| or ambulatory surgical treatment center, the certified | 2 |
| registered nurse anesthetist may provide only those services | 3 |
| that the collaborating podiatrist is authorized to provide | 4 |
| pursuant to the Podiatric Medical Practice Act of 1987 and | 5 |
| rules adopted thereunder. A certified registered nurse | 6 |
| anesthetist may select, order, and administer medication, | 7 |
| including controlled substances, and apply appropriate medical | 8 |
| devices for delivery of anesthesia services under the | 9 |
| anesthesia plan agreed with by the anesthesiologist or the | 10 |
| operating physician or operating podiatrist. | 11 |
| (c-10) A certified registered nurse anesthetist who | 12 |
| provides anesthesia services in a dental office shall enter | 13 |
| into a written collaborative agreement with an | 14 |
| anesthesiologist or the physician licensed to practice | 15 |
| medicine in all its branches or the operating dentist | 16 |
| performing the procedure. The agreement shall describe the | 17 |
| working relationship of the certified registered nurse | 18 |
| anesthetist and dentist and shall authorize the categories of | 19 |
| care, treatment, or procedures to be performed by the certified | 20 |
| registered nurse anesthetist. In a collaborating dentist's | 21 |
| office, the certified registered nurse anesthetist may only | 22 |
| provide those services that the operating dentist with the | 23 |
| appropriate permit is authorized to provide pursuant to the | 24 |
| Illinois Dental Practice Act and rules adopted thereunder. For | 25 |
| anesthesia services, an anesthesiologist, physician, or | 26 |
| operating dentist shall participate through discussion of and |
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| agreement with the anesthesia plan and shall remain physically | 2 |
| present and be available on the premises during the delivery of | 3 |
| anesthesia services for diagnosis, consultation, and treatment | 4 |
| of emergency medical conditions. A certified registered nurse | 5 |
| anesthetist may select, order, and administer medication, | 6 |
| including controlled substances, and apply appropriate medical | 7 |
| devices for delivery of anesthesia services under the | 8 |
| anesthesia plan agreed with by the operating dentist. | 9 |
| (d) A copy of the signed, written collaborative agreement | 10 |
| must be available
to the Department upon request from both the | 11 |
| advanced practice nurse
and the collaborating physician or | 12 |
| podiatrist. | 13 |
| (e) Nothing in this Act shall be construed to limit the | 14 |
| delegation of tasks or duties by a physician to a licensed | 15 |
| practical nurse, a registered professional nurse, or other | 16 |
| persons in accordance with Section 54.2 of the Medical Practice | 17 |
| Act of 1987 . | 18 |
| (f) An advanced
practice nurse shall inform each | 19 |
| collaborating physician, dentist, or podiatrist of all | 20 |
| collaborative
agreements he or she
has signed and provide a | 21 |
| copy of these to any collaborating physician, dentist, or | 22 |
| podiatrist upon
request.
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| (Source: P.A. 95-639, eff. 10-5-07.)
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| Section 15. The Physician Assistant Practice Act of 1987 is | 25 |
| amended by changing Section 7.5 as follows:
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| (225 ILCS 95/7.5)
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| (Section scheduled to be repealed on January 1, 2018)
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| Sec. 7.5. Prescriptions. A supervising physician may | 4 |
| delegate
limited prescriptive authority to a physician | 5 |
| assistant.
This authority may, but is not required to, include | 6 |
| prescription and
dispensing of legend
drugs and legend | 7 |
| controlled substances categorized as Schedule III, IV, or V
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| controlled substances, as defined in Article II of the Illinois | 9 |
| Controlled
Substances Act, as delegated in the written | 10 |
| guidelines required by this
Act. To prescribe Schedule III, IV, | 11 |
| or V controlled substances under this
Section, a physician | 12 |
| assistant must obtain a mid-level practitioner
controlled | 13 |
| substances license. Medication orders issued by a
physician
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| assistant shall be reviewed
periodically by the supervising | 15 |
| physician. The supervising physician shall file
with the | 16 |
| Department notice of delegation of prescriptive authority to a
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| physician assistant and
termination of delegation, specifying | 18 |
| the authority delegated or terminated.
Upon receipt of this | 19 |
| notice delegating authority to prescribe Schedule III,
IV, or V | 20 |
| controlled substances, the physician assistant shall be | 21 |
| eligible to
register for a mid-level practitioner controlled | 22 |
| substances license under
Section 303.05 of the Illinois | 23 |
| Controlled Substances Act.
Nothing in this Act shall be | 24 |
| construed to limit the delegation of tasks or
duties by the | 25 |
| supervising physician to a nurse or other appropriately trained |
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SB0318 Enrolled |
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LRB096 08980 ASK 19119 b |
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| persons in accordance with Section 54.2 of the Medical Practice | 2 |
| Act of 1987
personnel .
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| The Department shall establish by rule the minimum | 4 |
| requirements for
written guidelines to be followed under this | 5 |
| Section.
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| (Source: P.A. 90-116, eff. 7-14-97; 90-818, eff. 3-23-99 .)
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| Section 20. The Podiatric Medical Practice Act of 1987 is | 8 |
| amended by changing Section 20.5 as follows: | 9 |
| (225 ILCS 100/20.5) | 10 |
| (Section scheduled to be repealed on January 1, 2018)
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| Sec. 20.5. Delegation of authority to advanced practice | 12 |
| nurses.
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| (a) A podiatrist in active clinical practice may | 14 |
| collaborate with an advanced practice nurse in accordance with | 15 |
| the requirements of the Nurse Practice Act. Collaboration shall | 16 |
| be for the purpose of providing podiatric consultation and no | 17 |
| employment relationship shall be required. A written | 18 |
| collaborative agreement shall conform to the requirements of | 19 |
| Section 65-35 of the Nurse Practice Act. The written | 20 |
| collaborative agreement shall be for services the | 21 |
| collaborating podiatrist generally provides to his or her | 22 |
| patients in the normal course of clinical podiatric practice, | 23 |
| except as set forth in item (3) of this subsection (a). A | 24 |
| written collaborative agreement and podiatric collaboration |
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SB0318 Enrolled |
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LRB096 08980 ASK 19119 b |
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| and consultation shall be adequate with respect to advanced | 2 |
| practice nurses if all of the following apply: | 3 |
| (1) The agreement is written to promote the exercise of | 4 |
| professional judgment by the advanced practice nurse | 5 |
| commensurate with his or her education and experience. The | 6 |
| agreement need not describe the exact steps that an | 7 |
| advanced practice nurse must take with respect to each | 8 |
| specific condition, disease, or symptom, but must specify | 9 |
| which procedures require a podiatrist's presence as the | 10 |
| procedures are being performed. | 11 |
| (2) Practice guidelines and orders are developed and | 12 |
| approved jointly by the advanced practice nurse and | 13 |
| collaborating podiatrist, as needed, based on the practice | 14 |
| of the practitioners. Such guidelines and orders and the | 15 |
| patient services provided thereunder are periodically | 16 |
| reviewed by the collaborating podiatrist. | 17 |
| (3) The advance practice nurse provides services that | 18 |
| the collaborating podiatrist generally provides to his or | 19 |
| her patients in the normal course of clinical practice. | 20 |
| With respect to the provision of anesthesia services by a | 21 |
| certified registered nurse anesthetist, the collaborating | 22 |
| podiatrist must have training and experience in the | 23 |
| delivery of anesthesia consistent with Department rules. | 24 |
| (4) The collaborating podiatrist and the advanced | 25 |
| practice nurse meet in person at least once a month to | 26 |
| provide collaboration and consultation. |
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LRB096 08980 ASK 19119 b |
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| (5) Methods of communication are available with the | 2 |
| collaborating podiatrist in person or through | 3 |
| telecommunications for consultation, collaboration, and | 4 |
| referral as needed to address patient care needs. | 5 |
| (6) With respect to the provision of anesthesia | 6 |
| services by a certified registered nurse anesthetist, an | 7 |
| anesthesiologist, physician, or podiatrist shall | 8 |
| participate through discussion of and agreement with the | 9 |
| anesthesia plan and shall remain physically present and be | 10 |
| available on the premises during the delivery of anesthesia | 11 |
| services for diagnosis, consultation, and treatment of | 12 |
| emergency medical conditions. The anesthesiologist or | 13 |
| operating podiatrist must agree with the anesthesia plan | 14 |
| prior to the delivery of services. | 15 |
| (7) The agreement contains provisions detailing notice | 16 |
| for termination or change of status involving a written | 17 |
| collaborative agreement, except when such notice is given | 18 |
| for just cause. | 19 |
| (b) The collaborating podiatrist shall have access to the | 20 |
| records of all patients attended to by an advanced practice | 21 |
| nurse. | 22 |
| (c) Nothing in this Section shall be construed to limit the | 23 |
| delegation of tasks or duties by a podiatrist to a licensed | 24 |
| practical nurse, a registered professional nurse, or other | 25 |
| appropriately trained persons. | 26 |
| (d) A podiatrist shall not be liable for the acts or |
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SB0318 Enrolled |
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LRB096 08980 ASK 19119 b |
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| omissions of an advanced practice nurse solely on the basis of | 2 |
| having signed guidelines or a collaborative agreement, an | 3 |
| order, a standing order, a standing delegation order, or other | 4 |
| order or guideline authorizing an advanced practice nurse to | 5 |
| perform acts, unless the podiatrist has reason to believe the | 6 |
| advanced practice nurse lacked the competency to perform the | 7 |
| act or acts or commits willful or wanton misconduct.
| 8 |
| (Source: P.A. 95-639, eff. 10-5-07 .) | 9 |
| Section 99. Effective date. This Act takes effect January | 10 |
| 1, 2010. |
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