1. Mississippi Board of Nursing
Advanced Practice Registered Nurses (APRNs): Updates
Lynn Langley, DNP, FNP-BC, ANP-BC, CPHQ
Executive Director
&
Phyllis Johnson, MSN, MS, FNP-BC
Director of Advanced Practice

2. Mississippi Nurse Practice Law
Mississippi Board of Nursing
Legally charged to protect the public by regulating the practice of Nursing.
Mississippi Nurse Practice Act defines the practice of nursing; ( )

3. Administrative Code Mississippi Board of Nursing
Mississippi Administrative Code
Title 30: Professions and Occupations
Parts 2801 – 2900
The authority of the Mississippi Board of Nursing
is to promulgate rules and regulations for the licensure of registered nurses, advanced practice registered nurses, licensed practical nurses, expanded role licensed nurses and certified hemodialysis technicians as provided for in the laws of the Miss. Code Ann. Sections (a), &

4. Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNs) in Mississippi
Registered Nurses, approximately: 45,000
APRNs account for approximately: 3751
CRNAs – 750
CNM – 56
CNP – 2,945
Special areas of concern***

5. APRNs in Mississippi – Collaboration State Law
Each APRN must have one collaborating physician who will be available to…
Review protocols/agreement.
Collaboration/ consultation at all times APRN is practicing.
Agrees to implement Quality Assurance Plan with APRN and make quarterly face to face visits with the APRN to review for QA.
Recommend a secondary collaborating physician.
Cathy

6. Quality Assurance (QA)Review
Sample size:
10% of patients seen per month or ….
20 charts (which ever is less)
Monthly review
Quarterly -sign by collaborating physician and APRN

7. MSBN QA Requirements
If APRN consulted with the collaborating physician, this will count as a review.
Put this on your log.
Keep records for seven (7) years.
QA log kept at primary practice site.

8. Protocol/Agreement
MBML wants signed protocol on site. Be sure physician reads protocol
APRN must have an agreement with a collaborating physician before practicing. (Recommend a signed copy.**)
Important that physician and APRNs reads and understands protocol/agreement.
Put a textbook with protocol in trunk of car if you are going to make home visits
If you use a book, the volume at your clinical site is the volume you are held to, so be sure to update with new editions
Takes about 14 days to process protocols
The approved verification form is mailed to NP only
Office does not fax or give verbal approvals unless it is an emergency, you cannot have unlimited emergencies

9. MSBML - Collaboration
Rule 1.2 Definitions. For the purpose of Part 2630, Chapter 1 only, the following terms have the meanings indicated:
A. “Physician” means any person licensed to practice medicine or osteopathic medicine in the state of
Mississippi who holds an unrestricted license or whose practice or prescriptive authority is not limited
as a result of voluntary surrender or legal/regulatory order.
B. “Free Standing Clinic” means a clinic or other facility wherein patients are treated by a nurse
practitioner, which is more than fifteen (15) miles away from the primary office of the
collaborative/consultative physician. Excluded from this definition are all licensed hospitals, state
health department facilities, federally qualified community health clinics and volunteer clinics.
C. “Primary Office” means the usual practice location of a physician and being the same location
reported by that physician to the Mississippi State Board of Medical Licensure and the United States
Drug Enforcement Administration.
D. “Collaborating/Consulting Physician” means a physician who, pursuant to a duly executed protocol
has agreed to collaborate/consult with a nurse practitioner.
E. “Nurse Practitioner” means any person licensed to practice nursing in the state of Mississippi and
certified by the Mississippi Board of Nursing to practice in an expanded role as a nurse practitioner.
F. “Advanced Practice Registered Nurse” includes all nurse practitioners, certified nurse midwives and certified registered nurse anesthetists.
Source: Miss.

10. APRN & Collaborating Physicians
An APRN must have a collaboration physician who has an unrestricted license in Mississippi.
Recommend backup collaborating physician.

11. APRN Practice Site
APRN must have a practice site prior to beginning practice.
This is a problem!!!

12. Collaborating Physician and APRN
Physician and APRN must have a comparable or “same “like” practice.

13. Why Not….
Joined at the “hip” does NOT meet the intent of either boards’ requirements for QA activities.

14. What’s New? MSBP – Prescription Monitoring Program
The Mississippi Prescription Monitoring Program (MS PMP) is managed by Mississippi Board of Pharmacy. The Mississippi Prescription Monitoring Program, MS PMP, is Mississippi solution for monitoring Schedule II-V controlled substances dispensed in Mississippi.
Mississippi State Statutes , and set forth the legal requirements for reporting Schedule II-V controlled substances dispensed in Mississippi for use in the PMP system. Similarly, any drug containing Ephedrine or Pseudoephedrine is to be reported as a schedule III, and any drug containing Tramadol or Butalbital is to be reported as a schedule IV.

15. Mississippi Board of Pharmacy- PMP
Information about controlled substance dispensing activities is reported regularly to the state of Mississippi through the authorized data collection vendor.
Pharmacies and other dispensers (clinics, etc.) are required by law to provide such reporting to the data collection vendor in approved formats and frequencies. This includes mail order pharmacies that routinely mail orders into the state.

16. Mississippi PMP
Mississippi began collecting information in April 2005.
Reports available to law enforcement in October 2005.
State Law – Doctor Shopping
PMPi is the Interconnect between states. Not all states are on board.
We currently share with 10 states – AR, TN, ND, AZ, IL, KS, MN, NM, MI, ID

17. MS PMP
The primary beneficiaries of Mississippi PMP are patients throughout Mississippi.
Because of the Mississippi PMP, healthcare providers can make better and more informed treatment decisions that allow them to provide the most appropriate medical care for their patients.
All Mississippi citizens ultimately benefit through improved medical care and reductions in the abuse and diversion of controlled substance prescription drugs. (Above information from Mississippi State Board of Pharmacy)

18. What is the requirement for enrolling in the Mississippi Prescription Monitoring Program (MS PMP) and how do I get enrolled?

19. Enrolled in the Mississippi Prescription Monitoring Program (PMP)
All Physicians must have been enrolled in MS PMP by December 2013.
Regulated by MS BOML.
May delegate to assist with PMP.
CNPs, CNMs and CRNAs (who work in a pain clinic only), must have been enrolled in the MS PMP by December 2014.
Regulated by MS BON.
May delegate to a licensed nurse to assist with PMP.

20. Controlled Substances
Boards of Nursing have information about state’s laws that determine if you are eligible to prescribe controlled substances (CSs).
In some states prescribing CSs may be limited to a certain APRN role such as a nurse practitioner.
In states where there is delegation of prescriptive authority or that require collaboration or supervision for APRN prescribing there may be special requirements for eligibility.

21. Why are Regulator Boards Requiring Enrollment in the PMP?
Prescription drug abuse has become the #1 healthcare problem in the nation.

22. Red Flags
Among the prescription medication frequently seized by the Mississippi Bureau of Narcotics are OxyContin, Lorazepam, hydrocodone and Xanax
*Holy Trinity

23. Why Change is Needed
Drug overdose death rates have been rising steadily since 1992 with a 102% increase from 1999 to 2010 alone.
In 2010, 30,006 (78%) of the 38,329 drug overdose deaths in the United States were unintentional, 5,298 (14%) of suicidal intent, and 2,963 (8%) were of undetermined intent.

24. Controlled Substance
In 2012, 90 percent of overdose deaths in Mississippi were caused by prescription drugs, and most were accidental.
Proper storage and disposal of medications can prevent injuries and deaths from drug abuse and drug overdoses.
Mississippi is ranked #30 nationally on drug overdose.
National Survey on Drug Use and Health, roughly 2.8 million people aged 12 or older had illegally used the prescription drug OxyContin at least once.
Mississippi has ordered opiods 6.1/10,000 with national average 7.1/10,000

25. Reason for Improvement
Health care environments are recognizing and reshaping their services to meet the needs of the transition in the cultural diversity and complexion of communities across the country.
Shifting regulatory landscape. Federal health policymakers and private foundations are making changes based on the Affordable Health Care Act.

26. Paradigm Shift Making the mistake that you think you know everything.
Individual behavior occur in context of a particular environment.
(Lee, 2006)
Tip of the iceberg.

27. Culture – Woodstock to Now

28. Barriers
Highest risk factors associated with prescription drug abuse are ….
rurality and poverty.
Where do providers work?

29. Rural and Poverty Areas
Mississippi is 46,907 square miles, (82 counties) with 60% of population living in rural areas and 20% of the population living in poverty.

30. Educate --Educate
Every eight minutes a child is treated in the ER for drug overdose (more than fatal car accidents).
Drugs are obtained from individuals “medicine cabinets”.
Education must be implemented for storage of medication correctly.

31. DEA Practitioner’s Manual
2006 Edition
Joseph T. Rannazzisi Deputy Assistant Administrator Office of Diversion Control
Mark W. Caverly Chief, Liaison and Policy Section
This manual has been prepared by the Drug Enforcement Administration, Office of Diversion Control, to assist practitioners (physicians, dentists, veterinarians, and other registrants authorized to prescribe, dispense, and administer controlled substances) in their understanding of the Federal Controlled Substances Act and its implementing regulations as they pertain to the practitioner’s profession.

32. National Investigation of Drug and Diversion Association (NIDDA)
Great example is NIDDA organization.
Nurses must be involved in order to make change.

33. Educational Classes
APRN New Graduate mandatory orientation classes implemented in October 2012.
New APRNs were losing their license to practice based on deficient controlled substance prescribing practices.

34. Schedule II, Controlled Substances
These drugs have a high potential for abuse that may lead to severe psychological or physical dependence.
Examples include:
Morphine, methadone (Dolophine®), meperidine (Demerol®), fentanyl (Duragesic®)
Oxycodone (Percocet®, Oxycontin®), hydromorphone (Dilaudid®)
Amphetamines (Dexedrine®, Adderall® ,(Ritalin®, Concerta®)
Cocaine, amobarbital and pentobarbital
Effective October 6, 2014, Hydrocodone (Examples Lortab, Norco, Vicodin, etc.) changed to a Scheduled II.

35. Documentation: Controlled Substances
Complete record of examination including-
Diagnosis
Reason for prescribing
Controlled Substance
Name
Dose
Strength
Quantity
Date
Refills (Should limit to one, however until Administrative Code changed has five)*

36. Documentation: Controlled Substances
Good faith agreement or contract.
Patient treatment goals.
Follow up.

37. Thank You for Your Kind Attention
Questions??