30 E. Broad St., 3rd Floor Columbus, Ohio 43215 (614) 466-3934 www.med.ohio.gov

Rules and Policies February 10, 2021

1. Rule Review Update 2. Updates to Rule 4731-11-03 3. RN Scope of Practice - Surgical Tasks 4. Legislative Update 30 E. Broad St., 3rd Floor Columbus, Ohio 43215 (614) 466-3934 www.med.ohio.gov

MEMORANDUM

TO: Mark Bechtel, M.D., President Members, State Medical Board of Ohio

FROM: Kimberly C. Anderson, Chief Legal Counsel

RE: Rule Review Updates

DATE: February 4, 2021

Attached please find the updated rule schedule and rule spreadsheet. Please note that the rules impacted by HB442 have been added to the rule spreadsheet.

Please let me know if you have any questions.

Action Requested: No Action Needed

Legal Dept. Rules Schedule As of February 4, 2021

RULES AT CSI RULES AT JCARR

Comment Deadline 5/27/20 4731-10-CME Rules (amended to reflect HB442 4731-18 – Light Based Medical Device Rules changes)

Comment Deadline 10/19/20 4731-11-02 4731-11-03 4731-11-04 Ready to be filed with JCARR 4731-11-04.1 4731-11-07 4731-11-11 4731-8-01 4731-8-02 4731-8-03 4731-8-04 4731-8-05 4731-8-06 4774-1-01 4774-1-02 4774-1-03 Comment Deadline 11/6/20 4731 Chapter 13 – 36 rules 4774-1-04 4731-17-01 4731-17-02 4731-17-03 4731-17-04 4731-17-05

4731-17-06 4731-17-07 4731-36-04 Comment Deadline 11/23/20 4759-4-04 4759-4-08 4759-6-02

Rules for review in 2021

4731-1-12-Examination-Due 11.30.21 RULES SENT FOR INITIAL CIRCULATION 4731-1-16-Massage Therapy Curriculum-Due 11.30.21 Comment Deadline – September 25, 2020 4731-6-14 4731-11-08-Utilizing controlled substances for self and family members-Due 8.17.21 4731-14-01-Pronouncement of Death-Due 6.30.21 Comment Deadline – February 12, 2021 4731-23-01-Delegation of Medical Tasks-Definitions- 4731-11-08 4731-14-01 4731-23-01 Due 11.30.21 4731-23-02 4731-23-03 4731-23-04 4731-23-02-Delegation of Medical Tasks-Due 4731-26-01 4731-26-02 4731-26-03 11.30.21 4730-1-07 4730-2-07 4731-35-01 4731-23-03-Delegation of Medical Tasks- 4731-35-02 Prohibitions-Due 8.17.21 4731-23-04-Violations-Due 8.17.21 4731-26-01-Sexual Misconduct Definitions-Due-

6.30.21 4731-26-02-Prohibitions-Due 6.14.21 4731-26-03-Violations; Miscellaneous-Due 6.30.21

Rules Needing Amendments Due to HB442

The following rules need to be amended or rescinded to remove references to cosmetic therapy

and oriental medicine:

4731-1-01 Definition of terms 4731-1-02 Application of rules governing limited branches of medicine or surgery 4731-1-03 General prohibitions

4731-1-07 Eligibility of electrologists licensed

by Ohio state board of cosmetology to obtain licensure as cosmetic therapists (rescind) Rules Needing Amendments Due to HB442, con’t.

4731-1-08 Continuing cosmetic therapy education requirements (rescind) 4731-1-09 Cosmetic therapy curriculum requirements (rescind) 4731-1-10 Distance education 4731-1-11 Application and examination for certificate to practice cosmetic therapy 4731-1-15 Determination of standing of school, college or institution 4731-1-17 Instructional staff in Ohio cosmetic therapy and massage therapy programs 4731-1-18 Grounds for suspension, revocation or denial of certificate of good standing 4731-16-01 Impaired Practitioners Definitions 4731-16-02 General Procedures in Impairment cases 4731-16-05 Examinations 4731-16-08 Criteria for approval 4731-16-18 Eligibility for one-bite program 4731-17-07 Exposure-Prone Invasive Procedure Precautions 4731-18-03 Delegation of Use of Light-based Medical Devices 4731-22-07 Change to active status 4731-26-01 Definitions 4731-26-03 Violations; miscellaneous 4731-30-03 Approval of licensure applications 4731-36-01 Military Provisions Related to Education and Experience Requirements for Licensure

Changes related to massage therapy curriculum requirements

4731-1-12 Application and examination for certificate to practice massage therapy 4731-1-16 Massage therapy curriculum requirements

Changes related to continuing education (volunteer hours and clinical research faculty certificate)

4731-10-02 Requisite hours of continuing medical education Board Sent for New Current Approval CSI recom‐ JCARR Rules JCARR Board Rule Number Rule Description Initial CSI filing Effective Review to File with mendation filing Hearing Hearing Adoption Comment Date Date CSI

No change 4730‐1‐01 Regulation of Physician Assistants ‐ Definitions 06/12/19 07/16/19 11/07/19 06/18/20 rule 09/16/20 06/18/25 No change 4730‐1‐05 Quality Assurance System 06/12/19 07/16/19 11/07/19 06/19/20 rule 09/17/20 06/19/25 4730‐1‐06 Licensure as a physician assistant 03/22/19 06/12/19 12/04/19 06/18/20 07/23/20 08/17/20 09/09/20 12/31/20 09/30/23 4730‐1‐07 Miscellaneous Provisions 01/25/21 09/30/20 09/30/23 Physician Delegated Prescriptive Authority ‐ No change 4730‐2‐01 Definitions 06/12/19 07/16/19 11/07/19 06/18/20 rule 09/18/20 06/18/25 Period of on‐site supervision of physician‐ 4730‐2‐04 delegated prescriptive authority 06/12/19 07/16/19 11/07/19 06/18/20 07/23/20 08/17/20 09/09/20 09/30/20 11/15/23 Addition of valid prescriber number after 4730‐2‐05 initial licensure 06/12/19 07/16/19 11/07/19 06/18/20 07/23/20 08/17/20 09/09/20 09/30/20 09/30/23 4730‐2‐07 Standards for Prescribing 01/25/21 09/30/20 09/30/25

4730‐2‐10 Standards and Procedures for use of OARRS 06/12/19 07/16/19 11/07/19 06/18/20 07/23/20 08/17/20 09/09/20 09/30/20 09/30/23 4730‐4‐01 Definitions 05/09/19 11/15/19 05/20/20 06/18/20 07/23/20 08/17/20 10/14/20 10/31/20 04/30/24 Standards and procedures for withdrawal 4730‐4‐02 management for drug or alcohol addition 05/09/19 11/15/19 05/20/20 06/18/20 07/23/20 08/17/20 10/14/20 10/31/20 10/31/25

4730‐4‐03 Office Based Treatment for Opioid addiction 04/30/19 04/30/24 Medication assisted treatment using 4730‐4‐04 naltrexone 04/30/19 04/30/24 4730‐5‐01 4730‐5‐02 4731‐1‐01 Limited Practitioners ‐ Definition of Terms 03/30/20 03/30/25 Application of Rules Governing Limited 4731‐1‐02 Branches of Medicine or Surgery 07/31/19 07/31/24 4731‐1‐03 General Prohibitions 08/31/23 4731‐1‐04 Scope of Practice: Mechanotherapy 12/31/18 12/31/23 Refiled 8/20/19 4731‐1‐05 Scope of Practice: Massage Therapy 04/24/19 4/29/19 06/05/19 10/16/19 11/05/19 11/05/24 4731‐1‐06 Scope of Practice: Naprapathy 08/31/18 08/31/23 Board Sent for New Current Approval CSI recom‐ JCARR Rules JCARR Board Rule Number Rule Description Initial CSI filing Effective Review to File with mendation filing Hearing Hearing Adoption Comment Date Date CSI

Eligibility of Electrologists Licensed by the Ohio State Board of Cosmetology to Obtain Licensure as Cosmetic Therapists Pursuant to 4731‐1‐07 Chapter 4731 ORC and Subsequent Limitations 12/31/18 12/31/23 Continuing Cosmetic Therapy Education Requirements for Registration or Reinstatement of a License to Practice 4731‐1‐08 Cosmetic Therapy 09/30/19 09/30/24

4731‐1‐09 Cosmetic Therapy Curriculum Requirements 08/31/23 4731‐1‐10 Distance Education 01/31/19 01/31/24 Application and Certification for certificate to 4731‐1‐11 practice cosmetic therapy 03/30/20 03/30/25 4731‐1‐12 Examination 11/30/16 11/30/21 Determination of Standing of School, College 4731‐1‐15 or Institution 12/31/18 12/31/23 Massage Therapy curriculum rule (Five year 4731‐1‐16 review) 01/31/19 11/30/21 4731‐1‐17 Instructional Staff 05/31/19 05/31/24

Grounds for Suspension, Revocation or Denial 4731‐1‐18 of Certificate of Good Standing, Hearing Rights 03/30/20 03/30/25

4731‐1‐ 19 Probationary Status of a limited branch school 03/30/20 03/30/25 4731‐1‐24 Massage Therapy Continuing Education 03/09/16 10/26/16 04/24/19 04/29/19 06/05/19 4731‐2‐01 Public Notice of Rules Procedure 12/07/17 12/07/22 4731‐4‐01 Criminal Records Checks ‐ Definitions 09/30/19 09/30/24 4731‐4‐02 Criminal Records Checks 09/30/19 09/30/24 4731‐5‐01 Admission to Examinations 06/09/17 06/09/22

4731‐5‐02 Examination Failure; Inspection and Regrading 06/09/17 06/09/22 4731‐5‐03 Conduct During Examinations 06/09/17 06/09/22 4731‐5‐04 Termination of Examinations 06/09/17 06/09/22

4731‐6‐01 Medical or Osteopathic Licensure: Definitions 07/31/19 07/31/24 Preliminary Education for Medical and 4731‐6‐02 Osteopathic Licensure 07/31/19 07/31/24 Board Sent for New Current Approval CSI recom‐ JCARR Rules JCARR Board Rule Number Rule Description Initial CSI filing Effective Review to File with mendation filing Hearing Hearing Adoption Comment Date Date CSI Demonstration of proficiency in spoken 4731‐6‐04 English 06/09/17 06/09/22 Format of Medical and Osteopathic 4731‐6‐05 Examination 07/31/19 07/31/24 4731‐6‐14 Examination for physician licensure 09/03/20 07/31/19 07/31/24 Eligibility for Licensure of National Board Diplomats and Medical Council of Canada 4731‐6‐15 Licentiates 07/31/19 07/31/24 Application Procedures for Certificate Issuance; Investigation; Notice of Hearing 4731‐6‐21 Rights 07/31/19 07/31/24 Abandonment and Withdrawal of Medical and 4731‐6‐22 Osteopathic Licensure Applications 07/31/19 07/31/24 4731‐6‐30 Training Certificates 07/31/19 07/31/24 Limited Preexamination Registration and 4731‐6‐31 Limited Certification 07/31/19 07/31/24 4731‐6‐33 Special Activity Certificates 07/31/19 07/31/24 4731‐6‐34 Volunteer's Certificates 07/31/19 07/31/24 4731‐7‐01 Method of Notice of Meetings 07/31/19 07/31/24 4731‐8‐01 Personal Information Systems 04/29/20 10/05/20 11/18/20 04/21/16 04/21/21 4731‐8‐02 Definitions 04/29/20 10/05/20 11/18/20 04/21/16 04/21/21 Procedures for accessing confidential personal 4731‐8‐03 information 04/29/20 10/05/20 11/18/20 04/21/16 04/21/21 Valid reasons for accessing confidential 4731‐8‐04 personal information 04/29/20 10/05/20 11/18/20 04/21/16 04/21/21 4731‐8‐05 Confidentiality Statutes 04/29/20 10/05/20 11/18/20 07/31/16 07/31/21 Restricting & Logging access to confidential 4731‐8‐06 personal information 04/29/20 10/05/20 11/18/20 04/21/16 04/21/21 Record of Board Meetings; Recording, Filming, 4731‐9‐01 and Photographing of Meetings 09/15/19 06/17/24 Revised filing 11/3/20 4731‐10‐01 Definitions 10/25/19 05/26/20 10/30/20 12/04/20 12/07/20 02/02/18 02/02/23 Revised Requisite Hours of Continuing Medical filing Education for License Renewal or 11/3/20 4731‐10‐02 Reinstatement 10/25/19 05/26/20 10/30/20 12/04/20 12/07/20 05/31/18 05/31/23 Board Sent for New Current Approval CSI recom‐ JCARR Rules JCARR Board Rule Number Rule Description Initial CSI filing Effective Review to File with mendation filing Hearing Hearing Adoption Comment Date Date CSI Revised filings 11/24 & 11/3 ‐ orig 4731‐10‐03 CME Waiver 10/25/19 05/26/20 10/30/20 12/04/20 12/07/20 05/31/18 05/31/23 Revised filings 11/24 & Continuing Medical Education Requirements 11/3 ‐ orig 4731‐10‐04 for Restoration of a License 10/25/19 05/26/20 10/30/20 12/04/20 12/07/20 05/31/18 05/31/23 Revised filings 11/24 & 11/3 ‐ orig 4731‐10‐05 Out‐of‐State Licensees 10/25/19 05/26/20 10/30/20 12/04/20 12/07/20 05/31/18 05/31/23 Revised filings 11/24 & Licensure After Cutoff for Preparation of 11/3 ‐ orig 4731‐10‐06 Registration Notices 10/25/19 05/26/20 10/30/20 12/04/20 12/07/20 05/31/18 05/31/23 Revised filings 11/24 & 11/3 ‐ orig 4371‐10‐07 Internships, Residencies and Fellowships 10/25/19 05/26/20 10/30/20 12/04/20 12/07/20 05/31/18 05/31/23 Revised filings 11/24 & 11/3 ‐ orig 4371‐10‐08 Evidence of Continuing Medical Education 10/25/19 05/26/20 10/30/20 12/04/20 12/07/20 05/31/18 05/31/23 Revised filings 11/24 & Continuing Medical Education Requirement 11/3 ‐ orig 4731‐10‐09 for Mid‐term Licensees 10/25/19 05/26/20 10/30/20 12/04/20 12/07/20 05/31/18 05/31/23 Board Sent for New Current Approval CSI recom‐ JCARR Rules JCARR Board Rule Number Rule Description Initial CSI filing Effective Review to File with mendation filing Hearing Hearing Adoption Comment Date Date CSI Revised filings 11/24 & Continuing Medical Education Requirements 11/3 ‐ orig 4731‐10‐10 Following License Restoration 10/25/19 05/26/20 10/30/20 12/04/20 12/07/20 05/31/18 05/31/23 Revised filings 11/24 & 11/3 ‐ orig 4731‐10‐11 Telemedicine Certificates 10/25/19 05/26/20 10/30/20 12/04/20 12/07/20 05/31/18 05/31/23 corrected‐ Controlled substances; General Provisions 7/16/20 4731‐11‐01 Definitions 11/14/19 6/18/2020 07/23/20 08/17/20 10/14/20 10/31/20 10/31/25 4731‐11‐02 Controlled Substances ‐ General Provisions 07/26/19 11/13/19 10/05/20 04/30/19 12/31/20

4731‐11‐03 Schedule II Controlled Substance Stimulants 07/26/19 11/13/19 10/05/20 12/31/15 12/31/20 Controlled Substances: Utilization for Weight 4731‐11‐04 Reduction 07/26/19 11/13/19 10/05/20 02/29/16 02/28/21 Controlled substances: Utilization for chronic 4731‐11‐04.1 weight management 07/26/19 11/13/19 10/05/20 12/31/15 12/31/20 4731‐11‐07 Research Utilizing Controlled Substances 07/26/19 11/13/19 10/05/20 09/30/15 09/30/20 Utilizing Controlled Substances for Self and 4731‐11‐08 Family Members 01/25/21 08/17/16 08/17/21 Prescribing to persons the physician has never 4731‐11‐09 personally examined. 03/23/17 03/23/22

Standards and procedures for review of "Ohio 4731‐11‐11 Automated Rx Reporting System" (OARRS). 07/26/19 11/13/19 10/05/20 12/31/15 12/31/20

4731‐11‐13 Prescribing of Opioid Analgesics for Acute Pain 08/31/17 08/31/22 corrected‐ 7/16/20 4731‐11‐14 Prescribing for subacute and chronic pain 3/21/19 11/14/19 6/18/2020 07/23/20 08/17/20 10/14/20 10/31/20 12/23/23 Preliminary Education for Licensure in 4731‐12‐01 Podiatric Medicine and Surgery 06/30/17 06/30/22 Standing of Colleges of Podiatric Surgery and 4731‐12‐02 Medicine 06/30/17 06/30/22 Board Sent for New Current Approval CSI recom‐ JCARR Rules JCARR Board Rule Number Rule Description Initial CSI filing Effective Review to File with mendation filing Hearing Hearing Adoption Comment Date Date CSI Eligibility for the Examination in Podiatric 4731‐12‐03 Surgery and Medicine (see note below) 04/19/17 04/19/22 Eligibility of Licensure in Podiatric Medicine and Surgery by Endorsement from Another 4731‐12‐04 State 06/30/17 06/30/22 Application Procedures for Licensure in Podiatric Medicine and Surgery, Investigation, 4731‐12‐05 Notice of Hearing Rights. 06/30/17 06/30/22 4731‐12‐06 Visiting Podiatric Faculty Certificates 06/30/17 06/30/22 4731‐12‐07 Podiatric Training Certificates 06/30/17 06/30/22 Conduct of Hearings ‐ Representative; 4731‐13‐01 Appearances 08/26/20 10/14/20 10/23/20 07/31/16 07/31/21 4731‐13‐02 Filing Request for Hearing 08/26/20 10/14/20 10/23/20 07/31/16 07/31/21 amended filing 1/6/21 4731‐13‐03 Authority and Duties of Hearing Examiners 08/26/20 10/14/20 10/23/20 09/30/18 07/31/21 4731‐13‐04 Consolidation 08/26/20 10/14/20 10/23/20 04/21/21 4731‐13‐05 Intervention 08/26/20 10/14/20 10/23/20 04/21/21 4731‐13‐06 Continuance of Hearing 08/26/20 10/14/20 10/23/20 09/30/16 09/30/21 4731‐13‐07 Motions 08/26/20 10/14/20 10/23/20 09/30/18 04/21/21 Form and page limitations for briefs and 4731‐13‐07.1 memoranda 08/26/20 10/14/20 10/23/20 09/30/18 09/30/23 4731‐13‐08 Filing 08/26/20 10/14/20 10/23/20 07/31/16 07/31/21 4731‐13‐09 Service 08/26/20 10/14/20 10/23/20 07/31/16 07/31/21 4731‐13‐10 Computation and Extension of Time 08/26/20 10/14/20 10/23/20 07/31/16 07/31/21 4731‐13‐11 Notice of Hearings 08/26/20 10/14/20 10/23/20 07/31/16 07/31/21 4731‐13‐12 Transcripts 08/26/20 10/14/20 10/23/20 07/31/16 07/31/21 4731‐13‐13 Subpoenas for Purposes of Hearing 08/26/20 10/14/20 10/23/20 07/31/16 07/31/21 4731‐13‐14 Mileage Reimbursement and Witness Fees 08/26/20 10/14/20 10/23/20 04/21/21 4731‐13‐15 Reports and Recommendations 08/26/20 10/14/20 10/23/20 07/31/16 07/31/21 4731‐13‐16 Reinstatement or Restoration of Certificate 08/26/20 10/14/20 10/23/20 07/31/16 07/31/21 Settlements, Dismissals, and Voluntary 4731‐13‐17 Surrenders 08/26/20 10/14/20 10/23/20 04/21/16 04/21/21 4731‐13‐18 Exchange of Documents and Witness Lists 08/26/20 10/14/20 10/23/20 07/31/16 07/31/21 Depositions in Lieu of Live Testimony and 4731‐13‐20 Transcripts in place of Prior Testimony 08/26/20 10/14/20 10/23/20 07/31/16 07/31/21 4731‐13‐20.1 Electronic Testimony 08/26/20 10/14/20 10/23/20 07/31/16 07/31/21 Board Sent for New Current Approval CSI recom‐ JCARR Rules JCARR Board Rule Number Rule Description Initial CSI filing Effective Review to File with mendation filing Hearing Hearing Adoption Comment Date Date CSI 4731‐13‐21 Prior Action by the State Medical Board 08/26/20 10/14/20 10/23/20 04/21/16 04/21/21 4731‐13‐22 Stipulation of Facts 08/26/20 10/14/20 10/23/20 04/21/16 04/21/21 4731‐13‐23 Witnesses 08/26/20 10/14/20 10/23/20 09/14/16 09/30/21 4731‐13‐24 Conviction of a Crime 08/26/20 10/14/20 10/23/20 04/21/16 04/21/21 4731‐13‐25 Evidence 08/26/20 10/14/20 10/23/20 07/31/16 07/31/21 Broadcasting and Photographing 4731‐13‐26 Administrative Hearings 08/26/20 10/14/20 10/23/20 04/21/16 04/21/21 4731‐13‐27 Sexual Misconduct Evidence 08/26/20 10/14/20 10/23/20 04/21/16 04/21/21 4731‐13‐28 Supervision of Hearing Examiners 08/26/20 10/14/20 10/23/20 04/21/16 04/21/21 4731‐13‐30 Prehearing Conference 08/26/20 10/14/20 10/23/20 04/21/16 04/21/21 4731‐13‐31 Transcripts of Prior Testimony 08/26/20 10/14/20 10/23/20 04/21/16 04/21/21 4731‐13‐32 Prior Statements of the Respondent 08/26/20 10/14/20 10/23/20 04/21/16 04/21/21 4731‐13‐33 Physician's Desk Physician 08/26/20 10/14/20 10/23/20 04/21/16 04/21/21 4731‐13‐34 Ex Parte Communication 08/26/20 10/14/20 10/23/20 07/31/16 07/31/21 4731‐13‐35 Severability 08/26/20 10/14/20 10/23/20 04/21/16 04/21/21 4731‐13‐36 Disciplinary Actions 08/26/20 10/14/20 10/23/20 07/31/16 07/31/21 4731‐14‐01 Pronouncement of Death 01/25/21 06/30/16 06/30/21

4731‐15‐01 Licensee Reporting Requirement; Exceptions 11/17/17 11/17/22 4731‐15‐02 Healthcare Facility Reporting Requirement 11/17/17 11/17/22 4731‐15‐03 Malpractice Reporting Requirement 11/17/17 11/17/22 4731‐15‐04 Professional Society Reporting 11/17/17 11/17/22 Liability; Reporting Forms; Confidentially and 4731‐15‐05 Disclosure 11/17/17 11/17/22

Rules governing impaired physicians and 4731‐16‐01 approval of treatments programs ‐ Definitions 11/17/17 11/17/22 4731‐16‐02 General Procedures in Impairment Cases 11/17/17 11/17/22 4731‐16‐04 Other Violations 11/17/17 11/17/22 4731‐16‐05 Examinations 11/17/17 11/17/22 Consent Agreements and Orders for 4731‐16‐06 Reinstatement of Impaired Practitioners 11/17/17 11/17/22 4731‐16‐07 Treatment Provider Program Obligations 11/17/17 11/17/22 4731‐16‐08 Criteria for Approval 11/17/17 11/17/22 4731‐16‐09 Procedures for Approval 11/17/17 11/17/22 4731‐16‐10 Aftercare Contracts 11/17/17 11/17/22 Revocation, Suspension, or Denial of 4731‐16‐11 Certificate of Good Standing 11/17/17 11/17/22 Board Sent for New Current Approval CSI recom‐ JCARR Rules JCARR Board Rule Number Rule Description Initial CSI filing Effective Review to File with mendation filing Hearing Hearing Adoption Comment Date Date CSI 4731‐16‐12 Out‐of‐State Impairment Cases 11/17/17 11/17/22 4731‐16‐13 Patient Consent; Revocation of Consent 11/17/17 11/17/22 Caffeine, Nicotine, and Over‐The Counter 4731‐16‐14 Drugs 11/17/17 11/17/22 4731‐16‐15 Patient Rights 11/17/17 11/17/22 4731‐16‐17 Requirements for the one‐bite program 01/31/19 01/31/24 4731‐16‐18 Eligibility for the one‐bite program 01/31/19 01/31/24

4731‐16‐19 Monitoring organization for one‐bite program 01/31/19 01/31/24

4731‐16‐20 Treatment providers in the one‐bite program 01/31/19 01/31/24 4731‐16‐21 Continuing care for the one‐bite program 01/31/19 01/31/24 Exposure‐Prone Invasive Procedure 4731‐17‐01 Precautions ‐ Definitions 08/26/20 10/14/20 10/23/20 11/24/20 12/31/16 12/31/21 4731‐17‐02 Universal Precautions 08/26/20 10/14/20 10/23/20 11/24/20 11/30/16 11/30/21 4731‐17‐03 Hand Washing 08/26/20 10/14/20 10/23/20 11/24/20 08/17/21 4731‐17‐04 Disinfection and Sterilization 08/26/20 10/14/20 10/23/20 11/24/20 12/31/16 12/31/21

4731‐17‐05 Handling and Disposal of Sharps and Wastes 08/26/20 10/14/20 10/23/20 11/24/20 08/17/21 4731‐17‐06 Barrier Techniques 08/26/20 10/14/20 10/23/20 11/24/20 08/17/21 4731‐17‐07 Violations 08/26/20 10/14/20 10/23/20 11/24/20 11/09/16 11/30/21 4731‐18‐01 Definitions 01/10/18 01/20/20 05/12/20 4731‐18‐02 Use of Light Based Medical Devices 01/10/18 01/20/20 05/12/20 05/31/02 06/30/05 Delegation of the Use of Light Based Medical 4731‐18‐03 Devices 01/10/18 01/20/20 05/12/20 06/30/00 06/30/05 Delegation of phototherapy and 4731‐18‐04 photodynamic therapy 01/10/18 01/20/20 05/12/20 05/31/02 05/31/07 Surgery Privileges of Podiatrist ‐ Definition of 4731‐20‐01 Foot 05/31/18 05/31/23 4731‐20‐02 Surgery: Ankle Joint 05/31/18 05/31/23 4731‐22‐01 Emeritus Registration ‐ Definitions 08/31/17 08/31/22 4731‐22‐02 Application 08/31/17 08/31/22 4731‐22‐03 Status of Registrant 05/12/17 05/12/22 4731‐22‐04 Continuing Education Requirements 05/12/17 05/12/22 4731‐22‐06 Renewal of Cycle of Fees 05/12/17 05/12/22 4731‐22‐07 Change to Active Status 08/31/17 08/31/22 Cancellation of or Refusal to Issue an Emeritus 4731‐22‐08 Registration 05/12/17 05/12/22 Board Sent for New Current Approval CSI recom‐ JCARR Rules JCARR Board Rule Number Rule Description Initial CSI filing Effective Review to File with mendation filing Hearing Hearing Adoption Comment Date Date CSI 4731‐23‐01 Delegation of Medical Tasks ‐ Definitions 01/25/21 11/30/16 11/30/21 4731‐23‐02 Delegation of Medical Tasks 01/25/21 11/30/16 11/30/21 4731‐23‐03 Delegation of Medical Tasks: Prohibitions 01/25/21 08/17/16 08/17/21 4731‐23‐04 Violations 01/25/21 08/17/16 08/17/21 4731‐24‐01 Anesthesiologist Assistants ‐ Definitions 07/31/19 07/31/24 4731‐24‐02 Anesthesiologist Assistants; Supervision 07/31/19 07/31/24 Anesthesiologist Assistants; Enhanced 4731‐24‐03 Supervision 07/31/19 07/31/24 4731‐25‐01 Office‐Based Surgery ‐ Definition of Terms 03/01/23 4731‐25‐02 General Provisions 05/31/18 05/31/23 Standards for Surgery Using Moderate 4731‐25‐03 Sedation/Analgesia 05/31/18 08/31/23 Standards for Surgery Using Anesthesia 4731‐25‐04 Services 05/31/18 05/31/23 4731‐25‐05 Liposuction in the Office Setting 03/01/18 03/01/23 4731‐25‐07 Accreditation of Office Settings 05/31/18 05/31/23 4731‐25‐08 Standards for Surgery 09/30/19 09/30/24 4731‐26‐01 Sexual Misconduct ‐ Definitions 01/25/21 06/30/16 06/30/21 4731‐26‐02 Prohibitions 01/25/21 06/14/16 06/14/21 4731‐26‐03 Violations; Miscellaneous 01/25/21 06/30/16 06/30/21 4731‐27‐01 Definitions 02/04/19 02/02/24

4731‐27‐02 Dismissing a patient from the medical practice 05/31/19 05/31/24 Notice of termination of physician employment or physician leaving a practice, selling a practice, or retiring from the practice 4731‐27‐03 of medicine 05/31/19 05/31/24 4731‐28‐01 Mental or Physical Impairment 08/31/17 08/31/22

Eligibility for confidential monitoring program 4731‐28‐02 08/31/18 08/31/23 Participation in the confidential monitoring 4731‐28‐03 program 08/31/18 08/31/23

Disqualification from continued participation 4731‐28‐04 in the confidential monitoring program 08/31/18 08/31/23 Termination of the participation agreement 4731‐28‐05 for the confidential monitoring program 08/31/18 08/31/23 Board Sent for New Current Approval CSI recom‐ JCARR Rules JCARR Board Rule Number Rule Description Initial CSI filing Effective Review to File with mendation filing Hearing Hearing Adoption Comment Date Date CSI Standards and procedures for operation of a 4731‐29‐01 pain management clinic. 06/30/17 06/30/22 4731‐30‐01 Internal Management Definitions 09/23/18 09/23/23 4731‐30‐02 Internal Management Board Metrics 07/26/19 09/23/18 09/23/23 4731‐30‐03 Approval of Licensure Applications 05/07/20 10/17/19 10/17/24 Requirements for assessing and granting clearance for return to practice or 4731‐31‐01 competition. (concussion rule) 04/10/19 05/13/19 11/30/19 11/30/24 4731‐32‐01 Definition of Terms 09/08/17 09/08/22

4731‐32‐02 Certificate to Recommend Medical Marijuana 09/08/17 09/08/22 4731‐32‐03 Standard of Care 09/08/17 09/08/22 Suspension and Revocation of Certificate to 4731‐32‐04 Recommend 09/08/17 09/08/22 Petition to Request Additional Qualifying 4731‐32‐05 Condtion or Disease 09/08/17 09/08/22 4731‐33‐01 Definitions 05/09/19 11/15/19 05/20/20 06/18/20 07/23/20 08/17/20 10/14/20 10/31/20 04/30/24 Standards and procedures for withdrawal 4731‐33‐02 managment for drug or alcohol addiction 05/09/19 11/15/19 05/20/20 06/18/20 07/23/20 08/17/20 10/14/20 10/31/20 10/31/25

4731‐33‐03 Office‐Based Treatment for Opioid Addiction 04/30/19 04/30/24 Medication Assisted Treatment Using 4731‐33‐04 Naltrexone 04/30/19 04/30/24 Standards and Procedures to be followed by physicians when prescribing a dangerous drug that may be administered by a pharmacist by 4731‐34‐01 injection. 07/31/19 07/31/24 4731‐35‐01 Consult Agreements 01/25/21 10/31/20 10/31/25 4731‐35‐02 Standards for managing drug therapy 01/25/21 10/31/20 10/31/25 Military provisions related to education and 4731‐36‐01 experience requirements for licensure 03/22/19 06/12/19 12/05/19 09/11/20 09/25/20 10/27/20 11/16/20 12/09/20 12/31/20 12/31/25 Military provisions related to renewal of 4731‐36‐02 license and continuing education 03/22/19 06/12/19 12/05/19 09/11/20 09/25/20 10/27/20 11/16/20 12/09/20 12/31/20 12/31/25 Processing applications from service members, veterans, or spouses of service members or 4731‐36‐03 veterans. 03/22/19 06/12/19 12/05/19 09/11/20 09/25/20 10/27/20 11/16/20 12/09/20 12/31/20 12/31/25 4731‐36‐04 Temporary license for military spouse 02/11/20 02/12/20 02/14/20 4759‐2‐01 Definitions 11/30/19 11/30/24 Board Sent for New Current Approval CSI recom‐ JCARR Rules JCARR Board Rule Number Rule Description Initial CSI filing Effective Review to File with mendation filing Hearing Hearing Adoption Comment Date Date CSI 4759‐4‐01 Applications 11/30/19 11/30/24 4759‐4‐02 Preprofessional experience 08/28/24 4759‐4‐03 Examination 11/30/19 11/30/24 4759‐4‐04 Continuing Education 08/27/19 11/10/20 11/30/19 11/30/24 8/27/19 4759‐4‐08 Limited permit 4/19/18 07/11/18 11/10/20 11/30/19 11/30/24 4759‐4‐09 License certificates and permits 04/19/18 07/11/18 09/25/18 11/30/19 11/30/24 4759‐5‐01 Supervision of persons claiming exemption 08/28/19 08/28/24 4759‐5‐02 Student practice exemption 11/30/19 11/30/24 4759‐5‐03 Plan of treatment exemption 11/30/19 11/30/24 4759‐5‐04 Additional nutritional activities exemption 07/01/24 4759‐5‐05 Distribution of literature exemption 07/01/24 4759‐5‐06 Weight control program exemption 07/01/24 4759‐6‐01 Standards of practice innutrition care 11/30/19 11/30/24 4759‐6‐02 Standards of professional performance 04/19/18 07/11/18 11/10/20 12/18/17 4759‐6‐03 Interpretation of standards 11/30/19 11/30/24 4759‐9‐01 Severability 11/30/19 11/30/24 4759‐11‐01 Miscellaneous Provisions 11/30/19 11/30/24 4761‐2‐03 Board Records 02/28/19 02/28/24 4761‐3‐01 Definition of terms 02/28/19 02/28/24 4761‐4‐01 Approval of educational programs 02/28/19 02/28/24 Monitoring of Ohio respiratory care 4761‐4‐02 educational programs 02/28/19 02/28/24 Waiver of licensing requirements pursuant to division (B) of section 4761.04 or the Revised 4761‐5‐01 Code 04/23/19 06/12/19 11/06/19 01/10/20 06/18/20 07/23/20 08/17/20 09/09/20 09/30/20 09/30/25 Admission to the Ohio credentialing No change 4761‐5‐02 examination 04/23/19 06/12/19 11/06/19 01/10/20 06/19/20 rule 09/19/20 06/19/25 4761‐5‐04 License application procedure 04/23/19 06/12/19 11/06/19 01/10/20 06/18/20 07/23/20 08/17/20 09/09/20 09/30/20 09/30/25 Respiratory care practice by No change 4761‐5‐06 polysomnographic technologists 04/23/19 06/12/19 11/06/19 01/10/20 06/18/20 rule 09/18/20 06/18/25 4761‐6‐01 Limited permit application procedure 04/23/19 06/12/19 11/06/19 01/10/20 06/18/20 07/23/20 08/17/20 09/09/20 09/30/20 02/28/24 Original license or permit, identification card 4761‐7‐01 or electronic license verification 02/28/19 02/28/24 4761‐7‐03 Scope of respiratory care defined 11/15/23 4761‐7‐04 Supervision 11/06/19 01/10/20 06/18/20 07/23/20 08/17/20 09/09/20 09/30/20 09/30/25 4761‐7‐05 Administration of medicines 11/15/23 4761‐8‐01 Renewal of license or permits 03/22/19 06/12/19 12/05/19 09/11/20 09/25/20 10/27/20 11/16/20 12/09/20 12/31/20 12/31/25 Board Sent for New Current Approval CSI recom‐ JCARR Rules JCARR Board Rule Number Rule Description Initial CSI filing Effective Review to File with mendation filing Hearing Hearing Adoption Comment Date Date CSI Defnition of respiratory care continuing 4761‐9‐01 education 11/06/19 01/10/20 06/18/20 07/23/20 08/17/20 09/09/20 09/30/20 02/28/24 General RCCE requirements and reporting 4761‐9‐02 mechanism 03/22/19 06/12/19 12/05/19 09/11/20 09/25/20 10/27/20 11/16/20 12/09/20 12/31/20 12/31/25 Activities which do not meet the Ohio RCCE 4761‐9‐03 requirements 02/28/19 02/28/24 Refiled Ohio respiratory care law and professional 8/24/20 9/24/20 4761‐9‐04 ethics course criteria 11/06/19 01/10/20 6/18/2020 7/23/2020 08/17/20 11/10/20 02/28/24

4761‐9‐05 Approved sources of RCCE 11/06/19 01/10/20 06/18/20 07/23/20 08/17/20 09/09/20 09/30/20 02/28/24 Auditing for compliance with RCCE 4761‐9‐07 requirements 11/06/19 01/10/20 06/18/20 07/23/20 08/17/20 09/09/20 09/30/20 09/30/25 4761‐10‐01 Ethical and professional conduct 02/28/19 02/28/24 4761‐10‐02 Proper use of credentials 11/15/23 4761‐10‐03 Providing information to the Board 04/23/19 06/12/19 11/06/19 01/10/20 06/18/20 07/23/20 08/17/20 09/09/20 09/30/20 09/30/25 4761‐15‐01 Miscellaneous Provisions 02/28/19 02/28/24 4774‐1‐01 Definitions 04/29/20 10/14/20 10/23/20 11/24/20 12/31/16 12/31/21 4774‐1‐02 Application for Certificate to Practice 04/29/20 10/14/20 10/23/20 11/24/20 11/30/16 11/30/21 4774‐1‐03 Renewal of Certificate to Practice 04/29/20 10/14/20 10/23/20 11/24/20 11/30/16 11/30/21 4774‐1‐04 Miscellaneous Provisions 04/29/20 10/14/20 10/23/20 11/24/20 08/17/16 08/17/21 4778‐1‐01 Definition 01/29/19 01/24/24 4778‐1‐02 Application 04/30/19 04/30/24 4778‐1‐03 Special Activity License 01/24/19 01/24/24 4778‐1‐05 Collaboration Agreement 04/30/19 04/30/24 4778‐1‐06 Miscellaneous Provisions 04/30/19 04/30/24 30 E. Broad St., 3rd Floor Columbus, Ohio 43215 (614) 466-3934 www.med.ohio.gov

MEMORANDUM

TO: Mark Bechtel, M.D., President Members, State Medical Board of Ohio

FROM: Kimberly C. Anderson, Chief Legal Counsel

RE: Updates to Rule 4731-11-03, Ohio Administrative Code

DATE: January 28, 2021

Rule 4731-11-03, OAC, regarding the utilization of anabolic steroids, schedule II controlled substance cocaine hydrochloride, and schedule II controlled substance stimulants is currently pending at CSI for its five-year rule review.

Dr. Schottenstein recommended some changes to update paragraph (B) regarding the use of a schedule II controlled substance stimulant. The proposed changes update the terminology, current practice and streamline the language.

If approved, I will update the rule with the Common Sense Initiative.

Action Requested: Approve updated language to be filed with Common Sense Initiative

4731-11-03 Utilization of anabolic steroids, schedule II controlled substance cocaine hydrochloride, and schedule II controlled substance stimulants.

(A) A physician shall not:

(1) Utilize anabolic steroids, growth hormones, testosterone or its analogs, human chorionic gonadotropin ("HCG"), or other hormones for the purpose of enhancing athletic ability.

(2) Utilize the schedule II controlled substance cocaine hydrochloride for a purpose other than one of the following:

(a) As a topical anesthetic in situations in which it is properly indicated; or

(b) For in-office diagnostic testing for pupillary disorders.

(3) Utilize a schedule II controlled substance stimulant in any of the following circumstances:

(a) For purposes of weight reduction or control;

(b) When the physician knows or has reason to believe that a recognized contra-indication to its use exists; or

(c) In the treatment of a patient who the physician knows or should know is pregnant, except if the following criteria are met:

(i) After the physician's medical assessment the physician and patient determine that the benefits of treating the patient with a schedule II controlled substance stimulant outweigh the risks, and

(ii) The basis for the determination is documented in the patient record.

(B) Utilizing a schedule II controlled subtance stimulant:

(1) Before initiating treatment utilizing a schedule II controlled substance stimulant, the physician shall perform all of the following:

(a) Obtain a thorough history;

(b) Perform an appropriate physical examination and mental status examination of the patient; and

(c) Rule out the existence of any recognized contra-indications to the use of the controlled subtance stimulant to be utilized.

(2) A physician may utilize a schedule II controlled substance stimulant only for one of the following purposes: (a) The treatment of narcolepsy, idiopathic hypersomnia, and hypersomnias due to medical conditions known to cause excessive sleepiness;

(b) The treatment of abnormal behavioral syndrome (attention deficit hyperactivity disorder, hyperkinetic syndrome), and/or related disorders;

(c) The treatment of major or mild neurocognitive disorder due to traumatic brain injury or substance/medication-induced major or mild neurocognitive disorderdrug-induced or trauma- induced brain dysfunction;

(d) The differential diagnostic psychiatric evaluation of depression;

(de) The treatment of depression shown to be refractory to other therapeutic modalities, including pharmacologic approaches, such as antidepressants;

(ef) As adjunctive therapy in the treatment of chronic pain, as defined in rule 4731-11-01 of the administrative codethe following:

(i) Chronic severe pain;

(ii) Closed head injuries;

(iii) Cancer-related fatigue;

(iv) Fatigue experienced during the terminal stages of disease;

(v) Depression experienced during the terminal stages of disease; or

(vi) IntractableChronic pain, as defined in rule 4731-21-01 4731-11-01 of the Administrative Code.

(fg) The treatment of binge eating disorder.

(3) Upon ascertaining or having reason to believe that the patient has a history of or shows a propensity for alcohol or drug abuse, or that the patient has consumed or disposed of any controlled substance other than in strict compliance with the treating physician's directions, the physician shall perform both of the following;

(a) Reappraise the desirability of continued utilization of schedule II controlled substance stimulants and shall document in the patient record the factors weighed in deciding to continue their use; and

(b) Actively monitor such patient for signs and symptoms of drug abuse and drug dependency.

(C) A violation of any provision of this rule, as determined by the board, shall constitute any or all of the following:

(1) "Failure to maintain minimal standards applicable to the selection or administration of drugs," as that clause is used in division (B)(2) of section 4731.22 of the Revised Code; (2) "Selling, giving away, personally furnishing, prescribing, or administering drugs for other than legal and legitimate therapeutic purposes," as that clause is used in division (B)(3) of section 4731.22 of the Revised Code;

(3) "A departure from, or the failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances, whether or not actual injury to a patient is established," as that clause is used in division (B)(6) of section 4731.22 of the Revised Code.

Replaces: 4731-11-02, 4731-11-03, 4731-11-05

Effective: 12/31/2015 Five Year Review (FYR) Dates: 12/31/2020 Promulgated Under: 119.03 Statutory Authority: 4731.05 Rule Amplifies: 4731.22 Prior Effective Dates: 11/17/86; 10/31/98; 9/1/00, 4/30/2009

30 E. Broad St., 3rd Floor Columbus, Ohio 43215 (614) 466-3934 www.med.ohio.gov

MEMORANDUM

TO: Mark Bechtel, M.D., President Members, State Medical Board of Ohio

FROM: Kimberly C. Anderson, Chief Legal Counsel

RE: RN Scope of Practice-Surgical Tasks

DATE: February 4, 2021

Eric Plinke, an attorney at Dinsmore has asked for the Board to review whether specific surgical tasks may be delegated to an RN under the direct supervision of a physician under the Board’s delegation rules in Chapter 4731-23. The questions, on behalf of a hospital client, arise from hypothetical situations where only one surgeon would be available, each of these tasks would be done at the direction of the surgeon, and each would be performed by the nurse under the surgeon’s direct supervision. The tasks are as follows:

1. Pressing the trigger on a powered drill to fully insert a pin into a bone after the pin placement has already been started by the surgeon, while the surgeon maintains traction/fracture reduction on the bone;

2. Tapping the tip of a bone cutting instrument with a hammer after the surgeon has placed the bone cutting instrument against the bone while the surgeon, by hand, manually feels and assesses the depth of the bone cut being made. The surgeon would then verbally tell the nurse when to stop tapping the bone cutting instrument with the hammer based on his/her manual assessment; and

3. Insert/advance orthopedic instrumentation via manual pressure or mallet while the surgeon maintains bone reduction on an implant that has been placed by the surgeon within or outside the bone and the surgeon maintains position of the implant while the nurse inserts/advances the instrumentation.

The Ohio Board of Nursing reviewed the questions and stated that these tasks are not within an RN’s scope of practice, but that it is possible that they may delegated to an RN by a surgeon, pursuant to the surgeon’s judgment and delegation and with the surgeon’s direct supervision under the Medical Board’s delegation rules in Chapter 4731-23, OAC. I have attached some guidance from the Ohio Board of Nursing with respect to RN scope of practice.

In addition, I requested some clarification from Mr. Plinke and he provided the following:

1. The three tasks would be performed in orthopedic cases in a hospital OR with surgeon directly supervising the nurse. More precisely, the physician is immediately present, giving verbal instruction/direction to the nurse at the time the nurse would be performing the task(s) and the physician is also performing a corresponding aspect of the surgery as described in the tasks.

2. In requesting your guidance and direction as to any requirements the surgeon must follow in connection with the delegation of such tasks, we wish to make clear that the delegated tasks would be performed and completed under the above conditions and in very temporally limited portions of the surgery. The description of the tasks and any delegation of them would not include on-going authority or tasks that are inconsistent with an RN’s existing scope that could be performed outside the immediate presence and direction of the surgeon. As such we would expect that your guidance would mandate that the surgeon be immediately present and directing the nurse’s performance of these tasks.

Under Rule 4731-23-02(B), OAC, the following must be determined by a physician prior to delegating each medical task:

(1) That the task is within that physician's authority;

(2) That the task is indicated for the patient;

(3) The appropriate level of supervision;

(4) That no law prohibits the delegation;

(5) That the person to whom the task will be delegated is competent to perform that task; and,

(6) That the task itself is one that should be appropriately delegated when considering the following factors:

(a) That the task can be performed without requiring the exercise of judgment based on medical knowledge;

(b) That results of the task are reasonably predictable;

(c) That the task can safely be performed according to exact, unchanging directions;

(d) That the task can be performed without a need for complex observations or critical decisions;

(e) That the task can be performed without repeated medical assessments; and,

(f) That the task, if performed improperly, would not present life threatening consequences or the danger of immediate and serious harm to the patient.

State Medical Board of Ohio 30 E. Broad St., 3rd Floor  Columbus, Ohio 43215  (614) 466-3934 www.med.ohio.gov Action requested: Review the request and formulate a response based on Rule 4731-23-02, OAC.

State Medical Board of Ohio 30 E. Broad St., 3rd Floor  Columbus, Ohio 43215  (614) 466-3934 www.med.ohio.gov

Scopes of Practice: Registered Nurses (RNs) and Licensed Practical Nurses (LPNs)

This document is to provide guidance regarding the scopes of practice for RNs and LPNs based on the requirements in the Nurse Practice Act (NPA) and administrative rules. The Nurse Practice Act and administrative rules can be found on the “law and rules” page of the Board website at www.nursing.ohio.gov.

Section 4723.01, Ohio Revised Code (ORC), specifies scopes of practice for RNs and LPNs. Chapter 4723-4, Ohio Administrative Code (OAC), specifies RN and LPN standards of practice, and addresses patient safety and the nursing process.

Registered Nurses Section 4723.01(B), ORC, defines the scope of RN practice as: “Providing to individuals and groups nursing care requiring specialized knowledge, judgment, and skill derived from the principles of biological, physical, behavioral, social, and nursing sciences. Such nursing care includes:

(1) Identifying patterns of human responses to actual or potential health problems amenable to a nursing regimen;

(2) Executing a nursing regimen through the selection, performance, management, and evaluation of nursing actions;

(3) Assessing health status for the purpose of providing nursing care;

(4) Providing health counseling and health teaching;

(5) Administering medications, treatments, and executing regimens authorized by an individual who is authorized to practice in this state and is acting within the course of the individual’s professional practice;

(6) Teaching, administering, supervising, delegating, and evaluating nursing practice.”

RNs have independent licensed authority to engage in all aspects of practice specified in Section 4723.01(B), ORC, except that, when providing nursing care pursuant to Section 4723.01(B)(5), ORC, the RN must have an order from an individual who is authorized to practice in this state and is acting within the course of the individual's professional practice for administration of medication or treatments or for the regimen that is to be executed. Rule 4723- 4-03(D), OAC.

The RN determines the data to be collected to "assess the patient’s health status for the purpose of providing nursing care," as identified in Section 4723.01(B)(3), ORC. Assessing health status is further defined in Section 4723.01(D), ORC, as “the collection of data through nursing assessment techniques, which may include interviews, observation, and physical evaluations for the purpose of providing nursing care.”

1 October 2018 Based on the “health status assessment” RNs determine the nursing care needs of the patient and the resulting nursing regimen that will be executed in accordance with Section 4723.01(B)(2), ORC. Nursing regimen is defined in Section 4723.01(C), ORC, in that it “may include preventative, restorative, and health-promotion activities.” The definition of patient, set forth in Rule 4723-4-01(A)(4), OAC is “the recipient of nursing care, which may include an individual, a group, or a community.” Therefore, the nursing regimen determined by RNs is not limited to individual patients, but may be established for specific populations or defined groups. Rule 4723-4-03, OAC, provides further information about the implementation of the nursing regimen and the standards of RN practice.

RN Role/Nursing Process The following examples of RN practice are in the NPA and administrative rules. The RN: • Collects patient health data from patient, patient family, and LPN or other health care providers. • Analyzes data to determine nursing regimen. • Establishes, accepts, or modifies a nursing diagnosis or problem. • Implements and communicates the plan of nursing care. • Evaluates and documents the patient’s response to the nursing care. • Reassesses and revises the nursing plan of care as appropriate.

Licensed Practical Nurses Section 4723.01(F), ORC, defines the scope of LPN practice as “Providing to individuals and groups nursing care requiring the application of basic knowledge of the biological, physical, behavioral, social, and nursing sciences at the direction of a registered nurse or any of the following who is authorized to practice in this state: a physician, physician assistant, dentist, podiatrist, optometrist, or chiropractor. Such nursing care includes:

(1) Observation, patient teaching, and care in a diversity of health care settings;

(2) Contributions to the planning, implementation, and evaluation of nursing;

(3) Administration of medications and treatments authorized by an individual who is authorized to practice in this state and is acting within the course of the individual’s professional practice, except that administration of intravenous therapy shall be performed only in accordance with section 4723.18 or 4723.181 of the Revised Code. Medications may be administered by a licensed practical nurse upon proof of completion of a course in medication administration approved by the board of nursing.

(4) Administration to an adult of intravenous therapy authorized by an individual who is authorized to practice in this state and is acting within the course of the individual’s professional practice, on the condition that the licensed practical nurse is authorized under section 4723.18 or 4723.181 of the Revised Code to perform intravenous therapy and performs intravenous therapy only in accordance with those sections;

(5) Delegation of nursing tasks as directed by a registered nurse;

(6) Teaching nursing tasks to licensed practical nurses and individuals to whom the licensed practical nurse is authorized to delegate nursing tasks as directed by a registered nurse.”

2 October 2018 LPNs have a "dependent" practice, which means the LPN is authorized to practice only when the practice is directed by a registered nurse or any of the following who is authorized to practice in this state: a physician, physician assistant, dentist, podiatrist, optometrist or chiropractor (Section 4723.01(F), ORC). The “direction” required for LPN practice is further defined as “communicating a plan of care to a licensed practical nurse” in Rule 4723-4-01(B)(6), OAC. A physician, physician assistant, dentist, podiatrist, optometrist or chiropractor, or the RN may provide LPNs verbal or written direction of the plan that each of these health care providers have established for the patient. LPNs are authorized to execute the plan in accordance with the standards of LPN practice in accordance with Rule 4723-4-04, OAC. When the RN communicates the plan of care to the LPN, it may be verbally, in the form of an established nursing plan of care, or both. Rule 4723-4-04, OAC, further explains that the direction provided by RNs to LPNs about nursing practice is not meant to imply the RN is supervising the LPN in the employment context. The LPN is accountable to identify the RN or other authorized health care provider who is directing the LPN’s practice. Otherwise, the LPN may be engaging in practice beyond the LPN authorized scope.

LPN Practice Prohibitions The following are specific LPN practice prohibitions contained in the NPA and rules: • Engaging in nursing practice without RN or authorized health care provider direction. • Administering IV push medications (IV medications other than Heparin or Saline to flush an intermittent infusion device). • Teaching the “practice of nursing.” • Supervising and evaluating “nursing practice.” • Assessing health status for purposes of providing nursing care.

The LPN contributes to all steps of the nursing process by communicating with the RN or the directing authorized health care provider concerning the patient’s status and needs. When a RN is directing LPN practice, it is the RN who establishes the nursing regimen and communicates the nursing practice needs of the patient.

LPN Role/Nursing Process The following are examples of LPN practice in the NPA and administrative rules. The LPN: • Collects and documents objective and subjective data and observations about the patient. • Contributes observations and health information to the nursing assessment and reports all data to the RN or authorized directing health care provider. • Implements the current plan of nursing care at the direction of the RN, or the medication or treatment authorized by the directing physician, physician assistant, dentist, podiatrist, optometrist or chiropractor. • Documents the patient’s response to the nursing plan of care or the medication or treatment. • Contributes to the revision of the nursing plan of care. • Contributes to the evaluation of the patient’s response to the plan of care through documentation and verbal communication with other members of the health care team.

LPN IV Therapy Chapter 4723-17, OAC, addresses LPN IV therapy for the LPN who is IV therapy certified. The Chapter defines terms, IV therapy procedures IV therapy certified LPNs may perform, and IV 3 October 2018 therapy procedures that LPNs are prohibited from performing. It also establishes the minimum curriculum requirements for LPNs to obtain their IV therapy certification.

Supervision of Nursing Practice The supervision of nursing practice is specified within the definition of RN practice, noting that RNs teach, administer, supervise, delegate, and evaluate nursing practice (Section 4723.01(B)(6), ORC). The LPN is authorized to delegate nursing practice when directed to do so by a RN, to teach a nursing task, and to make observations and provide patient teaching (Section 4723.01(F)(1), (F)(5), and (F)(6), ORC). Regarding the RN supervision of nursing practice, it is the “practice” of nursing that the RN supervises and evaluates, rather than a person’s employment performance. Supervision and evaluation of nursing practice is further addressed in Rule 4723-4-06, OAC.

The supervision of nursing practice may include a determination by the RN that a particular nursing intervention is no longer appropriate for a patient and that the nursing regimen should be changed in response to the patient’s needs. The RN may base this change on information communicated by the LPN and the RN may further direct the LPN to implement the revised nursing regimen, or the RN may implement the revision him/herself. The supervising RN must be continuously available through some form of telecommunication with the supervised nurse. Although the supervising RN is not required to be on-site on a routine basis to supervise the LPN in all of the nursing practice activities performed by the LPN, the supervising RN is required to take all action necessary, including but not limited to conducting periodic on-site visits, in order to insure the supervised nurse is practicing in accordance with acceptable and prevailing standards of safe nursing care. There are circumstances when on- site supervision by a RN is explicitly required by nursing law and rule. For example, on-site supervision is required in certain environments in which a qualified LPN performs IV therapy (Section 4723.18(B) and (C), ORC).

Supervision of employee performance and other employment requirements are established by the employer and may encompass responsibilities beyond the licensed practice of nursing.

Implementing Health Care Provider Orders Both the RN and the LPN administer medications and treatments authorized by an authorized prescriber/health care provider, such as a physician or an advanced practice registered nurse. The RN is also authorized to execute a regimen authorized by an authorized health care provider. When administering medications and treatments, or when a RN is executing an authorized regimen, the licensed nurse must practice within their statutorily defined scope. An authorized health care provider’s order does not expand the licensed nurse’s scope. For example, an order from a physician does not authorize a LPN to intravenously administer a dose of Lasix because Section 4723.18, ORC, prohibits it. Similarly, an order does not authorize an RN to engage in activities that constitute advanced practice registered nursing or the practice of medicine or surgery, as prohibited by Section 4723.151(A), ORC.

Implementing the Nursing Process Both the RN and LPN implement the nursing process in the provision of nursing care in accordance with Rules 4723-4-07 and 4723-4-08, OAC, respectively. The scope of LPN practice does not include assessing health status for purposes of providing nursing care that is included in the RN scope. Although it is the RN who reviews and assimilates the patient’s health status data and information into the nursing assessment for purposes of providing nursing care, the LPN is authorized to contribute to this process by obtaining responses to health questions posed to the patient, performing physical examinations, recognizing changes in patient status or complications that occur and communicating information collected to the RN 4 October 2018 or to the authorized health care provider who is directing the LPN’s practice.

Delegation

Chapter 4723-13, OAC, addresses delegation of nursing tasks to an unlicensed person. The rules in this chapter provide general information about the delegation of nursing tasks; specific prohibitions regarding delegation of nursing tasks; criteria and standards for a licensed nurse delegating to an unlicensed person; minimum curriculum requirements for teaching a nursing task; and supervision of the performance of a nursing task performed by an unlicensed person.

FAQs

Q. Can LPNs perform an initial assessment of a patient who has just been admitted to the unit?

A. Whether it is an initial or ongoing assessment of a patient, the LPN’s role is the same, which is to collect only objective and subjective data. The assimilation and analysis of the data and the formulation of the plan of nursing care is always the RN’s responsibility.

Q. Is the RN required to co-sign the documentation of the LPN?

A. The law and rules regulating the practice of nursing do not require that the RN co-sign the LPN’s documentation. It is within the LPN scope of practice and a requirement of nursing standards that LPNs accurately and timely document their observations of the patient, the nursing care they provide, and the patient’s response to the nursing care.

Q. What is meant by directing the nursing care provided by the LPN?

A. Direction means communicating a plan of care to a LPN (Rule 4723-4-01(B)(6), OAC). The LPN has a scope of practice defined in law. The RN directs the LPN in the provision of nursing care for individuals or groups of individuals within the scope of practice of the LPN. Rule 4723-4-03(K), OAC, requires a RN to assess certain aspects of the clinical situation and the LPN’s knowledge skill and ability when directing a specific LPN’s practice:

“(K) When a registered nurse provides direction to a licensed practical nurse in accordance with Chapters 4723-1 to 4723-23 of the Administrative Code, the registered nurse shall first assess:

(1) The condition of the patient who needs nursing care, including, but not limited to, the stability of the patient;

(2) The type of nursing care the patient requires;

(3) The complexity and frequency of the nursing care needed;

(4) The training, skill, and ability of the licensed practical nurse who will be performing the specific function or procedure, to perform the specific function or procedure; and

(5) The availability and accessibility of resources necessary to safely perform the specific function or procedure.”

5 October 2018 Additional practice resources Additional practice resources are available on Practice RN and LPN page of the Board's website. These include a RN LPN FAQ and a Decision Making Model adopted by the Board to assist nurses “in determining whether a specific procedure, task or activity is within the RN's or LPN's scope of practice and, if so, whether the specific procedure, task or activity is consistent with standards of practice, appropriate to perform based on the individual nurse's knowledge and skills, and is appropriate based on the clinical setting.” Questions that cannot be addressed by reference to the RN LPN FAQ and/or the Decision Making Model, may be emailed to [email protected].

6 October 2018 5.2.5.1

DECISION MAKING MODEL

Registered Nurses and Licensed Practical Nurses

The Decision Making Model is a guide for registered nurses (RNs) and licensed practical nurses (LPNs) to use when determining whether a specific procedure, task or activity is within the RN's or LPN's scope of practice and, if so, whether the specific procedure, task or activity is consistent with standards of practice, appropriate to perform based on the individual nurse's knowledge and skills, and is appropriate based on the clinical setting.

The Board also publishes Interpretive Guidelines that address specific practices and these are available on the Board website: www.nursing.ohio.gov. However, since it is not possible for the Board to establish Interpretive Guidelines for every procedure, task or activity performed by nurses, the Decision Making Model was developed so nurses could apply it as needed for their specific practices.

All nurses are responsible for knowing and practicing within the legal scope of practice set forth in Section 4723.01(B), Ohio Revised Code (ORC) for RNs and in Section 4723.01(F), ORC, for LPNs. In addition, RNs and LPNs are responsible for knowing and following the Standards of Practice for RNs and LPNs established in Chapter 4723-4, Ohio Administrative Code.

The Nurse Practice Act and the Administrative Rules are available for review in their entirety on the Board of Nursing website under the “Law and Rules” link.

Adopted 11/17/94 Last Revision: March 2015 RN and LPN Decision Making Model

Define/Describe the activity or task

Is the activity or task within the scope of practice of the nurse and NOT prohibited or precluded by any other law or rule?

The Nurse Practice Act; Section 4723.01 (B), ORC: practice as an RN Activity/ Section 4723.01 (F), ORC: practice as an LPN task NOT Section 4723.43, ORC: practice as an APRN within scope www.nursing.ohio.gov/law_and_rule.htm and/or Administrative Rules: prohibited Chapters 4723-1 to 4723-27, OAC by law or www.nursing.ohio.gov/law_and_rule.htm rule

Review Other Applicable Laws or Rules: Pharmacy Practice Act: Chapter 4729., ORC www.pharmacy.ohio.gov Medical Practice Act: Chapter 4731., ORC www.med.ohio.gov

YES

Can the nurse perform the activity or task and meet the standards of safe nursing practice as defined in Chapter 4723-4, OAC? www.nursing.ohio.gov NO

Can the nurse demonstrate and document current knowledge, skills, and abilities?

YES

Is this activity or task safe and appropriate to perform with this patient at NO this time?

YES

The nurse may perform the activity/task according to acceptable and prevailing standards of safe NO nursing care and prepare to accept accountability for the nursing actions STOP Do NOT perform the March 2015 activity or task 30 E. Broad St., 3rd Floor Columbus, Ohio 43215 (614) 466-3934 www.med.ohio.gov

Legislative Update: February 10, 2021

Bills of high interest or with significant activity since the last board meeting:

SB 6 – Join Interstate Medical Licensure Compact (Sen. Roegner and Sen. Steve Huffman)

To enter into the Interstate Medical Licensure Compact

Areas of Interest:

• Requires entrance into the Interstate Medical Licensure Compact (IMLC). • Model compact language must be adopted as written and cannot be amended though amendments that do not require changes to the actual membership contract may be considered by the IMLC. • Several stakeholders have offered testimony in support of this legislation including OSMA and OHA. • The policy, legal and licensing team continue to research this issue. Several other states with introduced legislation and passed legislation were contacted when this language was introduced in the last General Assembly. • Director Loucka and Chelsea Wonski attended an interested party meeting hosted by the bill sponsors and additional meetings with the sponsors are planned.

Board Position: Interested Party

Status: 1/27/2021 Introduced in the Senate. Second hearing in Senate Health, Human Services and Medicaid 2/3/2020

Bills that continue to be monitored but have not seen significant activity since the last board mee Bills of high interest or with significant activity since the last board meeting:

SB 4 – Public Records (Sen. Roegner)

To exempt personal info of certain persons from public records law

Areas of Interest:

• Includes emergency service telecommunicators and certain Ohio National Guard members as individuals whose residential and familial information is exempt from disclosure under the Public Records Law.

Board Position: Neutral

Status: Introduced in the Senate: 1/19/2021 - Second hearing in Senate Judiciary 1/26/2021

State Medical Board of Ohio 30 E. Broad St., 3rd Floor ⚫ Columbus, Ohio 43215 ⚫ (614) 466-3934 www.med.ohio.gov

2 | P a g e

SB 9 – Regulations (Sen. McColley and Sen. Roegner)

To reduce regulatory restrictions in administrative rules

Areas of Interest:

• Requires certain agencies to reduce the number of regulatory restrictions in their administrative rules. • This applies to administrative agencies only and does not currently impact the Medical Board.

Board Position: Neutral

Status: Introduced in the Senate: 1/21/2021 - Second hearing in Senate Government Oversight and Reform 1/26/2021

SB 48 – Cultural Competency (Sen. Maharath and Sen. Antonio)

To require certain health care professionals to complete instruction in cultural competency.

Areas of Interest:

• Requires certain health care professionals to complete instruction in cultural competency and provide proof of completion at initial application for licensure and at renewal. • Includes: dentists, nurses, pharmacists, physicians, psychologists, and social workers.

Board Position: Neutral

Status: Introduced in the Senate: 2/3/2021

State Medical Board of Ohio 30 E. Broad St., 3rd Floor ⚫ Columbus, Ohio 43215 ⚫ (614) 466-3934 www.med.ohio.gov Bill Name Current Bill Status Committee Board Position Bill Sponsor(s) Date Areas of Interest Action Taken Action Needed Number/ Assignment Introduced Link

SB 4 Public Records Introduced 1/19/2021 Senate Judiciary Neutral Senator Kristina Roegner 1/19/2021 Includes emergency service Monitoring None First Senate Hearing 1/26/2021 (R-27 Hudson) telecommunicators and certain 1/26/2021 Ohio National Guard members Second Senate Hearing as individuals whose residential 2/2/2021 and familial information is exempt from disclosure under the Public Records Law

SB 6 Enter into Interstate Introduced 1/19/2021 Senate Health Interested Party Senator Kristina Roegner 1/19/2021 Would make Ohio a member of Chelsea and Stephanie attended Additional meetings with the Medical Licensure First Senate Hearing 1/26/2021 (R-27 Hudson) and Senator the Interstate Medical Licensure an interested party meeting bills sponsor and health Compact 1/27/2021 Steve Huffman (R-5 Tipp Compact hosted by the bills sponsors. committee chair are being Second Senate Hearing City) - Interested party testimony scheduled. 2/3/2021 was offered at the second committee hearing - Additional meetings with the bill sponsors are planned

SB 9 Reduce regulatory Introduced 1/21/2021 Senate Government Neutral - does not Senator Rob McColley (R-1 1/21/2021 Requires certain agencies to Monitoring for future potential The policy team will continue restrictions in First Senate Hearing Oversight and Reform currently impact Napoleon) and Senator reduce the number of inclusion to monitor this bill as it administrative rules 1/26/2021 1/26/2021 SMBO Kristina Roegner (R-27 regulatory restrictions in their progresses through the Second Senate Hearing Hudson) administrative rules. legislative process. 2/3/2021 SB 48 Cultural Competency Introduced 2/3/2021 Pending Neutral Senator Tina Maharath (D- 2/3/2021 Require certain health care Monitoring The policy team will continue 3 Canal Winchester) and professionals to complete to monitor this bill as it Nickie Antonio (D-23 instruction in cultural progresses through the Lakewood) competency. Includes: dentists, legislative process. nurses, pharmacists, physicians,

Key Monitoring - currently no impact on the Board

Monitoring - potential impact on the Board Requires immediate action Enacted No Longer Active