PIEDMONT ACCESS TO HEALTH SERVICES, INC.
Policy Number: 01-02-037
SUBJECT: Protocol for Chart Review of a Licensed Nurse Practitioner or Physician Assistant by Supervising Physician
EFFECTIVE DATE: 07/1/2012
REVIEW/REVISED: 02/11/2014
______
POLICY: PATHS is dedicated to providing the highest quality of care to its patients. A licensed nurse practitioner shall be authorized to engage in practices constituting the practice of medicine in collaboration with, and under the medical direction and supervision of a licensed physician(s). Medical direction and supervision means participation in the development of a written protocol including provision for periodic review and revision, development of guidelines for availability and ongoing communications which provide consultation among collaborating parties and the patient, and periodic joint evaluation of services provided, e.g., chart review and review of patient outcomes.
PROCEDURE:
1. A nurse practitioner shall perform duties as outlined in PATHS’ “Practice Agreement for Patient Care Conducted by a Licensed Practitioner. When a question arises as to the appropriateness of any treatment or therapy outlined in these materials, the Nurse Practitioner is required to consult his/her supervising physician. Any such consult should be clearly documented in the patient record.
2. The physician assigned to the center where the nurse practitioner is assigned will serve as the supervising physician. All other physicians employed by PATHS shall be designated alternate supervising physicians. Physician supervision will be available at all times, either on-site or by telephone, when consultation is needed for any reason. In accordance with 18VAC90-40-100, should the nurse practitioner practice at a site different than that of the supervising physician, the supervising physician shall provide supervisory services to such separate practices by making regular site visits for consultation and direction for appropriate patient management. The site visits shall occur no less frequently than once a quarter.
3. A nurse practitioner will be managing primary care conditions and developing treatment plans utilizing the resources listed in “Appendix 1” of the Practice Agreement for Patient Care Conducted by a Licensed Nurse Practitioner. In general, however, physician consultation will be sought for all the following situations and any others deemed appropriate. Whenever a physician is consulted, a notation to that effect, including the physician’s name, must be made in the patient chart. Additionally, the physician consulted with will co-sign the progress note after it has been completed by the nurse practitioner. All PATHS Providers have been provided instructions on the process of co-signing a chart.
4. Additionally, the supervising physician shall participate in an informal evaluation during consultations and case review, and conduct a monthly, random review of no less than five (5) patient charts on which the nurse practitioner has entered a prescription for an approved drug or device. The results of the chart review will be discussed with the nurse practitioner and a copy will be provided to the Medical Director.
This protocol has been reviewed and agreed upon by the parties below:
SIGNATURES:
______Date: ___ / ___ / ___
Supervising Physician For The Following:
Hope Kieft ______Date:___ / ___ / ___
PNP
______Date: ___ / ___ / ___
Alternate Supervising Physician For The Above:
______Date: ___ / ___ / ___
Supervising Physician For The Following:
Amy Bowles______Date:___ / ___ / ___
PA
Karen Highlander ______Date:___ / ___ / ___
FNP
Judy Broughton______Date: ___ / ___ / ___
FNP
Elizabeth Hagan______Date:___ / ___ / ___
FNP
Michelle Proffitt______Date:___ / ___ / ___
FNP
Betsy Pickeral ______Date:___ / ___ / ___
FNP
______Date: ___ / ___ / ___
Alternate Supervising Physician For The Above:
______/ ___ / ___
Chief Executive Officer Date
APPENDIX 1: Resources
Dermatology:
Fitzpatrick, MD, et al. (1997). Color Atlas and Synopsis of Clinical Dermatology (3rd Ed). New York, NY; McGraw Hill, Inc.
Habif, T.P. (1996) Clinical Dermatology: A Color Guide to Diagnosis Therapy (3rd Ed). St. Louis, MO: Mosby-Yearbook, Inc.
Diagnostic Studies:
Breuninger, C.C. and Wittig, P. (2001) Diagnostics. Springhouse, PA: Springhouse Co.
General Medicine:
Braunwald, E., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L. and Jameson, J.L. (2002). Harrison’s Manual of Medicine (15th ed) New York, NY: Mcraw Hill, Inc.
Ewald, G.A. and McKenzie, C.R. (1995). The Washington Manual (28th Ed). Boston, MA: Little Brown and Co.
Wilson, J.D., Braunwald, E., Isselbacher, K.J., Petersdorf, R.G., Marin, J.B., Fauci, A.S., and Root, R.K. (1992). Harrison’s Principles of Internal Medicine (12th Ed) New York, NY: McGraw Hill, Inc.
General Urology:
Gomella, L.G. (2000) The 5-minute Urology Consult. Philadelphia, PA: Lippincott, Williams & Wilkins.
Walsh, P.C. Retik, A.B., Vaughan, E.D., Jr., and Wein, A.J. (1998) Campbell’s Urology (7th Ed) Philadelphia, PA: W.B. Saunders Co.
Pediatrics:
Griffiths 5-Minute Pediatric Consult
Pharmacology:
Physician’s Desk Reference. (Current year) Montvale, NJ: Medical Economics
Guide to Antimicrobial Therapy. (Current handbook) Sandford
Tarascon Pocket Pharmacopaeia (2003 Deluxe Ed): Loma Linda, CA: Tarascon Publishing
Procedures:
Edmunds, M.W. and Mayhew, M.S. (1996) Procedures for Primary Care Practitioners. St. Louis, MO: Mosby Yearbook, Inc.
Women’s Health:
Yougkin, E.Q. and Davis, M.S. (1994) Women’s Health: A Primary Care Clinical Guide. Norwalk, CT: Appleton & Lange
01-02-037: Protocol for Chart Review of a Licensed Nurse Practitioner or Physician Assistant by Supervising Physician
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