RN and LPN Decision Making Model
School Nurse Decision Making Model
PICC Tip Verification by RN via X-Ray Prohibited
RN and LPN Scopes of Practice
RN and LPN Practice FAQs
Transition to Practice - NCSBN Press Release
Transition to Practice White Paper by the Legislative
and Practice Committee of the Ohio Organization of Nurse Executives
New Ohio Law: Determination and Pronouncement of Death
An amendment to the Ohio Nurse Practice Act (Chapter 4723, Ohio Revised Code (ORC)) authorizes certified nurse practitioners, clinical nurse specialists, and registered nurses, under specific circumstances, to determine and pronounce death. The new law is effective March 22, 2013 by the enactment of Am Sub HB 284 during the 129th General Assembly.
Click Here for the Complete Announcement
Click Here to Download Am Sub HB 284
Click Here to Download the Legislative Services Commission Final Analysis
Patient Safety Initiative - Creating a Culture of Safety and Accountability
By implementing a more comprehensive approach to practice complaints, the Board is more directly addressing and impacting patient safety. The goal is to increase patient safety through effective reporting, remediation, modification of systems, and accountability. The objectives are to:
- Increase employer reporting of information related to practice breakdowns
- Increase employer-sponsored practice remediation
- Incorporate Just Culture for the review of practice complaints
- Create a statewide patient safety database
- Assist with the development of a national patient safety database
- Increase the use of the Practice Intervention and Improvement Program, an alternative to discipline program of the Board.
Information Regarding Ebola
The Ohio Board of Nursing is committed to providing the public, including health care providers, with information about Ebola. Having accurate information is important for optimal care of patients, for nurse safety in managing this infectious disease, and public protection.
The Ohio Department of Health has set up a 24/7 call line for the public, staffed by registered nurses: 866-800-1404.
Links to important sources of information are listed below:
- What you need to Know about Ebola: Click here to view the Ebola infographic
- Ohio Department of Health: http://www.odh.ohio.gov/en/odhprograms/dis/orbitdis/ebola/Ebola.aspx
- Centers for Disease Control and Prevention: http://www.cdc.gov/vhf/ebola/index.html
- Medical Reserve Corps: http://www.ohioresponds.gov/omrc.stm
Nurses are advised to follow the regulatory standards of practice specified in Chapter 4723-4, Ohio Administrative Code (OAC). Dialysis Technicians, Community Health Workers, and Medication Aides are advised to follow the regulatory standards contained in Chapters 4723-23, 4723-26, and 4723-27, respectively. All licensees are to follow the regulations regarding prevention of disease transmission in Chapter 4723-20, OAC. To access the OAC Chapters, click on Law and Rules.
Healthcare workers are also encouraged to contact their state and/or federal associations for information.
Patient Centered Medical Home (PCMH) Education Pilot Project
In June 2010, Ohio House Bill 198 established the Patient Centered Medical Home (PCMH) Education Pilot Project enabling 44 primary care practices (40 physician-led and 4 APRN-led) educationally affiliated with select medical or nursing schools in Ohio to implement the PCMH model of care in their practices. TransforMED, a nationally known company with a successful history of assisting primary care practices towards transformation to the PCMH model, has been contracted to facilitate several components of the Pilot Project.
Additional information regarding the PCMH Education Pilot Project can be found online at:
Introduction: Utilizing Interpretive Guidelines
Guidelines for Registered Nurse Filling and Unfilling a Client’s Gastric Band
Guidelines for Conservative Sharp Wound Debridement
Guidelines for Intrapartum Monitoring of Obstetrical Patients Receiving Epidural Infusions
Guidelines for Monitoring and Management of Epidural Infusions
Guidelines for Administration of Medications, and Monitoring
of Patients Receiving Intravenous Moderate Sedation for Medical/Surgical Procedures
Guidelines for the Care of Patients Receiving Intramuscular, Subdermal,
or Subcutaneously Injected Medications for Cosmetic/Aesthetic Treatment
Guidelines for a Registered Nurse’s Role in Emergent Intubation Performed by an Authorized Provider
Guidelines for Registered Nurse Performance of a History and Physical Examination
for Purposes of Providing Nursing Care
Guidelines for Registered Nurse Use of Devices for PICC Tip Placement Confirmation in Adults
Advanced Practice Registered Nurses
Certificate of Authority (COA) Information
Decision Making Guide for Determining APRN Scope of Practice
Instructions for Updating Collaborating Physician Information
Click Here for Certificate of Authority Verification
Click Here for Advanced Practice Forms
APRN Consensus Model
The APRN Consensus Model is the result of the collaborative work of the APRN Consensus Work Group and the National Council of State Boards of Nursing (NCSBN) APRN Advisory Committee with extensive review and comments from the larger APRN stakeholder community. The Consensus Model was developed to promote uniformity in requirements for advanced practice nursing.
LACE (Licensure, Accreditation, Certification, and Education), a communication network that includes licensure, accreditation, certification, and educational organizations that represent the components of APRN regulation, is facilitating the implementation of the APRN Consensus Model with stakeholders interested in advancing uniformity in APRN regulation and requirements.
NCSBN is taking a major role in promoting and assisting state boards of nursing in the adoption of the regulatory components of the APRN Consensus Model. Beginning in 2008 and subsequently, the Ohio Board of Nursing reviewed the APRN Consensus Model and the related NCSBN Model Law and Rules. Below are two grids that provide comparison information about the APRN Consensus Model requirements and the Ohio Nurse Practice Act and administrative rules. For questions regarding the requirements of the APRN Consensus Model compared to the Ohio Nurse Practice Act and administrative rules, please email firstname.lastname@example.org.
The APRN Consensus Model, as well as numerous related documents are available at www.ncsbn.org.
2014 APRN Consensus Model by State
Comparison of the Consensus Model for Ohio
Emergency Facility Opioid and Other Controlled Substances Prescribing Guidelines
The Ohio Emergency and Acute Care Facility Opioid and Other Controlled Substances Prescribing Guidelines (OOCS Guidelines) were issued in May of 2012. The OOCS Guidelines were developed through a collaborative effort of health care/medical professional associations, individual medical professionals and state agencies that were brought together under the Professional Education Work Group of the Governor’s Cabinet Opiate Action Team (GCOAT). These guidelines along with the accompanying patient handout and pocket card guide were distributed to all hospitals and emergency physicians in Ohio in August 2012. The OOCS Guidelines, patient handout, pocket cards and background information can be accessed at this link: http://www.healthyohioprogram.org/ed/guidelines.
Please share this information with emergency medical professionals and emergency and acute care facilities in your area and encourage them to implement these guidelines. A limited quantity of the pocket cards is still available. To request pocket cards please send an email to: BHPRR@odh.ohio.gov
Sub. SB 83 (SB 83) Expanded Authority to Prescribe Schedule II Controlled Substances
SB 83, introduced by Senator Scott Oelslager on February 16, 2011, expanded the authority of advanced practice registered nurses (APRNs) who hold a Certificate to Prescribe (CTP) to prescribe schedule II controlled substances. The bill was signed by Governor Kasich on March 9, 2012 and became effective on June 8, 2012.
As directed by SB 83, the Board adopted rules pertaining to schedule II controlled substances, including prescribing and CE requirements for CTP holders. New Rule 4723-9-13, OAC, addresses the CE requirements and when you renew your CTP, you will be required to verify completion of the continuing education course.
The amended rules in Chapters 4723-8 and 4723-9 became effective on November 5, 2012 to provide ample time for CTP holders to complete the required six hours of continuing education before the renewal cycle ends on August 31, 2013. To review the rules, go to the front page of the web site and click on “Law and Rules”.
FAQs answering questions about the new prescribing law and CE requirements are located at the link below. If you have additional questions, please contact the Board at email@example.com.
Am. Sub. HB 93 Pain Management Clinics; OARRS
In May 2011, Governor Kasich signed into law Amended Substitute House Bill 93, sponsored by Representatives David E. Burke, R.Ph., and Dr. Terry Johnson, D.O. Amended Substitute House Bill 93 aggressively focuses on further regulating facilities and prescribers operating as pain management clinics by requiring that the Board of Pharmacy license those clinics. Additionally, the Medical Board must adopt rules establishing standards for physician operation of pain management clinics and standards to be followed by physicians who provide care at pain management clinics. The bill also modifies the operation of OARRS (Ohio Automated Rx Review System), a drug database administered by the Pharmacy Board that is used to monitor the misuse and diversion of controlled substances and other dangerous drugs.Click Here to View the Complete Summary
Rule on Advanced Practice Registered Nurses Primary Source Recertification Documentation
If you are an advanced practice registered nurse, your certificate of authority (COA) is current and valid only if you meet all requirements of the Board including maintaining certification or recertification by the applicable national certifying organization. Please refer to the 'Nursing Practice' page of the Board’s website for a list of Board approved national organizations.
Effective February 1, 2011, the Board requires primary source verification for advanced practice registered nurse national recertification. For this to occur, you must request that your national certifying organization notify the Board directly of national recertification within thirty days of your recertification. The Board no longer accepts documentation of recertification from a COA holder.
If you have any questions, please contact the Advanced Practice Unit at firstname.lastname@example.org or (614) 466-6180.
Prescriptive Authority / Certificate to Prescribe (CTP)
SB 110: Prescribe-Delegate Authority
SB 110: Prescribe-Delegate Authority SB 110, passed by the 131st General Assembly, authorizes CTP holders to delegate non-controlled drug administration under specified circumstances to unlicensed persons. Please click on the links below to access the statute and the Legislative Services Commission (LSC) Analysis for further details.
Effective October 15, 2015, APRNs holding prescriptive authority are authorized to delegate medication administration as specified in Sections 4723.48(C) and 4723.489, Ohio Revised Code (ORC). In doing so, APRNs must comply with standards of safe practice, including delegation, set forth in the law and rules, including Chapter 4723-13, Ohio Administrative Code (OAC). Please be aware that the new authorization in ORC Section 4723.48(C) supersedes rule language currently found in Chapter 4723-13, OAC, with respect to APRN prescribers, which previously limited the types of medication that could be delegated to an unlicensed person.
SB 110 authorizes the Board to adopt rules establishing standards and procedures for APRN delegation. The Board will convene a Board Committee on Practice meeting on January 20, 2016 at noon at the Board office to gather public input regarding the need for administrative rules.
If you have questions, please email email@example.com. To access the Ohio Revised Code and the Ohio Administrative Code, CLICK HERE.
Click Here for SB-110 - Summary
Click Here for SB-110 - Documents
CTP-E: Online Instruction as Part of Required Coursework
HB 64, the budget bill, included an amendment modifying the structure of the course in advanced pharmacology and related topics that an APRN must complete to obtain a certificate to prescribe. It eliminates a provision specifying that the course must consist of “planned classroom and clinical instruction,” thus enabling instruction to be online if that is preferred. This amendment becomes law on September 29, 2015.
If you have questions about these law changes, please email firstname.lastname@example.org. To access the Ohio Revised Code and the Ohio Administrative Code, CLICK HERE.
Electronic Prescribing of Controlled Substances (EPCS)
The Ohio Health Information Partnership (OHIP) through ClinicSync has released information regarding the Electronic Prescribing of Controlled Substances (EPCS). These documents discuss steps that APRNs with prescriptive authority and other Ohio prescribers must take to include the use of EPCS in their prescribing practices.
The OHIP is a nonprofit entity whose mission is to assist physicians and other providers with the adoption and implementation of health information technology (HIT) throughout Ohio, specifically in the adoption and use of electronic health records. Funded through the Office of the National Coordinator of HIT within the U.S. Department of Health and Human Services, OHIP is also responsible for the creation of a technological infrastructure that will allow Ohio physicians, hospitals and healthcare professionals to electronically share patient health records across the state.
HB 341: OARRS Registration Requirements
Legislative initiatives of 2014 and Ohio Administrative Code rule changes continue to target prescribing of opioids, benzodiazepines and other drugs that can be dangerous when misused or abused. The Board established a link on the front page of its website, “Prescriptive Authority Resources” at http://www.nursing.ohio.gov/Practice.htm#CTP, to provide faster access to resources supporting prescriber awareness and education.
The Board wants to remind prescribers of the following:
- HB 341 imposes new legal requirements for CTP holders. CTP holders who hold appropriate DEA certification and prescribe opioid analgesics or benzodiazepines are required to be registered with OARRS. To register for OARRS, go to http://www.ohiopmp.gov.
- Beginning April 1, 2015, the prescriber, before initially prescribing or personally furnishing an opioid analgesic or a benzodiazepine, must request patient information from OARRS that covers at least the previous 12 months, and make periodic requests for patient information from OARRS if the course of treatment continues for more than 90 days.
- Exceptions to the requirement to check OARRS under these circumstances include drugs prescribed when: (1) A drug database report regarding the patient is not available, in which case the nurse shall document in the patient's record the reason that the report is not available; (2) The drug is prescribed in an amount indicated for a period not to exceed seven days; (3) The drug is prescribed for the treatment of cancer or another condition associated with cancer; (4) The drug is prescribed to a hospice patient in a hospice care program, as those terms are defined in section 3712.01 of the Revised Code, or any other patient diagnosed as terminally ill; (5) The drug is prescribed for administration in a hospital, nursing home, or residential care facility. The law further requires the Nursing Board to verify that licensees prescribing in this manner are registered and using OARRS appropriately.
For more information about OARRS and HB 341 requirements please click on the following link to review the Ohio State Board of Pharmacy’s FAQs: Click Here.
Important OARRS Registration Information for CTP Holders
Rule 4723-9-12, Ohio Administrative Code (OAC), requires that under certain circumstances APRN prescribers use the OARRS information in their practice when prescribing controlled substances. You can access Rule 4723-9-12, OAC, “Standards And Procedures For Review of OARRS,” via the link below.
To register for OARRS, go to https://www.ohiopmp.gov/Portal/Brochure.pdf. The Board encourages you to register immediately so you are in compliance with this legal requirement.
ALERT: CTP Number is Required on All Prescriptions
All CTP holders are reminded that Rule 4723-9-09(I), Ohio Administrative Code (OAC), states:
A nurse holding a current valid certificate to prescribe shall satisfy all requirements for prescribing set forth in rule 4729-5-30 of the Administrative code, and shall include the nurse’s prescriber number on each prescription.” [emphasis added]
You are required to include your prescriber number on every prescription you issue. In addition you must satisfy all other requirements for prescribing set forth in Pharmacy Board Rule 4729-5-30, OAC, Manner of Issuance of a Prescription. The Board of Nursing may discipline the license of any nurse for violating the Nurse Practice Act and any rules adopted under it. This includes a nurse’s failure to issue a prescription without the CTP number.
Chapter 4723-9, OAC, Prescriptive Authority, is available for review on the Board’s website, under the “Law and Rules" link.
Rule 4729-5-30, OAC, and all other Pharmacy Board regulations can be located on the Pharmacy Board website: www.pharmacy.ohio.gov
JOINT REGULATORY STATEMENT: Prescription of Naloxone to High-Risk Individuals
Updated September 2014
The Nursing, Medical, and Pharmacy Boards originally issued a joint policy regulatory statement in April 2013 endorsing the prescription of naloxone (Narcan™) to those individuals at high-risk for opioid drug overdose. The purpose of the statement is to promote wider utilization of naloxone for high-risk individuals by educating prescribers on the proper use of naloxone.
The Boards updated their joint policy statement in September 2014 to reflect changes in House Bill 170, effective March 11, 2014. Ohio law now permits authorized prescribers, including APRN prescribers, to "personally furnish" or issue a prescription for naloxone to a friend, family member, or other individual in a position to provide assistance to an individual at risk of experiencing an opioid-related overdose. In addition, the law grants a health care professional who in good faith personally furnishes or issues a prescription for naloxone, immunity from criminal or civil liability or professional disciplinary action for the actions or omissions of the individual to whom the drug is furnished or prescription is issued. To learn more about the benefits of naloxone and its proper use, please see the following link to the updated joint regulatory statement.
New Active Cumulative Morphine Equivalent (ACME) Graph
There is a new feature, the active cumulative morphine equivalent graph, in the Ohio Automated Rx Reporting system (OARRS). This graph allows prescribers to view a patient’s ACME score for a period of time up to 24 months. To learn more about this new feature, including a sample of the new graph as part of a patient’s history report, see http://pharmacy.ohio.gov/MEDGraph.
Ohio House Bill 314: Prescribing Opioids to Minors
Effective September 17, 2014
Effective September 17, 2014, HB 314 requires all authorized prescribers to obtain and document informed consent when prescribing a controlled substance containing opioids to a minor, unless the prescribing is done in response to a medical emergency or meets other specific circumstances set forth in statute. Thank you to the Ohio Board of Pharmacy for providing and allowing the Nursing Board to use their document as a basis for this advisory. Click here to download the advisory.
APRN Prescriber Alert: Prepare for Change
Hydrocodone Combination Products (HCPs) Classified as Schedule II Controlled Substances
Effective October 6, 2014
Effective October 6, 2014, all hydrocodone combination products (HCPs) will be classified as schedule II controlled substances pursuant to a rule adopted by the United States Drug Enforcement Agency (DEA). For specific guidance in prescribing and complying with this new regulation, click on the link to review the Ohio State Board of Pharmacy’s guidance document, http://www.pharmacy.ohio.gov/hydrocodone.
Tramadol and Products Containing Tramadol Classified as Schedule IV Controlled Substance
Effective August 18, 2014
Effective August 18, 2014, tramadol and products containing tramadol will be classified as Schedule IV controlled substances in the state of Ohio pursuant to a rule adopted by the United States Drug Enforcement Agency (DEA).
APRNs with prescriptive authority (CTP holders) will continue to be able to prescribe tramadol and products containing tramadol, in accordance with the Formulary. However, APRNs with prescriptive authority need to be aware of the requirements specified in the Ohio State Board of Pharmacy’s guidance document in preparation for the change in the drug classification. For example, because tramadol and products containing tramadol will be classified as controlled substances, APRNs prescribing these products will need to obtain a DEA number, if they do not have one already.
For specific guidance in prescribing and complying with this new regulation, click on the link below to review the Ohio State Board of Pharmacy’s guidance document. Please note the necessary steps to take prior to August 18, 2014 to prepare for the change.
If you have any questions about the guidance document, please contact the Ohio State Board of Pharmacy at 614-466-4143 or email by visiting http://www.pharmacy.ohio.gov/Contact.aspx.
If you have questions about the Formulary or prescribing as an APRN, contact email@example.com.
Important Changes to CTP Formulary
All CTP holders are required to amend their written standard care arrangements to comply with recent changes made to the Formulary by the Board of Nursing (Board)’s Committee on Prescriptive Governance (CPG). All drugs and drug categories that are listed in the Formulary under the new prescribing designation column, “In Accordance with the Standard Care Arrangement,” must be reviewed with the Collaborating Physician, and based on that review, given one of the following designations that is required to be documented in the written Standard Care Arrangement: may not prescribe; may prescribe; physician initiation; or physician consult. The amendments must be made no later than April 1 2014. Click here for the complete announcement.
Accessing the Practice Insight Report
The Practice Insight Report will provide prescribers with information about their patients. Accessing a Practice Insight Report is a simple process.
Step 1: After logging into OARRS, press the Submit link in the Requests Menu. This is the same link you press to request a Patient Rx History Report.
Step 2: In the upper left-hand corner of the request screen, above where you would enter your patient’s last name, there is a drop-down box that currently says “Patient”. Change this to Practitioner. After the screen changes, press the “Submit” button. There is no need to enter any additional information; the form is pre-populated.
Step 3: After your request has been submitted, click “View” from the requests menu. You will now see your “Practitioner” request listed among your normal “Patient” requests. Within a minute or two, your report will be ready for you to review.
The Practice Insight Report is run based on the DEA number that you provided on your OARRS registration. If you did not provide this number, or if it is out of date, please contact us at firstname.lastname@example.org to update your information.
The Board of Pharmacy believes that this new report will provide prescribers with a wealth of new information but also recognizes that many providers would like to see additional information. Health care professionals registered with OARRS can expect additional information added to the Practice Insight Report over the coming months and years as new sources of data become available.
The Board encourages OARRS users to provide feedback and suggestions regarding this report or other system improvements by emailing email@example.com. The Board encourages all prescribers to register with OARRS. For more information on registration, please visit: www.ohiopmp.gov.
Opiate Prescribing Resource Website
The appropriate treatment of pain is a priority in Ohio. The Governor’s Cabinet Opiate Action Team (GCOAT), the Nursing Board, and a group of professional health care provider regulatory boards, associations, individual providers and other key stakeholders have focused their efforts on educating health care professionals and patients. The goal of this educational effort is to help reduce and eliminate the misuse and abuse of opioid drugs.
The website www.opioidprescribing.ohio.gov features the “Guidelines for Prescribing Opioids for the Treatment of Chronic, Non-Terminal Pain”, a one-hour continuing education video and information and links to an improved OARRS reporting system keyed to this initiative.
Using the recently adopted guidelines in coordination with OARRS reports is a best practice that offers insight into a patient’s use of opioids and other controlled substances while also alerting prescribers to possibilities of medication conflicts and signs of abuse, addiction or diversion. OARRS reports have recently been enhanced to include a dosage calculator to assist prescribers in determining whether patients are at, near or over the daily 80 MED highlighted in the guidelines.
Ohio Automated Rx Reporting System
Ohio Opioid Prescribing Guidelines
Prevention of Neonatal Abstinence Syndrome
Center for Safe Prescribing
Drug Enforcement Administration (DEA) Registration & Validation
(Includes link to Practitioner’s Manual.)
Facts and Comparisons - Online
(Facts and Comparisons subscription required.)
The formulary contains bookmark links in the index to more easily access each drug category.
Formulary with Index for CTP Holders (May 18, 2015)
Special Formulary Update (Effective March 20, 2014)
Formulary Review and Revision Request Form
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Meeting Date: October 19, 2015