Nursing Texas Board of Nursing

Texas Prescriptive Authority Agreements

Any APRN or PA in Texas with a license in good standing can enter a prescriptive authority agreement.

This can only happen if his/her license if the APRN or PA does not face the following restrictions:

  • Facing revocation or has a license that’s already been revoked.
  • Isn’t delinquent.
  • Not facing suspension.
  • License isn’t inactive.
  • His or her license is subject to disciplinary orders.
  • Voluntarily surrendered his or her license.

Any of the above can prevent an APRN or PA from entering into a prescriptive authority agreement. As long as their license is in good standing the practitioner can enter into a Texas prescriptive authority agreement and order or prescribe drugs and devices to the extent mentioned by the board order. The Texas Board of Nursing or Texas Medical Board can also restrict an APRN or PA’s authority. They can do this by limiting an APRN or PA to just ordering or prescribing drugs or devices.

Disclosure of Information About Investigations and Discipline

Before signing any prescriptive authority agreement you need to disclose to the other parties of the agreement if you’ve received discipline in the past. This includes disciplinary action taken by other licensing boards in the past. Once you’re part of a prescriptive authority agreement and you receive any notice indicating you’re subject of an investigation you need to immediately inform the other parties of the agreement.

Necessary Information in a Prescriptive Authority Agreement

In prescriptive authority agreements the following elements are required:

  • The names, addresses and all the professional license numbers of everyone in the agreement.
  • A general plan for addressing referrals and consultations.
  • Describe the nature of practice, its location or practice settings.
  • Mention the different types of categories, devices or drugs which can and cannot be prescribed.
  • A plan for tackling patient emergencies.
  • Describe a quality assurance and improvement plan with its implementation tactics. The plan should include plans for chart reviews and regular face to face meetings.
  • Mention the process for communicating and sharing information regarding caring and treating patients.

Number of Charts to be Reviewed

Legally there’s no specific number or percentage of charts that need to be reviewed. On the contrary, parties of the prescriptive authority agreement determine how many charts need to be reviewed.

This number can vary from one practice setting to another based on factors like how long the APRN or PA has been in practice, how long the physician and APRN or PA have practiced together, if the prescriptive authority agreement parties practice in the same practice setting and the patient’s complexity of care.

There however has been no changes in law indicating a physician has to provide sufficient supervision of delegates. No matter what the situation may be, the number or percentage of charts reviewed has an important part at determining the physician’s supervision quality.

Frequency of Face to Face Meetings

At least once a month, until the third anniversary of the date of the agreement’s execution, meetings should be organized. However APRNs or PAs who have been in prescriptive authority agreement with essential physician supervision for at least five of the previous seven years, they should organize fact to face meetings at least once monthly till the first anniversary of the date the agreement was signed.

On completing the required monthly face to face meetings for the required period, the prescriptive agreement parties should hold face to face meetings at least quarterly. They also have to hold monthly meetings in between the quarterly meetings via remote electronic communication systems like the internet or videoconferencing technology.

In case the APRN’s or PA’s delegating physician changes for some reason or the other, then it’s essential to hold face to face meetings at least once a month.

Credit

According to calculations based on Chapter 157 of Texas Occupations Code, the amount of time an APRN or PA has practiced under a delegated physician’s prescriptive authority based on a prescriptive authority agreement includes the amount of time the APRN or PA had practiced under the delegated prescriptive authority of the same physician before November 1, 2013. To receive credit under this provision, you need to be practicing with the same physician since before November 1, 2013.

Skipping Face to Face Meetings

It is not possible to skip meetings even if the physician and APRN or PA practice in the same location. As part of your quality assurance and improvement plan, face to face meetings are required.

If the parties are in agreement they can always hold more meetings. Monthly and quarterly requirements are simply the minimum requirements based on Texas law. You cannot, however, meet less frequently than what is required by law. Moreover, the APRN or PA should meet the prescriptive authority agreement which may require more frequent meetings.

Protocol

APRNs and PAs should have authorized authority to provide medical aspects of patient care and this delegation had occurred through a protocol or written authorization. Instead of having and
using two documents, if both parties agree to it, this authorization can be included in a prescriptive authority agreement.

At times, an alternate physician may be temporarily responsible for delegating prescriptive authority. It is the prescriptive authority agreement which designates who is to serve as an alternate physician if it is okay to use alternate physician supervision.

Information about any alternate physician who participates in the quality assurance and improvement meetings with the APRN or PA should be included in the prescriptive authority agreement.