Who May Prescribe?
The right to prescribe drugs has traditionally been the respon-sibility of the physician, dentist, podiatrist, or veterinarian. Prescribing now includes—in a number of states and in varying degrees—pharmacists, nurse practitioners, nurse midwives, physician’s assistants, and optometrists (see Table 65–2). In the future, physical therapists may be licensed to prescribe drugs relevant to their practice. The development of large health maintenance organizations has greatly strengthened this expansion of prescribing rights because it offers these extremely powerful economic bodies a way to reduce their expenses.
The primary organizations controlling the privilege of pre-scribing in the USA are the state boards, under the powers delegated to them by the state legislatures. As indicated in Table 65–2, many state boards have attempted to reserve some measure of the primary responsibility for prescribing to physicians by requiring that the ancillary professional work with or under a physician according to a specific protocol. In the state of California, this protocol must include a statement of the training, supervision, and documentation requirements of the arrangement and must specify referral requirements, limitations to the list of drugs that may be prescribed (ie, a formulary), and a method of evaluation by the supervising physician. The protocol must be in writing and must be peri-odically updated (see reference: An Explanation of the Scope of RN Practice, 1994).
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