2006 Code of Virginia § 54.1-3408 - Professional use by practitioners

54.1-3408. Professional use by practitioners.

A. A practitioner of medicine, osteopathy, podiatry, dentistry, or veterinarymedicine or a licensed nurse practitioner pursuant to 54.1-2957.01, alicensed physician assistant pursuant to 54.1-2952.1, or a TPA-certifiedoptometrist pursuant to Article 5 ( 54.1-3222 et seq.) of Chapter 32 of thistitle shall only prescribe, dispense, or administer controlled substances ingood faith for medicinal or therapeutic purposes within the course of hisprofessional practice.

B. The prescribing practitioner's order may be on a written prescription orpursuant to an oral prescription as authorized by this chapter. Theprescriber may administer drugs and devices, or he may cause them to beadministered by a nurse, physician assistant or intern under his directionand supervision, or he may prescribe and cause drugs and devices to beadministered to patients in state-owned or state-operated hospitals orfacilities licensed as hospitals by the Board of Health or psychiatrichospitals licensed by the State Mental Health, Mental Retardation andSubstance Abuse Services Board by other persons who have been trainedproperly to administer drugs and who administer drugs only under the controland supervision of the prescriber or a pharmacist or a prescriber may causedrugs and devices to be administered to patients by emergency medicalservices personnel who have been certified and authorized to administer suchdrugs and devices pursuant to Board of Health regulations governing emergencymedical services and who are acting within the scope of such certification. Aprescriber may authorize a licensed respiratory care practitioner as definedin 54.1-2954 to administer by inhalation controlled substances used ininhalation or respiratory therapy.

C. Pursuant to an oral or written order or standing protocol, the prescriber,who is authorized by state or federal law to possess and administerradiopharmaceuticals in the scope of his practice, may authorize a nuclearmedicine technologist to administer, under his supervision,radiopharmaceuticals used in the diagnosis or treatment of disease.

D. Pursuant to an oral or written order or standing protocol issued by theprescriber within the course of his professional practice, such prescribermay authorize registered nurses and licensed practical nurses to possess (i)epinephrine for administration in treatment of emergency medical conditionsand (ii) heparin and sterile normal saline to use for the maintenance ofintravenous access lines.

Pursuant to the regulations of the Board of Health, certain emergency medicalservices technicians may possess and administer epinephrine in emergencycases of anaphylactic shock.

E. Pursuant to an oral or written order or standing protocol issued by theprescriber within the course of his professional practice, such prescribermay authorize licensed physical therapists to possess and administer topicalcorticosteroids, topical lidocaine, and any other Schedule VI topical drug.

F. Pursuant to an oral or written order or standing protocol issued by theprescriber within the course of his professional practice, such prescribermay authorize licensed athletic trainers to possess and administer topicalcorticosteroids, topical lidocaine, or other Schedule VI topical drugs, or topossess and administer epinephrine for use in emergency cases of anaphylacticshock.

G. Pursuant to an oral or written order or standing protocol issued by theprescriber within the course of his professional practice, and in accordancewith policies and guidelines established by the Department of Health pursuantto 32.1-50.2, such prescriber may authorize registered nurses or licensedpractical nurses under the immediate and direct supervision of a registerednurse to possess and administer tuberculin purified protein derivative (PPD)in the absence of a prescriber. The Department of Health's policies andguidelines shall be consistent with applicable guidelines developed by theCenters for Disease Control and Prevention for preventing transmission ofmycobacterium tuberculosis and shall be updated to incorporate anysubsequently implemented standards of the Occupational Safety and HealthAdministration and the Department of Labor and Industry to the extent thatthey are inconsistent with the Department of Health's policies andguidelines. Such standing protocols shall explicitly describe the categoriesof persons to whom the tuberculin test is to be administered and shallprovide for appropriate medical evaluation of those in whom the test ispositive. The prescriber shall ensure that the nurse implementing suchstanding protocols has received adequate training in the practice andprinciples underlying tuberculin screening.

The Health Commissioner or his designee may authorize registered nurses,acting as agents of the Department of Health, to possess and administer, atthe nurse's discretion, tuberculin purified protein derivative (PPD) to thosepersons in whom tuberculin skin testing is indicated based on protocols andpolicies established by the Department of Health.

H. Pursuant to a written order or standing protocol issued by the prescriberwithin the course of his professional practice, such prescriber mayauthorize, with the consent of the parents as defined in 22.1-1, anemployee of a school board who is trained in the administration of insulinand glucagon to assist with the administration of insulin or administerglucagon to a student diagnosed as having diabetes and who requires insulininjections during the school day or for whom glucagon has been prescribed forthe emergency treatment of hypoglycemia. Such authorization shall only beeffective when a licensed nurse, nurse practitioner, physician or physicianassistant is not present to perform the administration of the medication.

I. A prescriber may authorize, pursuant to a protocol approved by the Boardof Nursing, the administration of vaccines to adults for immunization, when apractitioner with prescriptive authority is not physically present, (i) bylicensed pharmacists, (ii) by registered nurses, or (iii) licensed practicalnurses under the immediate and direct supervision of a registered nurse. Aprescriber acting on behalf of and in accordance with established protocolsof the Department of Health may authorize the administration of vaccines toany person by a pharmacist or nurse when the prescriber is not physicallypresent.

J. A dentist may cause Schedule VI topical drugs to be administered under hisdirection and supervision by either a dental hygienist or by an authorizedagent of the dentist.

Further, pursuant to a written order and in accordance with a standingprotocol issued by the dentist in the course of his professional practice, adentist may authorize a dental hygienist under his general supervision, asdefined in 54.1-2722, to possess and administer topical oral fluorides,topical oral anesthetics, topical and directly applied antimicrobial agentsfor treatment of periodontal pocket lesions, as well as any other Schedule VItopical drug approved by the Board of Dentistry.

In addition, a dentist may authorize a dental hygienist under his directionto administer Schedule VI nitrous oxide and oxygen inhalation analgesia and,to persons 18 years of age or older, Schedule VI local anesthesia.

K. (For expiration date - See Editor's note) This section shall not preventthe administration of drugs by a person who has satisfactorily completed atraining program for this purpose approved by the Board of Nursing and whoadministers such drugs in accordance with a physician's instructionspertaining to dosage, frequency, and manner of administration, and inaccordance with regulations promulgated by the Board of Pharmacy relating tosecurity and record keeping, when the drugs administered would be normallyself-administered by (i) a resident of a facility licensed or certified bythe State Mental Health, Mental Retardation and Substance Abuse ServicesBoard; (ii) a resident of any assisted living facility which is licensed bythe Department of Social Services; (iii) a resident of the VirginiaRehabilitation Center for the Blind and Vision Impaired; (iv) a resident of afacility approved by the Board or Department of Juvenile Justice for theplacement of children in need of services or delinquent or alleged delinquentyouth; (v) a program participant of an adult day-care center licensed by theDepartment of Social Services; or (vi) a resident of any facility authorizedor operated by a state or local government whose primary purpose is not toprovide health care services.

K. (For effective date - see Editor's note) This section shall not preventthe administration of drugs by a person who has satisfactorily completed atraining program for this purpose approved by the Board of Nursing and whoadministers such drugs in accordance with a physician's instructionspertaining to dosage, frequency, and manner of administration, and inaccordance with regulations promulgated by the Board of Pharmacy relating tosecurity and record keeping, when the drugs administered would be normallyself-administered by (i) a resident of a facility licensed or certified bythe Department of Mental Health, Mental Retardation and Substance AbuseServices; (ii) a resident of the Virginia Rehabilitation Center for the Blindand Vision Impaired; (iii) a resident of a facility approved by the Board orDepartment of Juvenile Justice for the placement of children in need ofservices or delinquent or alleged delinquent youth; (iv) a programparticipant of an adult day-care center licensed by the Department of SocialServices; or (v) a resident of any facility authorized or operated by a stateor local government whose primary purpose is not to provide health careservices.

L. (For effective date - see Editor's note) Medication aides registered bythe Board of Nursing pursuant to Article 7 ( 54.1-3041 et seq.) of Chapter30 may administer drugs that would otherwise be self-administered toresidents of any assisted living facility licensed by the Department ofSocial Services. A registered medication aide shall administer drugs pursuantto this section in accordance with the prescriber's instructions pertainingto dosage, frequency, and manner of administration; in accordance withregulations promulgated by the Board of Pharmacy relating to security andrecordkeeping; in accordance with the assisted living facility's MedicationManagement Plan; and in accordance with such other regulations governingtheir practice promulgated by the Board of Nursing.

M. In addition, this section shall not prevent the administration of drugs bya person who administers such drugs in accordance with a physician'sinstructions pertaining to dosage, frequency, and manner of administrationand with written authorization of a parent, and in accordance with schoolboard regulations relating to training, security and record keeping, when thedrugs administered would be normally self-administered by a student of aVirginia public school. Training for such persons shall be accomplishedthrough a program approved by the local school boards, in consultation withthe local departments of health.

N. In addition, this section shall not prevent the administration of drugs bya person to a child in a child day program as defined in 63.2-100 andregulated by the State Board of Social Services or the Child Day CareCouncil, provided such person (i) has satisfactorily completed a trainingprogram for this purpose approved by the Board of Nursing and taught by aregistered nurse, licensed practical nurse, doctor of medicine or osteopathicmedicine, or pharmacist; (ii) has obtained written authorization from aparent or guardian; (iii) administers drugs only to the child identified onthe prescription label in accordance with the prescriber's instructionspertaining to dosage, frequency, and manner of administration; and (iv)administers only those drugs that were dispensed from a pharmacy andmaintained in the original, labeled container that would normally beadministered by a parent or guardian to the child.

O. In addition, this section shall not prevent the administration ordispensing of drugs and devices by persons if they are authorized by theState Health Commissioner in accordance with protocols established by theState Health Commissioner pursuant to 32.1-42.1 when (i) the Governor hasdeclared a disaster or a state of emergency caused by an act of terrorism orthe United States Secretary of Health and Human Services has issued adeclaration of an actual or potential bioterrorism incident or other actualor potential public health emergency; (ii) it is necessary to permit theprovision of needed drugs or devices; and (iii) such persons have receivedthe training necessary to safely administer or dispense the needed drugs ordevices. Such persons shall administer or dispense all drugs or devices underthe direction, control and supervision of the State Health Commissioner.

P. Nothing in this title shall prohibit the administration of normallyself-administered oral or topical drugs by unlicensed individuals to a personin his private residence.

Q. This section shall not interfere with any prescriber issuing prescriptionsin compliance with his authority and scope of practice and the provisions ofthis section to a Board agent for use pursuant to subsection G of 18.2-258.1. Such prescriptions issued by such prescriber shall be deemed tobe valid prescriptions.

R. Nothing in this title shall prevent or interfere with dialysis caretechnicians or dialysis patient care technicians who are certified by anorganization approved by the Board of Health Professions or personsauthorized for provisional practice pursuant to Chapter 27.01 ( 54.1-2729.1et seq.) of this title, in the ordinary course of their duties in aMedicare-certified renal dialysis facility, from administering heparin,topical needle site anesthetics, dialysis solutions, sterile normal salinesolution, and blood volumizers, for the purpose of facilitating renaldialysis treatment, when such administration of medications occurs under theorders of a licensed physician, nurse practitioner or physician assistant andunder the immediate and direct supervision of a licensed registered nurse.Nothing in this chapter shall be construed to prohibit a patient caredialysis technician trainee from performing dialysis care as part of andwithin the scope of the clinical skills instruction segment of a superviseddialysis technician training program, provided such trainee is identified asa "trainee" while working in a renal dialysis facility.

The dialysis care technician or dialysis patient care technicianadministering the medications shall have demonstrated competency as evidencedby holding current valid certification from an organization approved by theBoard of Health Professions pursuant to Chapter 27.01 ( 54.1-2729.1 et seq.)of this title.

S. Persons who are otherwise authorized to administer controlled substancesin hospitals shall be authorized to administer influenza or pneumococcalvaccines pursuant to 32.1-126.4.

(Code 1950, 54-497; 1956, c. 225; 1970, c. 650, 54-524.65; 1973, c. 468;1976, cc. 358, 614; 1977, c. 302; 1978, c. 224; 1980, cc. 270, 287; 1983, cc.456, 528; 1984, cc. 141, 555; 1986, c. 81; 1987, c. 226; 1988, c. 765; 1990,c. 309; 1991, cc. 141, 519, 524, 532; 1992, cc. 610, 760, 793; 1993, cc. 15,810, 957, 993; 1994, c. 53; 1995, cc. 88, 529; 1996, cc. 152, 158, 183, 406,408, 490; 1997, cc. 272, 566, 806, 906; 1998, c. 112; 1999, c. 570; 2000, cc.135, 498, 861, 881, 935; 2003, cc. 465, 497, 515, 794, 995, 1020; 2005, cc.113, 610, 924; 2006, cc. 75, 432, 686, 858.)

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