|
|
THE STATE
EDUCATION DEPARTMENT / THE UNIVERSITY
OF THE STATE OF |
|
TO: |
Higher Education and Professional Practice Committee |
|
FROM: |
Johanna Duncan-Poitier |
|
SUBJECT: |
Proposed Amendment to the Regulations of the
Commissioner of Education Relating to the Execution by Registered Nurses
of Non-Patient Specific Orders to Administer Human Immunodeficiency Virus
Tests |
|
DATE: |
February 27, 2007 |
|
STRATEGIC
GOAL: |
Goal 3 |
|
AUTHORIZATION(S): |
|
SUMMARY
Issue for
Discussion
Should the Board of Regents amend Section 64.7 of the Regulations of the Commissioner of Education relating to the execution by registered nurses of non-patient specific orders to administer Human Immunodeficiency Virus (HIV) tests?
Reason(s) for Consideration
Required by State Statute.
Proposed Handling
The proposed amendment is before the Higher Education and Professional Practice Committee for discussion in March 2007 and will be submitted for action at the May 2007 Regents meeting.
Procedural
History
A Notice of Proposed Rule Making concerning the proposed amendment will be published in the State Register on March 7, 2007. Supporting materials are available upon request from the Secretary of the Board of Regents.
Background
Information
Chapter 429 of
the Laws of 2005, effective August 2, 2005, added a new paragraph (d) to section
6909 of the Education Law, permitting registered professional nurses to execute
non-patient specific orders prescribed by a licensed physician or a certified
nurse practitioner for the administration of HIV tests. The existing list of procedures that
registered nurses can currently perform pursuant to a non-patient specific order
include: (1) administration of certain immunizations, (2) anaphylactic treatment
medications, and (3) tuberculin skin tests.
Section 6909 (5)
of the Education Law directs the Commissioner of Education to promulgate
regulations concerning the execution of such non-patient specific orders by
registered professional nurses.
The purpose of the
proposed amendment is to establish uniform requirements for registered
professional nurses to meet when executing non-patient specific orders to
administer HIV tests. Specifically,
the proposed amendment defines what information should be included in the
non-patient specific order and the requirements that must be set forth in the
protocol, for a registered professional nurse to follow when administering an
HIV test through a non-patient specific order. The proposed amendment also requires
registered professional nurses to either maintain or ensure the maintenance of a
copy of the non-patient specific order and protocol for a specified period of
time.
The non-patient specific order must contain
the following information: (a)
identification of the HIV-related test; (b) the period of time that the order is
effective; (c) the name(s) and license number(s) of the registered professional
nurse(s) authorized to execute the order or the name of the entity that is
legally authorized to employ or contract with registered professional nurses to
provide nursing services; (d) in instances in which registered professional
nurses are identified as employed or under contract with an entity, the order
shall contain a statement limiting registered professional nurses to execute
such order only in the course of such employment; and (e) the order must contain
the name, license number, and signature of the licensed physician or certified
nurse practitioner that has issued the order.
The proposed amendment further requires that
the protocol, which must be incorporated into the order, contain the following
procedures: the registered
professional nurse shall ensure that each potential recipient is assessed for
conditions that would preclude HIV-related testing; that each recipient’s record
of the test or refusal to be tested is documented; that the registered
professional nurse execute the non-patient specific order in accordance with
applicable State laws and regulations; and that the registered professional
nurse certify that he/she obtained the written, informed consent of the
recipient, or when the recipient lacks capacity to consent, a person authorized
pursuant to law to consent to health care for such individual, and provide
pre-test counseling prior to ordering the performance of the HIV-related test.
The registered professional nurse must also provide the recipient, or other
person legally responsible for the recipient, upon request, with a signed
certificate of HIV testing containing prescribed information. The registered professional nurse must
also ensure, with appropriate consent, that information about the test is
communicated to the recipient's primary health care provider, if one
exists.
This amendment is needed to advise
registered professional nurses of the requirements that they must meet to
execute a non-patient specific order for the administration of HIV tests; to
provide uniformity and consistency in the information that must be contained in
the order and the protocols to be followed when administering such tests and the
requirements for the maintenance of such records. At the present time, about 168,000
registered professional nurses are licensed to practice in
The amendment
is also needed to protect the public health. Providing such testing through
non-patient specific orders and protocols prescribed by licensed physicians and
certified nurse practitioners allows for a more effective response to the public
health need for HIV testing for many segments of the population of New York
State.
Representatives from the New York State
Department of Health and the Office of the Professions have collaborated on the
proposed content of the regulations. These regulations are the product of those
discussions and negotiations.
Recommendation
Not applicable.
Timetable for Implementation
The effective date of the proposed amendment is June 14, 2007.
AMENDMENT TO
REGULATIONS OF THE COMMISSIONER OF EDUCATION
Pursuant to
sections 207, 6507, 6527, 6902 and 6909 of the Education Law.
Section 64.7 of
the Regulations of the Commissioner of Education is amended, effective June 14,
2007, as follows:
64.7
Immunizations, emergency treatment of anaphylaxis, [and] purified protein
derivative (PPD) mantoux tuberculin skin tests and
human immunodeficiency virus (HIV) tests pursuant to non-patient specific
orders and protocols.
(a) . .
.
(b) . . .
(c) . . .
(d) Human Immunodeficiency Virus (HIV)
tests.
(1) As used in this subdivision, human immunodeficiency virus (HIV)
test means HIV-related test as defined in section 63.1 of the Rules and
Regulations of the New York State Department of Health (10 NYCRR
63.1).
(2) Pursuant to
section 6909(5) of the Education Law, a registered professional nurse shall be
authorized to execute an order to administer HIV tests, pursuant to a
non-patient specific order and protocol prescribed and ordered by a licensed
physician or a certified nurse practitioner, provided the order and protocol
meet the requirements of paragraph (3) of this subdivision. The following provisions apply to the
administration of an HIV test pursuant to a non-patient specific standing order
when such test is administered by a registered professional nurse.
(3) Order and
Protocol.
(i) The registered professional nurse shall either maintain
or ensure the maintenance of a copy of the non-patient specific order and
protocol prescribed by a licensed physician or a certified nurse practitioner,
which authorizes a registered professional nurse to execute the order to
administer an HIV test, in accordance with the requirements of paragraph (2) of
this subdivision. The order
prescribed in subparagraph (ii) of this paragraph shall incorporate a protocol
that meets the requirements of subparagraph (iii) of this paragraph. Such order and protocol shall be
considered a record of the patient who has received an HIV test and be
maintained as a record for the period of time prescribed in paragraph 29.2(a)(3)
of this Title.
(ii) The order
shall authorize one or more named registered professional nurses, or registered
professional nurses who are not individually named but are identified as
employed or under contract with an entity that is legally authorized to employ
or contract with registered professional nurses to provide nursing services, to
execute the order to administer HIV tests for a prescribed period of time. In instances in which the registered
professional nurses are not individually named in the order, but are identified
as employed or under contract with an entity that is legally authorized to
employ or contract with registered professional nurses to provide nursing
services, such registered professional nurses shall not be authorized by such
order to execute the order to administer HIV tests outside of such employment or
contract. The order shall contain
but shall not be limited to the following information:
(a) identification of the HIV test;
(b) the period of time that the order is effective, including the
beginning and ending dates;
(c) the name and
license number of the registered professional nurse(s) authorized to execute the
order to administer the HIV test; or the name of the entity that is legally
authorized to employ or contract with registered professional nurses to provide
nursing services with whom registered professional nurses who are not
individually named are employed or under contract to execute the order to
administer the HIV test;
(d) in instances
in which registered professional nurses are not individually named in the order,
but are identified as employed or under contract with an entity that is legally
authorized to employ or contract with registered professional nurses to provide
nursing services, the order shall contain a statement limiting registered
professional nurses to execute the order to administer HIV tests only in the
course of such employment or pursuant to such contract;
and
(e) the name, license number, and signature of the licensed
physician or certified nurse practitioner that has issued the
order.
(iii) The
protocol, incorporated into the order prescribed in subparagraph (ii) of this
paragraph, shall require the registered professional nurse to meet the following
requirements:
(a) The
registered professional nurse shall ensure that each potential recipient is
assessed for conditions that would preclude HIV testing and ensure that each
recipient's record of the HIV test with manufacturer and lot number or a
potential recipient's refusal to be tested is documented in accordance with
paragraph 29.2(a)(3) of this Title.
(b) The
registered professional nurse shall execute the order to administer an HIV test
in accordance with applicable State laws and regulations, including but not
limited to, Article 27-F of the Public Health Law and Part 63 of the Rules and
Regulations of the New York State Department of
Health.
(c) The
registered professional nurse shall certify that he/she obtained the written,
informed consent of the recipient, or when the recipient lacks capacity to
consent, a person authorized pursuant to law to consent to health care for such
individual, prior to ordering the performance of the HIV test. Informed consent shall include pre-test
counseling to the recipient, or if the recipient lacks capacity to consent, a
person authorized pursuant to law to consent to health care for such
individual. The written informed
consent and the pre-test counseling shall be obtained and conducted in
accordance with Article 27-F of the Public Health Law and Part 63 of the Rules
and Regulations of the New York State Department of
Health.
(d)
A physician or nurse practitioner who issues a non-patient specific order for
HIV testing shall retain responsibility for communication of a confirmatory,
positive HIV test result to the recipient, or when the
recipient lacks capacity to consent, a person authorized pursuant to law to
consent to health care for such individual. A registered professional nurse is not
authorized to deliver a final confirmatory HIV positive test result through a
non-patient specific order. A
registered professional nurse may only deliver a confirmatory, positive HIV test
result through a patient specific order as directed by the treating physician or
nurse practitioner.
(e) The registered professional nurse
shall, upon request, ensure that the recipient, or when the recipient lacks
capacity to consent, a person authorized pursuant to law to consent to health
care for such individual, is provided with a signed certificate of HIV testing
and results, with the recipient's name, date of the test, address where the test
was administered, the name of the administering nurse, manufacturer and product
lot number.
(f) With the
consent of the recipient or when the recipient lacks capacity to consent, a
person authorized pursuant to law to consent to health care for such individual,
and with an appropriate authorization for the release of confidential HIV
information, the registered professional nurse shall ensure that this
information is communicated to the recipient's primary health care provider if
one exists in accordance with the requirements of Article 27-F of the Public
Health Law and Part 63 of the Rules and Regulations of the New York State
Department of Health.
(g) Each
registered professional nurse shall ensure that a record of all persons so
tested including the recipient's name, date of the test, address where the test
was administered, administering nurse, test results, manufacturer, lot numbers
and such other information as may be necessary pursuant to the protocol is
recorded and maintained in accordance with section 29.2(a)(3) of this Title and
Article 27-F of the Public Health Law and Part 63 of the Rules and Regulations
of the New York State Department of Health.