JHACO, State practice act & Hospital bylaws

[quarternote]

I have several questions hopefully someone here has insight. I currently live in S.C. I did not post this in SC because I would like to hear from people in other states as to what they do. Recently our hospital bylaws have come under scrutiny. Myself along with another PA have been tasked to research our state law, JHACO, etc...current bylaw states that Midlevels can't give verbal or telephone orders. With implementing of EMR it has come to light. We are in the process of changing this. In reviewing bylaws there are other areas that need addressing such as DNR orders, restraints, DEA numbers and schedule II drugs.

Does anyone know where I can find information on this? What do most hospitals do in these cases? We are having a very hard time finding information on midlevels writing DNR orders.

As far as schedule II goes Midlevel's in SC can not write RX for schedule II. In the inpatient setting this is sometimes necessary. How do other hospitals handle this. Does the Midlevel write the order and then there is a window of time until the attending can cosign the order?

Thanks for any guidance.

[EMEDPA]

can't help with SC laws in particular. PM rcdavis as he has worked there in em and critical care for 35 years.

In WA a pa can sign anything their sponsoring physician can without any exceptions. there are also no restrictions on verbal orders, scheduled drugs, etc

JHACO isn't law by the way. it's one organization that makes suggestions. several hospitals have opted out of their services as they both charge for them and in many instances actively impede professionals doing their jobs with their often silly counterproductive rules....

[sbellin]

Again in Washington State in in-patient medicine I can order almost anything verbally including schedule II's (an exception would be chemical or physical restraints which would require my personal attention); the caveat is that the order must be signed by me or by a physician within 24 hours per bylaws. The same holds true for the physicians verbal orders except they cannot be signed by a midlevel only the ordering doc or another physician.

[quarternote]

Thanks Emed. The Med. staff and corporate compliance keep asking "is this state law, our bylaw or JHACO recommendation?" so we are having to look at all of them.

I'm interested to hear what other States do. I'll PM RCDavis in the meantime.

[Houstonian]

Whatever you do needs to conform with state practice laws. Pay close attention to what the state practice laws say about ORDERING (i.e. in an institutional setting) or PRESCRIBING (more likely in an outpatient setting).

 

MOST hospitals desire JCAHO accreditation. JCAHO requirements are not flexible; a recommendation, however, may be.