Senate Bill 200 - What's New
In order to assure that Ohio's patients receive quality care in a timely manner, CRNAs must have the ability to write orders for medications that will be administered by another licensed health care profession.
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Sponsor Testimony
Senator Sue Morano
Tuesday, December 15, 2009
Thank you Chairman Coughlin and colleagues for hearing my testimony on Senate Bill 2oo.
SB 200 amends Section 4723.43(B) to allow Certified Registered Nurse Anesthetists (CRNAs) to write orders for medications that will be administered by Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Respiratory Therapists (RTs). CRNAs are Advanced Practice Nurses (APNs) who specialize in anesthesia care (preoperative, intraoperative, postoperative phases of a patient's care). CRNAs must acquire at least a Masters degree to practice and are mandated to obtain at least 24 hours of continuing education hours by the Ohio Board of Nursing every 2 years. Nationally, CRNAs are required to obtain a minimum of 40 hours every 2 years. The hours required nationally do count towards the Ohio Board of Nursing requirements. Thus, CRNAs are highly qualified, educated nurses.
With the passage of H.B. 241 in 2000, some CRNAs and their eimployers believed they had obtained the authority to write orders for the administration of medications in the surgical setting. They looked to the provision enacted in H.B. 241 which provided that CRNAs did not need prescriptive authority to practice pre, intra, or post operative care. This provision coupled with the statutory provision which allows a CRNA to provide clinical support functions led many CRNAs to believe that they had obtained the authority to write orders for medications that would be administered by others. In fact, since the passage of H.B. 241, many CRNAs have been ordering mediciations that have been administered by RNs, LPNs, and RTs.
This practice changed when the Ohio Board of Nursing received an inquiry on this issue. After researching the statute and holding extensive discussions with the Association, the Board of Nursing concluded in August of 2008 that there was no specific statutory language in the Nurse Practice Act that gave CRNAs the authority to order medications in the anesthesia setting. In a letter to the Association's Presdient, the Ohio Board of Nursing stated that Section 4723.43(B) allows the CRNA to administer medications but does not provide specific authority to order medications to be administered by others. After reviewing the Ohio Board of Nursing's decision, the Ohio State Association of Nurse Anesthetists Board of Directors, with support of its membership, elected to seek legislation to correct and clarify this issue, hence, SB 200.
SB 200 requires that the ordering and administration of these medications are done under supervision and only where anesthesia services are being rendered by the CRNA. That is, a CRNA would be allowed to issue an order for the administration of medications during only the preoperative, intraoperative, postoperative phases of a patient's care, and when providing clinical support services. RNs, LPNs, and RTs are the professionals that would be allowed to administer these medications. The passage of the bill would in no way change or expand the scope of practice for CRNAs in Ohio.
This bill also amends Section 4729.01 because the Pharmacy Board has concluded that the writing of an order for a medication that is to be administered by another to come within the definition of prescribing. More specifically, Ohio's definition of prescription includes the common understanding of what most people consider to be a prescription. That is, a health care professional with prescriptive authority writes on a piece of paper the prescription that is then taken by the patient. Ohio's definition also includes the ordering of a medication that will be administered by another. Therefore, Section 4729.01 needs to be amended to include CRNAs.
Allowing CRNAs to write orders for medications that will be administered by another helps to assure that patients receive quality care in a timely manner. There are times when the CRNA is personally unavailable to administer the medication. Without the authority to ask another to do the adminstration, the supervising physician must be found so the physician can provide the order. If the supervising physician is not available, the patient must often wait for the physician or forego the medication. Waiting for the proper medication can cause uncontrolled pain, delaying the healing process and potentially causing longer lengths of stay in the hospital. A delay in nausea mediation can cause a post operative abdominal surgery patient to vomit and their incisions to open up, causing a significant risk for deadly infections. In my own personal experience I have had to administer care to a severely combative patient recovering from anesthesia. Waiting for a physician to give me an order for anti anxiety medication would have jeopardized the safety of me, my co-workers and the patient.
Thank you again Chairman Coughlin for giving me the opportunity to present SB200 to the committee. I will be happy to answer any questions.
