Section 1000-04-.09 - PREREQUISITES TO PRESCRIBING OR DISPENSING MEDICATIONS(1) Except as provided in paragraph (2), it shall be a prima facie violation of T.C.A. § 63-7-115(a) (1) (C) and (F) for an Advanced Practice Nurse, having proper authority to prescribe, to prescribe or dispense any drug to any individual, whether in person or by electronic means or over the Internet or over telephone lines, unless the Advanced Practice Nurse with proper authority to prescribe or the A.P.N's licensed supervisee and pursuant to appropriate protocols or orders, has completed and appropriately documented, for the person to whom a prescription is to be issued or drugs dispensed, all of the following: (a) Performed an appropriate history and physical examination; and(b) Made a diagnosis based upon the examinations and all diagnostic and laboratory tests consistent with good health care; and(c) Formulated a therapeutic plan, and discussed it, along with the basis for it and the risks and benefits of various treatments options, a part of which might be the prescription or dispensed drug, with the patient; and(d) Insured availability of the Advanced Practice Nurse with proper authority to prescribe, or coverage for the patient for appropriate follow-up care.(2) An Advanced Practice Nurse having proper authority to prescribe, or the A.P.N's licensed supervisee and pursuant to appropriate protocols or orders, may prescribe or dispense drugs for a person not in compliance with paragraph (1) consistent with sound judgment, examples of which are as follows: (a) In admission orders for a newly hospitalized patient; or(b) For a patient of a physician or of an Advanced Practice Nurse with proper authority to prescribe for whom the prescriber is taking calls or for whom the prescriber has verified the appropriateness of the medication; or(c) For continuation medications on a short-term basis for a new patient prior to the patient's first appointment; or(d) For established patients who, based on sound practices, the Advanced Practice Nurse having proper authority to prescribe, believes do not require a new physical examination before issuing new prescriptions.(3) Except as provided in paragraph (2), it shall be a prima facie violation of T.C.A. § 63-7-115(a) (1) (C) and (F) for an Advanced Practice Nurse having proper authority to prescribe, or the A.P.N's licensed supervisee and pursuant to appropriate protocols or orders, to prescribe or dispense any drug to any individual for whom the Advanced Practice Nurse with proper authority to prescribe, or the A.P.N's licensed supervisee and pursuant to appropriate protocols or orders, has not complied with the provisions of this rule based solely on answers to a set of questions regardless of whether the prescription is issued directly to the person or electronically over the Internet or telephone lines.(4) Advanced Practice Nurses having proper authority to prescribe, who elect to dispense medication for remuneration must comply with all Federal Regulations ( 21 CFR 1304 through 1308) for the dispensing of controlled substances.(5) Non-controlled drugs are to be dispensed in an appropriate container labeled with at least, the following: (c) Complete directions for usage.(d) The name and address of the Advanced Practice Nurse having proper authority to prescribe.(e) A unique number, or the name and strength of the medication.(6) Whenever dispensing takes place, appropriate records shall be maintained. A separate log must be maintained for controlled substances dispensing.(7) Whenever prescribing takes place, written or electronic prescription orders shall be prepared pursuant to T.C.A. § 63-7-123(b) (3).(8) It is not the intention of this Rule to interfere with the individual Advanced Practice Nurses, having proper authority to prescribe, and their appropriate use of professional samples, nor is it to interfere in any way with the rights of Advanced Practice Nurses, who have proper authority to prescribe, to directly administer drugs or medications to any patient.Tenn. Comp. R. & Regs. 1000-04-.09
Original rule filed March 21, 2005; effective June 4, 2005.Authority: T.C.A. §§ 4-5-202, 4-5-204, 53-11-301, 63-7-115, 63-7-123, 63-7-126, and 63-7-207.