Minutes Legislative Committee 2.23.15

Psych NP—involuntary committment

Sandi spoke to Addie Eckert (sponsor) who asked for help/support from psych NPs, but was unable to say specifically what would help. She seemed to indicate that there was not wide support for the bill among legislators. Julia testified in hearing during the week, which was rather rushed.

Attestation Bill ; all need to get letters of support signed; hearings coming up March 10 and 18—fax them to NPAM office by Thursday, March 5.

Dale has been working with a friend who is pres. Elect of Med Chi; Med Chi is voting on how vigorously to oppose the bill tonight

They may want to work out compromise---Option to have attestation for so many hours with a doc (thousands of hours) first; we are not happy with that. Sandi thought there was already some type of collaboration for new grads, but that is just for new grads who want to start practice before passing boards. 3500 hours are required in Nebraska to have full practice authority

Option---would we agree to the attestation form for new grads for 2 years.

Option-- see if a veteran NP can sign the form

Option--Is 5-10 yrs experience enough to waive the form?

Dale emphasized that we practice autonomously; we can’t find a MD now to sign our form; the 5 year relationship is not sensible; one issue was out west they are removing the physician agreement for med students whereas RNs have experience as a nurse

Dale forwarded 3 articles to the Pres Elect of Med Chi which answered a lot of their questions.

One problem was brought up—NPs who do not have nursing experience: Some universities have degrees without allowing RNs to work as RNs. It is possible for RN to get a DNP degree at Maryland without working; Hopkins is eliminating the BSN program next year and there will be a Masters Entry into Nursing prgm.

Med Chi questions our hours spent in residency. NPs can point to the fact that the attestation was our compromise in getting rid of written agreement and no increase in adverse events have been recorded.

Med Chi has 6000 members.

Julia states we are in a much better place than we were years ago. It may help to partner with MedChi on other bills. We have been doing this with professional midwives, but trying to work out some limited solution since it is widely supported by some legislators. Delegate Nick Kipke’s wife had home birth recently by midwife. Julia can reach out to MEd Chi tmrw to assess what their stand is on the midwife bill.

Question is whether the bill will go through without Med Chi Support.

Julia was corresponding on the pharmacist and internet bill; we are on the same wavelength as Med Chi for many bills.

Pharmacist Scope of Practice Revision bill

Hearing is next Thursday; bill is coming from School of Pharmacy

1) Initiation of meds is the problem

2) Vaccination administration permit pharm to admin all drugs where a pt has a dx and a script; authorized pharm to furnish/prescribe a drug

3) Who are prescribers? MDs NPs PAs CNMs Nurse Anesthetists, DO

4) Authorized pharmacy prescriber /conflict of interest

5) They do not have a lobbyist

6) Does the pharm D have disease mgmt. knowledge to promote continuity of care?

7) J. S. Hutt stated they have some disease mgmt. skills.

8) Pt identifies the need for the medication

9) Pharmacist may prescribe self administered medication; epi pen, OTC women’s products, Pan B (pregnancy prevention, day after treatment), albuterol, smoking cessation.

10) The assessment, plan intervention and mgmt. is not done by a pharmacist; so how will they be able to coordinate care?

11) Bill appears to fragment care

12) We need to determine what is meant by self administered medications; Julia will find out

13) Sandi states that we are required to have a pt chart with full Hx to prescribe; will the pharmacists have a chart? The minimum is an encounter of the interaction with the pt.

14) We have questions re fragmenting care and the documentation that will be done; is there a financial incentive? We need to know what their scope of practice is;

15) We are neutral right now; Julia will work with Deb tmrw. Care drug therapy contract

Med Chi does not have a problem

Is there a problem with the pharmacist changing the medication without a specific order

How can they dispense when NPs can’t dispense

NPs can only dispense the initial dose.

Some sites allow medications to be dispensed in full prescription (urgent care, schools)

Sandi states we want to use pharm to counsel patients; team based idea here

Use of ImmuNet-registry of Vaccine More of a pediatric issue; in school you can document that child has a vaccine; if school does not connect with EHR it becomes difficult to document esp for children who have re-located; private practices do have difficulties with this. It might be impractical for inpt and ED; it is standard in school based world and that system is not without error. The push now is to administer vaccines in any setting if possible. Sandi suggests we follow this bill. syPPPPsPPsP

Psych NPs Telehealth--will be able to bill based on new bill passage

Opiod abuse Julia will send the statement out to legislative members; Med Chi and ED MDs and non profit addiction centers are on board..

Sandi was asked to see if we could oppose the hastening death bill Richard Israel Dignity Act

Sandi responded that nurses should not be involved with hastening death. The bill states if a pt is within 6 mos of a terminal illness; they can request a lethal prescription; Sandi feels nurses should not be involved with this. Question is should we oppose this bill?

Bill is physician directed. It is the first year out for the bill; 5 states have adopted it; it requires a psych or psychological evaluation; forms are in code so as to not change language of intent; Julia suggests we google Death with Dignity Maryland; Sandi wonders if MNA has looked at this; we can ask Clare; Sandi’s concern is with the palliative care aspect, but we want to do what MDs do; no one has heard from other groups as to their stance on this bill. If anyone wants to look further into pharmacist bill, please do; Roseann will email Robert Ferroli, Pharm D who teaches at Hopkins in the pharmacology NP class

Next week is the q other Monday we are supposed to meet, so we will meet March 2nd and try to get back to every other week after that.

We will plan on meeting in one week and email in the interim.

Respectfully submitted,

Roseann Velez

Notes from Roseanne Velez email on 2/24/15:

Spoke with Meghan, who is a pharmacist; she spoke with the delegate last night pg 2 line 4 striking out; entire bold would be deleted; pg 4 line 20

what they hear from community pharm D; there are pt who on self administered injections (lovenox); if cognitive defects or RA and they can't inject, pharm D curriculum currently covers how to teach pt to administer the med; pharm who are currently practicing may need remedial training; the training for pharm D became mandatory 2001 currently the pharm D can use saline but not the real drug

only for self administered medication

previous BS training can't do this; board of pharmacy is developing a curriculum to get pharmacist who are not pharmD to train for this bill came out way broader than they liked

2. provide med for urgent issue for today pharm D would have training to self administer medications Pharm D trained years ago the board would detail out

12510 pg 3 line 8 tobacco cessation-increase pt access to these products; protocols would be adopted with BOM and pharmacist epi albuterol and naloxone, glucagon now they have to call 911 they should be able to provide in the pharmacy ; once the protocol is developed by the BOM and pharm board, they will spell out what the scenarios this

12508 this is what is currently existing in SOP; this is the old

Bill 716 Prescriber Pharm Agreements currently in MD pharm can enter into drug therapy mgmt with MDs (coagulation)

MD in Hopkins refers pt with coumadin and lovenox to Megan; this can only be done with physicians;

NPs are interested in working with this agreement with pharms this bill would allow NPs to work with this scenario

a. protocol would be developed bet NP and Pharm D b. agreement signed bet the NP and pharm D; the pharm entering the agreement would have to have post grad residency training or board certified; agreement can be multiple protocols; can state in agreement which protocol you want to use c. contract; notifies pt I am your provider and am collaborating with pharm D. pt signs the contract; this can occur in the NP office or NP can partner with an independent community pharmacy and contract can be ; usually occurs in PCMH

It is up to the NP is he/she wants to use this; this does include PAs ie; can use with insulin.