Header:
NEW YORK CODES, RULES AND REGULATIONS
TITLE 8. EDUCATION DEPARTMENT
CHAPTER II. REGULATIONS OF THE COMMISSIONER
SUBCHAPTER B. REGULATION OF PROFESSIONS
PART 64. NURSING
Date:
08/31/2009
Document:
ยง 64.7 Immunizations, emergency treatment of anaphylaxis, purified protein derivative (PPD) mantoux tuberculin skin tests and human immunodeficiency virus (HIV) tests pursuant to non-patient specific orders and protocols
(a) Immunizations.
(1) Pursuant to section 6909(5) of the Education Law, a registered professional nurse shall be authorized to administer immunization agents prescribed in paragraph (2) of this subdivision to patients therein specified, pursuant to a non-patient specific order and protocol prescribed and ordered by a licensed physician or a certified nurse practitioner, provided the registered nurse meets the prerequisite requirements prescribed in paragraph (3) of this subdivision and the order and protocol meets the requirements of paragraph (4) of this subdivision.
(2) Authorized immunization agents.
(i) Adult immunizations. A registered professional nurse that meets the requirements of paragraph (3) of this subdivision shall be authorized to administer the following immunization agents to patients 18 years of age or older, pursuant to a non-patient specific order and protocol prescribed and ordered by a licensed physician or a certified nurse practitioner that meets the requirements of paragraph (4) of this subdivision: Hepatitis A, Hepatitis B, Influenza, Pneumococcus, Meningococcus, Diphtheria, Tetanus, Measles, Mumps, Rubella, Varicella, Inactivated Polio, and additional immunizations agents approved by resolution of the Board of Regents upon recommendation by the commissioner that such additional immunization agents are safe and effective immunization agents for registered professional nurses to administer to patients who are 18 years of age or older, pursuant to a non-patient specific order and protocol as prescribed in this section, after consideration of the recommendations of State and/or nationwide authorities that evaluate the effectiveness and safety of immunization agents, including but not limited to the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services. Such additional immunization agents, which are not specifically enumerated in this subparagraph, may be removed by resolution of the Board of Regents, upon recommendation of the commissioner that such immunization agents are not safe and effective immunization agents for registered professional nurses to administer to patients who are 18 years of age or older, pursuant to a non- patient specific order and protocol as prescribed in this section, after consideration of the recommendations of State and/or nationwide authorities that evaluate the effectiveness and safety of immunization agents, including but not limited to the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services.
(ii) Child immunizations. A registered professional nurse that meets the requirements of paragraph (3) of this subdivision and who is employed or is acting as an agent for the Visiting Nurses Association or other equivalent organization as determined by the department that is legally authorized to provide nursing services, or for a State, county, municipal or other government agency, shall be authorized to administer the following immunization agents to patients under the age of 18, pursuant to a non-patient specific order and protocol prescribed and ordered by a licensed physician or a certified nurse practitioner that meets the requirements of paragraph (4) of this subdivision: Diphtheria, Tetanus, Acellular Pertussis, Measles, Mumps, Rubella, Varicella, Haemophilus Influenzae Type b (Hib), Inactivated Polio, Hepatitis B, and additional immunizations agents approved by resolution of the Board of Regents upon recommendation by the commissioner that such additional immunization agents are safe and effective immunization agents for registered professional nurses to administer to patients who are under the age of 18 years old, pursuant to a non-patient specific order and protocol as prescribed in this section, after consideration of the recommendations of State and/or nationwide authorities that evaluate the safety and effectiveness of immunization agents, including but not limited to the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services. Such additional immunization agents, which are not specifically enumerated in this subparagraph, may be removed by resolution of the Board of Regents, upon recommendation of the commissioner that such immunization agents are not safe and effective immunization agents for registered professional nurses to administer to patients who are under the age of 18 years old, pursuant to a non-patient specific order and protocol prescribed in this section, after consideration of the recommendations of State and/or nationwide authorities that evaluate the effectiveness and safety of immunization agents, including but not limited to the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services.
(iii) Epidemics. Notwithstanding the requirements of subparagraphs (i) and (ii) of this paragraph, a registered professional nurse that meets the requirements of paragraph (3) of this subdivision shall be authorized to administer to patients, pursuant to a non-patient specific order and protocol prescribed and ordered by a licensed physician or a nurse practitioner that meets the requirements of paragraph (4) of this subdivision, any immunization agents authorized under such order and protocol to be administered as part of an immunization program maintained, authorized, or under the auspices of the Commissioner of Health, a county commissioner of health, or a county public health director, when such an immunization program is instituted pursuant to an epidemic declared by such official.
(3) Prerequisite requirements. For a registered professional nurse authorized to administer immunization agents prescribed in paragraph (2) of this subdivision to recipients therein specified, pursuant to a non-patient specific order and protocol prescribed by a licensed physician or a certified nurse practitioner, such registered professional nurse shall be currently certified in cardio-pulmonary resuscitation by a program of the American Red Cross or the American Heart Association or an equivalent organization acceptable to the department, which has an established record of providing programs of cardio-pulmonary resuscitation training.
(4) 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 administer immunization agents, in accordance with the requirements of paragraph (1) 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 is immunized and maintained as a record for the period of time prescribed in section 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 administer specified immunization agents 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 administer immunizations outside of such employment or contract. The order shall contain but shall not be limited to the following information:
(a) the specific immunization agents that the registered professional nurse (s) is permitted to administer;
(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 administer the immunization agent(s) pursuant to the order; 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 administer the prescribed immunization agent(s) pursuant to the order;
(d) 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, the order shall contain a statement limiting the registered professional nurses to administering immunizations 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 nurse practitioner who 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 untoward conditions that would preclude immunization(s) and each recipient's record of immunization with manufacturer and lot number or a potential recipient's refusal to be immunized shall be documented in accordance with section 29.2(a)(3) of this Title.
(b) The registered professional nurse shall be responsible for having emergency anaphylaxis treatment agents, related syringes and needles available at the immunization site.
(c) The registered professional nurse shall inform each recipient of potential side effects and adverse reactions, orally and in writing, prior to immunization. The registered professional nurse shall provide written instructions to the recipient regarding the appropriate course of action in the event of untoward or adverse reactions, which statements are required to be developed by a competent entity knowledgeable about the untoward or adverse reactions of the immunization agent which shall be administered, such as the Centers for Disease Control of the U.S. Department of Health and Human Services, which issues vaccine information statements. The registered professional nurse shall not administer immunizations unless the recipient is adequately informed as prescribed in this clause and the recipient consents to the immunization; except for minors or other recipients incapable of consenting to the administration of an immunization, in which case a person legally responsible for the recipient shall have given prior written consent to the immunization after having been informed in writing as prescribed in this clause before it may be administered; or shall be in attendance during the immunization, informed as prescribed in this clause, and have consented to the immunization before it may be administered.
(d) The registered professional nurse shall provide to each recipient or other person legally responsible when the recipient is a minor or otherwise incapable of consenting to immunization, a signed certificate of immunization with the recipient's name, date of immunization, address of administration, administering nurse, immunization agent, manufacturer and lot number and recommendations for future immunizations recorded thereon. With the consent of the recipient or a person legally responsible when the recipient is a minor or otherwise incapable of consenting, the registered professional nurse shall communicate this information to the recipient's primary health care provider, if one exists.
(e) Each registered professional nurse shall report any adverse outcomes as may be required by Federal law on the vaccine adverse event reporting system form of the Centers for Disease Control of the U.S. Department of Health and Human Services, or on the successor form.
(f) Each registered professional nurse shall ensure that a record of all persons immunized including the recipient's name, date, address of administration, administering nurse, immunization agent, manufacturer, lot number and recommendations for future immunizations is recorded and maintained in accordance with section 29.2(a)(3) of this Title.
(b) Anaphylaxis treatment agents.
(1) Pursuant to section 6909(5) the Education Law, a registered professional nurse shall be authorized to administer anaphylaxis treatment agents, including but not limited to epinephrine, for the emergency treatment of anaphylaxis, 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 meets the requirements of paragraph (2) this subdivision.
(2) 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 administer anaphylaxis treatment agents, including but not limited to epinephrine, for the emergency treatment of anaphylaxis, in accordance with the requirements of paragraph (1) 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 receives the anaphylaxis treatment agent and maintained as a record for the period of time prescribed in section 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 administer specified anaphylaxis treatment agents 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 administer anaphylaxis treatment agents outside of such employment or contract. The order shall contain but shall not be limited to the following information:
(a) the specific anaphylaxis treatment agents that the registered professional nurse(s) is permitted to administer;
(b) the period of time that the order is effective, including the beginning and end date;
(c) the name and license number of the registered professional nurse(s) authorized to administer the anaphylaxis treatment agent(s) pursuant to the order; 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 administer the prescribed anaphylaxis treatment agent(s) pursuant to the order;
(d) 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, the order shall contain a statement limiting the registered professional nurses to administering anaphylaxis treatment agents 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 who 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) Each registered professional nurse shall ensure that a record of all persons to whom they have administered an anaphylaxis treatment agent, including but not limited to: the recipient's name, date, address of administration, administering nurse, anaphylaxis treatment agent, manufacturer, and lot number, is recorded and maintained in accordance with section 29.2(a)(3) of this Title.
(b) The registered professional nurse shall contact the local emergency medical services system following the administration of the anaphylaxis treatment agent, or shall ensure that equivalent follow-up care is provided through other arrangements.
(c) The registered professional nurse shall report to the local emergency medical system or other provider of equivalent follow-up care information concerning the administration of the anaphylaxis treatment agent, including but not limited to: when it was administered, the dosage, strength, and route of administration. The registered professional nurse shall also report such information to the patient's primary care provider if one exists, unless the patient is unable to communicate the identity of his or her primary care provider.
(c) Purified protein derivative (PPD) mantoux tuberculin skin tests.
(1) Pursuant to section 6909(5) of the Education Law, a registered professional nurse shall be authorized to execute the order to administer purified protein derivative (PPD) mantoux tuberculin skin 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 meets the requirements of paragraph (2) of this subdivision.
(2) 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 the purified protein derivative (PPD) mantoux tuberculin skin test, in accordance with the requirements of paragraph (1) 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 a purified protein derivative (PPD) mantoux tuberculin skin test and maintained as a record for the period of time prescribed in section 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 purified protein derivative (PPD) mantoux tuberculin skin 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 purified protein derivative (PPD) mantoux tuberculin skin tests outside of such employment or contract. The order shall contain but shall not be limited to the following information:
(a) identification of the purified protein derivative (PPD) mantoux tuberculin skin 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 purified protein derivative (PPD) mantoux tuberculin skin 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 prescribed purified protein derivative (PPD) mantoux tuberculin skin 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 purified protein derivative (PPD) mantoux tuberculin skin 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 untoward conditions that would preclude purified protein derivative (PPD) mantoux tuberculin skin testing and each recipient's record of the purified protein derivative (PPD) mantoux tuberculin skin test with manufacturer and lot number or a potential recipient's refusal to be tested shall be documented in accordance with section 29.2(a)(3) of this Title.
(b) The registered professional nurse shall be responsible for having emergency anaphylaxis treatment agents, related to syringes and needles available at the purified protein derivative (PPD) mantoux tuberculin skin testing site, except in an emergency as determined by the Commissioner of Health, a county commissioner of health, or a county public health director.
(c) When the recipient of the test is legally capable of consenting to the test, the registered professional nurse may execute the order to administer the purified protein derivative (PPD) mantoux tuberculin skin test only after the recipient is adequately informed in writing as prescribed in this clause and consents to the purified protein derivative (PPD) mantoux tuberculin skin test. In the case of minors or other recipients incapable of consenting to the test, the registered professional nurse may execute the order to administer the purified protein derivative (PPD) mantoux tuberculin skin test only after the person legally responsible for the recipient of the test is adequately informed in writing as prescribed in this clause and consents to the purified protein derivative (PPD) mantoux tuberculin skin test. Prior to the registered professional nurse executing the order to administer the test, the recipient of the test, or the person legally responsible for the recipient of the test in the case of minors or other recipients incapable of consenting to the test, shall be informed in writing about the potential side effects of and adverse reactions to the test, and the need for test evaluation within 48 to 72 hours after the test is administered.
(d) The registered professional nurse shall ensure that the recipient, or other person legally responsible for the recipient when the recipient is a minor or otherwise incapable of consenting to the test, is provided with a signed certificate of purified protein derivative (PPD) mantoux tuberculin skin testing and results, with the recipient's name, date of the test, address where the test was administered, administering nurse, manufacturer and lot number and recommendations for future tests recorded thereon. With the consent of the recipient or a person legally responsible for the recipient when the recipient is a minor or otherwise incapable of consenting, the registered professional nurse shall ensure that this information is communicated to the recipient's primary health care provider if one exists.
(e) Each registered professional nurse shall ensure that a record of all persons so testing including the recipient's name, date of the test, address where the test was administered, administering nurse, test results, manufacturer, lot number and recommendations for future tests is recorded and maintained in accordance with section 29.2(a)(3) of this Title.
(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 this Title.
(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 section 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 section 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 10 NYCRR Part 63;
(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 10 NYCRR Part 63;
(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 10 NYCRR Part 63; and
(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 10 NYCRR Part 63.
|