State Regulations on Prescriptive Practice

State regulations on prescriptive practices on controlled practices

Michigan

The state of Michigan has initiated a crack-down on practitioners carrying out prescribing controlled substances which has seen a scrutiny of practitioners within the state. The regulatory and enforcement teams have been developed and empowered by the state and federal governments to deal with problems arising from the use of controlled substance abuse. Such bodies include the State medical and pharmacy boards, the Federal health Care Fraud Prevention and Enforcement Action Team (HEAT), The DEA, the Department of Health and Human Services, DOJ, And the FBI. The state has placed the role of a gatekeeper to the physicians and pharmacist to assist in the deterrence, mitigation, and prevention of controlled substance diversion, fraud and misuse. These medical players are regarded as gatekeepers in closed circuit of prescription drug distribution structured to protect the health and safety and the welfare of the citizens by limiting the access to substances known to have serious and lethal adverse consequences if not used in the right manner. The state identifies the first step in the process as limiting the public access to the controlled substances. The state of Michigan requires these drugs be prescribed by a licensed provider. In Michigan a medical practitioner and a doctor of osteopathy needs to be licensed following the Michigan Statutory laws and the administrative laws put effected by the Bureau of Health within the department of licensing and regulatory affairs and also the board of medicine of Osteopathic  Medicine and Surgery respectively. 

The process of acquiring the license to operate as a physician or a doctor of osteopathy grants ones the rights to prescribe and dispense controlled substances. The physicians dealing with the prescription of controlled substances requires to get a license by the Michigan Boards of Pharmacy which offers the Michigan Controlled Substance License. A physician prescribing such substance from more than one location requires only one license. A separate Michigan controlled Substances License must be acquired for each business location from which the physicians and pharmacist prescribes the substances. On each pharmacy location requires its own Michigan Controlled Substance License. On top of this license, the physician carrying out routine dispensing of drugs whether controlled or non-controlled beyond the issuance of complimentary starter dose drugs requires a Michigan Drug Control License issued by the Board of Pharmacy for every location from where the physician carries out the operations. A physician who offers prescription dispenses narcotics as a treatment plan for substance abuse needs to obtain Michigan Substances Abuse License.  These Michigan’s States are required on top of the federal registrations issues by the DEA. The DEA requires a license for each site where the dispensing is carried out. Those dealing with drugs for dealing with treating substance abuse needs to acquire a separate DEA registration for Narcotic Treatment Programs (Iwrey & Mirafzali, 2012).

The Michigan State requires the physicians prescribing the controlled substances to do so in good faith. This requires the dispensing of the controlled substances by following the prescriber’s order and in the professional judgment of the pharmacist. The state further requires the prescription for controlled substance be issued and dispensed for a legitimate and professionally acknowledged purpose. The Michigan controlled Substance License does not give the authority to a licensee to dispense, manufacture, distribute, or prescribe the controlled substance for not recognized therapeutic, scientific, or industrial use not in line with the scope of the practitioner-licensee. The elements required by the Michigan rules on regulations on prescription for controlled substance must have the full name and address of the patient being given the prescription, the prescriber’s DEA number, printed name, address and profession title; the name of the drug, and the dosage,; quantity prescribed and directions for use of the drug (Iwrey & Mirafzali, 2012).

California

The state of California, through its rules and regulations requires that no individual should have the possession of any controlled substances unless they bear a prescription offered by a physician, dentist, podiatrist, optometrist, veterenian, or naturopathic doctor. This is in accordance with the section 3640.7. Under the section 2746.51, prescription may be issued by a certified nurse-midwife. A physician assistant may issue the prescription for controlled substance as prescribed by the section 3502.1, while a pharmacist by section 4052.1. The sections do not allow the above named category of professional the possession of the controlled substances, when in stock; they should be labeled correctly with a label bearing the identity of the supplier and the producer. The medical professionals described above are not authorized to order their own stock for the controlled substance.

The state of California prescribes a partial filling of schedule II prescriptions. A partial filling of the controlled substances may be offered if; the prescription is for an inpatient of a skilled nursing facility, the prescription being offered for a terminally ill patient. A partial filled is prescription that is only a portion of the amount prescribed is filled at any one time.  This is supposed to happen only where the total amount dispensed in the partial filling does not go beyond the amount written on the prescription. The partial filling requires to meet the following conditions: must be tendered and filled partially within 60 days from issuance date, the date and amount made on each partial filling needs to be recorded in a readily available form on the original prescription, there prescription should not be dispensed in 60 days before the first partial filling.

The State of California recognizes the following substances as controlled substance; the Anabolic steroids, Camphorated Tincture of opium, codeine contain cough preparations. Unlike other states where Carisoprodol is controlled substances, California State does not recognize it a controlled substances.  Much of the classification system adopted by the State of California is based on the DEA classification.

The State of California only authorizes the following people to carry out prescription of controlled substances; physician, veterenian, or naturopathic. A pharmacist acting within the frames of a project authorized by article 1 may also carry out the authorization. Other physicians also authorized the State of California include a registered nurse, a certified nurse-midwife, a physician-assistant, a naturopathic doctor, an optometrist  an out-of-state prescriber. The State of California prescriptive practices offer condition under which each and every practitioner can provide the prescriptions for the controlled substances.

The prescriptive practices in the state of California require that the prescription only be issued by a legitimate medical purpose by a practitioner acting in line of the professional practice. The responsibility for prescribing and issuance of the controlled substances rests upon the prescribing practitioner but corresponding responsibility is also held by the pharmacist who fills the prescription.  the rule and regulation as stated by the State of California identifies examples of illegal prescription: an order making a claim to be prescription but not issued in the normal course of the professional treatment or authorized research; an order for a drug substance user of controlled substances not provided in a manner of professional treatment or as component of the legitimate narcotic treatment program. Deliberate violation by an individual shall be liable to a punishment of imprisonment in the state prison or county jail of not more than one year or fine not more that $20000 or both.

State regulation for Education 

California

The nursing programs are proved in State of California. The nursing education programs are under the approval of BRN which has the power to approve the registered nursing and advanced nursing programs in California. The main of approval to make sure the education programs comply with the statutory and regulatory requirements. Pre-licensure nursing programs need to be approved by the BRN. Examples of these programs include AND, BSN, and ELM programs and ensure that they are within the statutory and regulatory. The advanced practice registered nurse within the nurse practitioner program is governed by the California Code of regulations section 1484 and with the approval by the BRN. The advanced practice registered nurse for the certified nurse-midwifery programs are governed by the California Code of Regulations section 1462 and with the approval of the BRN. The certified Nurse Anesthesia programs are under the council of Accreditation of Nurse Anesthesia Educational Programs which is the professional organization that approves the anesthesia programs all over the country. In their list of accredited nurse anesthesia programs, the California programs are included (California Department of Consumer Affairs). The other education programs under regulation in California are the Clinical Nurse specialist programs. These programs adhere to the requirements for Clinical Nurse Specialist Certification but have not yet been formally approved by the BRN.

The State of California provides guidelines on continuing education through Title 16, Division 14, and Article 5. Continuing education is considered as different types of learning experienced offered through lectures, conferences, academic studies, in-service education, workshops and seminars that registered nurses undertake to facilitate their relic ensure.  The learning opportunities aim to increase the knowledgebase of the registered nurse in the field of direct and indirect care. In the license renewal requirement, the State of California requires the pursuant to successfully undergo and complete thirty hours of continuing education as required by the board. After this one is required to complete an examination offered by the board which aims to assess the current level of knowledge in the field of registered nursing field. A failure will prompt an individual to complete thirty more hours of continuing education.

The continuing education courses that are recognized by the State of California, include; courses stipulated by an approved provider as per section 1454. These courses may be designed by the provider for engagement in activities such as nursing practice, publishing, and research as long as they satisfy the requirements in the section 1456. The states have some courses it considered voluntary and others as mandatory continuing education for the registered nurses which also need to meet the requirements under section 1456. The state further considers academic course in an accredited post-secondary institution which touched on particular knowledge and skills necessary for the practice of nursing. The board may at its own discretion approve other courses. The minimum requirement that is required by the State of California is a regional accreditation (California Department of Consumer Affairs).

Michigan

The state of Michigan recognizes the registered professional nurse (RN) and the licensed professional nurse (LPN). These professionals require varied education and the skills sets required for each category. There are two main types of education programs followed by the practitioners following that career path. One of the programs is the LPN certificate in nursing which takes two years of study at a community college. Another education program is the associate’s degree of nursing (ADN) that is covered within a period of two years in a community college. A bachelor of science in nursing (BSN) is a four-year university degree that is considered an important milestone in the nursing education. The state acknowledges that higher level of education leads to greater responsibility specialization and advancement in the workplace. For this reason, the state acknowledges the masters and doctoral degrees that most RN later acquires in APRN, healthcare management, consulting, researcg, and education roles (LARA).

The Michigan State under its Public Health Code and Board administrative rules requires nurse to undertake minimum of twenty five hours of contributing education during the time period of two years before the renewal of the license. Under this, the state requires the nurses to undertake at least an hour in pain and symptom management, behavior management and modification, clinical applications, and drug interventions. The courses ought to be approved by the board while has specific rules aimed at providing guidance on the continuing education courses and programs.

The Michigan Board of Nursing holds the rights of approving accreditation organizations with the responsibility of being continuing education providers. they include; American Nurses Credential Center’s Commission on Accreditation, National Association for Practical Nurse Education and Service, National League for Nursing, American Osteopathic Association, Accreditation Council for Continuing Medical Education, Certification in Basic and Advanced Life Support Set Forth by the American Heart Association, and the American College of Nursing Midwives (LARA).

Requirements for obtaining advanced practice license

California

The State of California manages its advanced nursing practice under the California Board of Registered Nursing (BRN). The first basic requirement for the advanced practice nurse is for the one to have the license of a registered nurse. The board acknowledges the following graduate-level advanced specialty nurse anesthetist, nurse practitioner, nurse-midwife, clinical nurse specialist, mental health nurse. For one to be certified as a nurse anesthetist, the Board is very specific with regard to education and certification requirement.  The other specialists have multiple pathways that the nurses may use attain the status of an advanced nursing practice. 

A nursing anesthetist is required to attend a program accredited by the council on accreditation of nurse anesthesia educational programs. They are further required to seek certification through the council on certification and recertification of the nurse anesthetists. The board further provides a list of accredited programs that are located in California State.  

For one to acquire the status of an advanced registered nurse as nurse practitioner, the California state requires one to complete an in-state program that is acknowledged and by the Board as having attained standards. One is required to earn a certification through an accepted organization. Finally is supposed to get an equivalent program. The board also lists the programs approved within California States. The agencies approved to offer certification for nursing practitioner include AANP, AACN, ANCC, NCC, and the pediatric nursing certification board (Nursing Licensure Org, 2017). For the certification, the nurse requires to have verified clinical experience and competency in offering of the primary care services. The competency in the clinical work is to be confirmed by a licensed physician and a licensed nursing practitioner. The licensing body also requires getting the documentation of course content.  

A nurse seeking the nurse-midwife license requires to show qualification for California nurse-midwife certification through successfully attending an approved California program, have completed another program meeting standards stipulated in section 1462, or get the certification through the American Mid-wifery Certification Board. Unless the one seeking the license is a recent graduate, they are required to provide a recency form that shows the clinical experience acquired in the preceding five years.

A nurse seeking the license of a clinical specialist needs to by having a master’s degree in a clinical nursing specialty or another degree in a related clinical field. The master’s program needs to be asserted by the Board of meeting its standards from where the graduate can be verified via education and clinical experience. The professional charged with role of verifying the clinical experience need to be conversant with clinical nurse specialist role and carry out an observation of the applicant performing a task in either of the following advanced nursing component areas: expert clinical nursing practice, clinical leadership, research, education, and consultation (Nursing Licensure Org, 2017).

Michigan

The Michigan State requires an applicant for advanced specialty nurse to complete and submit the application form for licensure as well as make payments set and attach supporting documents to the Board of Nursing. The Michigan Board may then provide the specialty certification where the applicant meets the state qualification requirements. The Michigan Boards requires a registered nurse to undergo a criminal background check and acquire biometric fingerprinting processing from the authorized agency.

The nursing anesthetist specialty certification needs to be vetted by the Michigan Board of Nursing Office. The application form is then forwarded to the American Association of Nurse Anesthetists Council on certification by the certifying agency. The Midwifery specialty is required to be done through the Nurse Midwife Specialty certification and then forwarded to the American Midwifery Certification Board. The Michigan Board of Nursing Office needs to receive directly from the certifying agency. The verification of the nurse midwife certification may be acquired form the American Midwifery Certification board to the Michigan Board of Nursing.

Michigan State provides specialty certification through the Michigan Department of licensing and Regulatory Affairs (LARA). The State of Michigan only recognizes three categories of nursing specialty; nurses may be state-certified on the basis of training and examination in four advanced nursing roles of nurse midwife, nurse anesthetist, and nurse practitioner of a clinical nurse specialist. The state has no distinction between nurse practitioner and the clinical nurse specialists but rather considers them and nurse practitioners. The certification by the state is developed in line with the national certification standards. Other checks on the qualification include criminal background checks and screening of out –of-state qualification

References

Access Pharmacy. (2017). California: Summary of Important Pharmacy Related Rules, Regulations, Statutes, and Practices that Apply to the Practice of Pharmacy. Retrieved from http://webcache.googleusercontent.com/search?q=cache:yh24wlP8Sg8J:accesspharmacy.mhmedical.com/content.aspx%3Fbookid%3D1354%26sectionid%3D72530559+&cd=9&hl=en&ct=clnk&client=firefox-b-ab

California Department of Consumer Affairs. (n.d.). California Code of Regulations. Continuing Education. Retrieved from http://www.rn.ca.gov/pdfs/applicants/ceptitle16.pdf.

California: Summary of Important Pharmacy Related Rules, Regulations, Statutes, and Practices That Apply to the Practice of Pharmacy. In: Feinberg WJ. Feinberg W.J. Ed. William J. Feinberg.eds. Pharmacy Law—Examination and Board Review New York, NY: McGraw-Hill;

Iwrey, R., & Mirafzali. (2012). The Dos and Don’ts of Controlled Substance Prescribing in Michigan. Retrieved from http://www.icle.org/contentfiles/partners/seminarmaterials/2012CI4110/20122K4110-1.pdf.

Iwrey, R., & Mirafzali, N. (2012). The Do and Don’ts of Controlled Substance Prescribing in Michigan. Retrieved from http://www.icle.org/contentfiles/partners/seminarmaterials/2012CI4110/20122K4110-1.pdf

Michigan State Government. (n.d.). Michigan Nurse (RN) Professional Licensing Guide. Retrieved from https://www.michigan.gov/documents/lara/Nursing_Licensing_Guide_511817_7.pdf.

Nursing Licensure . (2017). Advanced Practice Nurse Requirements in California. Retrieved from http://www.nursinglicensure.org/np-state/california-nurse-practitioner.html