2023 Texas Statutes › Occupations Code › Title 3 - Health Professions › Subtitle B - Physicians › Chapter 157 - Authority of Physician to Delegate Certain Medical Acts › Subchapter B. Delegation to Advanced Practice Registered Nurses and Physician Assistants › Section 157.054. Prescribing at Facility-Based Practice Sites

Sec. 157.054.  PRESCRIBING AT FACILITY-BASED PRACTICE SITES.  (a)  One or more physicians licensed by the board may delegate, to one or more physician assistants or advanced practice registered nurses acting under adequate physician supervision whose practice is facility-based at a hospital or licensed long-term care facility, the administration or provision of a drug and the prescribing or ordering of a drug or device if each of the delegating physicians is:
(1)  the medical director or chief of medical staff of the facility in which the physician assistant or advanced practice registered nurse practices;
(2)  the chair of the facility's credentialing committee;
(3)  a department chair of a facility department in which the physician assistant or advanced practice registered nurse practices; or
(4)  a physician who consents to the request of the medical director or chief of medical staff to delegate the prescribing or ordering of a drug or device at the facility in which the physician assistant or advanced practice registered nurse practices.
(a-1)  The limits on the number of advanced practice registered nurses or physician assistants to whom a physician may delegate under Section 157.0512 do not apply to a physician under Subsection (a) whose practice is facility-based under this section, provided that the physician is not delegating in a freestanding clinic, center, or practice of the facility.
(b)  A physician's authority to delegate under Subsection (a) is limited as follows:
(1)  the delegation must be made under a physician's order, standing medical order, standing delegation order, or another order or protocol developed in accordance with policies approved by the facility's medical staff or a committee of the facility's medical staff as provided by the facility bylaws;
(2)  the delegation must occur in the facility in which the physician is the medical director, the chief of medical staff, the chair of the credentialing committee, a department chair, or a physician who consents to delegate under Subsection (a)(4);
(3)  the delegation may not permit the prescribing or ordering of a drug or device for the care or treatment of the patients of any other physician without the prior consent of that physician; and
(4)  delegation in a long-term care facility must be by the medical director and is limited to the prescribing or ordering of a drug or device to not more than seven advanced practice registered nurses or physician assistants or their full-time equivalents.
(b-1)  A facility-based physician may not delegate at more than one hospital or more than two long-term care facilities under this section unless approved by the board.  The facility-based physician may not be prohibited from delegating the prescribing or ordering of drugs or devices under Section 157.0512 at other practice locations, including hospitals or long-term care facilities, provided that the delegation at those locations complies with all the requirements of Section 157.0512.
(c)  Physician supervision of the prescribing or ordering of a drug or device must conform to what a reasonable, prudent physician would find consistent with sound medical judgment but may vary with the education and experience of the particular advanced practice registered nurse or physician assistant.  A physician shall provide continuous supervision, but the constant physical presence of the physician is not required.
(d)  An alternate physician may provide appropriate supervision on a temporary basis as defined and established by board rule.
Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.  Amended by Acts 2003, 78th Leg., ch. 88, Sec. 5, eff. May 20, 2003.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 746 (S.B. 532), Sec. 3, eff. September 1, 2009.
Acts 2013, 83rd Leg., R.S., Ch. 418 (S.B. 406), Sec. 5, eff. November 1, 2013.