Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 9 - TEXAS MEDICAL BOARD › Chapter 193 - STANDING DELEGATION ORDERS › Section 193.9 - Delegation of Prescriptive Authority at a Facility-Based Practice Site

Current through Reg. 49, No. 28; July 12, 2024
(a) Acts that may
				be delegated. One or more physicians licensed by the board shall be authorized
				to 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, prescribing
				or ordering of a drug or device if each of the physicians is: the medical
				director or chief of medical staff of the facility in which the physician
				assistant or advanced practice registered nurse practices, the chair of the
				facility's credentialing committee, a department chair of a facility department
				in which the physician assistant or advanced practice registered nurse
				practices, or 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.
(b) The
				limitations on the number of advanced practice registered nurses or physician
				assistants to whom a physician may delegate under §
									193.7(d)
				of this title (relating to Prescriptive Authority Agreements Generally) do not
				apply to a physician whose practice is facility-based under this chapter,
				subject to the limitations in subsection (c)(4) of this section.
(c) Limitations on authority to delegate. A
				physician's authority to delegate under this subsection is limited as follows:
(1) the delegation is pursuant to a
				physician's order, standing medical order, standing delegation order, or other
				order or protocol developed in accordance with policies approved by the
				facility's medical staff or a committee thereof as provided in facility
				bylaws;
(2) the delegation occurs
				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 § 157.054(a)(4) of the
				Act;
(3) the delegation does 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;
(4) delegation in a
				long-term care facility must be by the medical director and the medical
				director is limited to delegating the prescribing or ordering of a drug or
				device to no more than seven advanced practice registered nurses or physician
				assistants or their full-time equivalents; and
(5) under this section, a facility-based
				physician may not delegate at more than one hospital or more than two long-term
				care facilities pursuant to § 157.054 of the Act; however, facility-based
				physicians are not prohibited from delegating the prescribing or ordering or
				drugs or devices under § 157.0512 of the Act or §
										193.7
				and §
										193.8
				of this title (relating to Prescriptive Authority Agreements Generally and
				Prescriptive Authority Agreements: Minimum Requirements), at other practice
				locations, including hospital or long-term care facilities, provided that the
				delegation at those locations complies with all requirements under §
				157.0512 of the Act.
(6) Physician
				supervision. Physician supervision of the prescribing or ordering of a drug or
				device shall conform to what a reasonable, prudent physician would find
				consistent with sound medical judgment but may vary with the education and
				experience of the advanced practice registered nurse or physician assistant. A
				physician shall provide continuous supervision, but the constant physical
				presence of the physician is not required.