STANDARD CARE ARRANGEMENT
FOR
NURSE MIDWIVES
This Standard Care Arrangement (SCA) is a written formal guide for planning and evaluating the health care of clients cared for by Certified Nurse Midwives (CNM). This SCA ha been developed in accordance with Section 4723.431 of the Ohio Revised Code and Rules adopted by the Board of Nursing for Advanced Practice Nurses.
Under provisions of SB 154, a SCA is required between each CNM and her collaborating physician(s) or medical director. The following is a practice agreement between (Name o fMidwife) CNM and (Name of Medical Director), medical director of Neighborhood Family Practice, 3569 Ridge Rd., Cleveland, OH 44102.
STANDARD CARE ARRANGEMENT
An SCA shall be entered into prior to engaging in practice as a Certified Nurse Midwife or when changing collaborating physician. The SCA will be reviewed and signed by the CNM and he collaborating physician(s) on an annual basis. The most current copy of the SCA w\shall be retained and available upon request at all sites where the CNM practices.
COLLABORATIVE RELATIONSHIP
The CNM (s) of Neighborhood Family Practice (NFP) practice in collaboration with board certified and board eligible family practice physicians, and obstetrician/gynecologists.
Collaboration means that a physician whose specialty is similar to the CNM is continuously available to communicate with the CNM either in person, by radio, telephone or other form of telecommunication.
SECTION I: STATEMENT OF SERVICES
The CNM may provide the management of preventive services and those primary care services necessary to provide health care to women antepartally, intrapartally, postpartally, and gynecologically, consistent with the nurse’s education and certification and in accordance with rules adopted by the Board and section 4723.43 of the Revised Code.
The CNM who holds a valid Certificate to Prescribe (including an externship CtP) may prescribe in accordance with Sections 4723.48 through 4723. 485, Ohio Revised Code, the rules of the Board of Nursing, and within the formulary made available by the Ohio Board of Nursing (see section VI of this SCA). The CNM activities may include education, research and consultation.
SECTION II: INCORPORATION OF NEW TECHNOLOGY OR NEW PROCEDURES
The CNM will incorporate new technology in a manner consistent with the American College of Nurse Midwive’s Guidelines for Incorporation of New Procedures. The CNM will also utilize education in-services, educational conferences and develop written competencies for evaluation, as part of this process.
SECTION III: QUALITY ASURANCE PROVISIONS
A. Criteria for Referral/Consultation of a Client:
Consultation: For the purpose of this section, consultation will represent a clinical interaction between a CNM and a physician.
The CNM, in accordance with her level of clinical expertise and educational preparation, shall determine when physician consultation is necessary. Consultation options include, but are not limited to telephone contact, on site case review or discussion, and/or physical examination of the client by the collaborating physician. The method of consultation chosen and resulting plan of care shall be documented in the patient record.
B. CNM – Criteria for referral to a physician:
- Request from a patient to see the collaborating physician (s)
- A patient whose clinical condition is unusual, who is not making satisfactory progress, or whose condition is unresponsive to the plan of care.
- Patients with complicated diagnoses and/or multifaceted treatment outside of parameters established by the CNM and collaborating physicians.
- Any other reason as determined by the CNM and the collaborating physician.
C. Conditions Necessitating Referral
Conditions that require referral of a patient to physician management include, but are not limited to those abnormal conditions identified in the Nurse Midwife Practice Guidelines. The nurse midwife may continue to provide supportive and educational care to the client who has been referred when possible or indicated (see addendum).
D. Procedure for Regular Review of Charts and Referrals to Other Health Professionals
A random selection of completed patient records for chart review by the CNM and the collaborating physician will occur on an annual basis. Care outcomes will be reviewed by the CNM and the collaborating physician. This process is confidential and is an opportunity for professional growth.
SECTION IV: PRESCRIPTIVE AUTHORITY
The CNM who holds a valid Certificate to Prescribe (including extership CtP), may prescribe in accordance with Sections 4723.48 through 4723.485, Ohio Revised Code, the rules of the Board of Nursing, and within the formulary made available by the OBN.
A. Availability of Timely and Direct Evaluation of the Patient by the Physician:
In order to ensure timely and direct evaluation of the patient by a physician, the collaborating physician or designated physician colleague shall be readily available to evaluate a patient.
B. Formulary Compliance:
The CNM may prescribe medications for off -label use if the following criteria
are met:
1. The off label use must be consistent with the CNM Scope of Practice and clinical
subspecialty practice.
2. The drug and off-label indication(s) are included in the attached dated addendum to
this document.
3. The off-label indications(s) is/are supported by standard clinical practice and literature.
4. The signature of the CNM and the collaborating physician (s) indicates agreement to the off-label indications(s) in the addendum to this SCA.
C. Prescribing Parameters:
1.The CNM may prescribe within her scope of practice, as indicated by her educational
preparation and training.
2. The signature of the CNM and the collaborating physician (s) on the SCA implies acceptance of the formulary as written.
3. Any restrictions to selected drugs within the formulary, as agreed upon by the CNM and the physicians shall be indicated in the addendum to this SCA.
4. Specific drugs, such as opiates, antidepressants and steroids, must be reviewed as indicated on the formulary.
D. Quality Assurance Provisions Related to Prescriptive Authority:
The CNM and the collaborating physician(s) will review a randomized sample of written prescriptions a least semi- annually. This review may be completed as part of the QA review described above (Section III). Documentation of these reviews will be noted on the signature page of this document.
Section V: Provisions for Coverage of Absences
In the event of a planned or unplanned absence by the CNM, scheduled patients will be seen by another CNM or collaborating physician, or contacted and rescheduled. In case of emergency in the CNM’s absence, the covering CNM or collaboration physician on call will be contacted.
In the event of a planned or unplanned absence by the collaborating physician(s), the CNM will be notified of the designated colleague covering this absence and will contact the physician as needed.
Section VI: Policy for resolution of Clinical Disagreements
Should a disagreement arise between the CNM and the collaborating physician, regarding diagnosis or treatment of a patient, one or more of the following means of resolution should be followed:
A. Consult with an uninvolved physician and /or CNM colleague with the clinical department.
B. Refer to current professional literature (journals, research, and texts) appropriate to the area in question.
C. Consult a specialist in the area in question.
D. Appropriate institutional chain-of-command procedures will be adhered to as necessary or required.
Section VII: Reimbursement Arrangements
Current local, state and federal laws governing reimbursement shall be adhered to.
Section VIII: Addendum/Attachments
1. Abnormal Conditions Requiring Referral to Physician Management
2. Standards of Care (ACNM) which include “Guidelines for Incorporation of New Technology”.
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