1. (a) Any nurse practicing as a registered nurse practitioner shall practice in accordance with protocols developed in collaboration with and signed by a licensed physician.

2. (b) Protocols shall address:

   1. (1) Established procedures for the management of common medical problems in the practice setting;
   2. (2) The degree to which collaboration, independent action, and supervision are required; and

   3. (3) Acts including but not limited to:

      1. (A) Assessment;
      2. (B) Diagnosis;
      3. (C) Treatment; and
      4. (D) Evaluation.
3. (c) Protocols shall not include controlled substances.

4. (d) Documentation.

   1. (1) Orders transmitted from protocols shall be documented on the client's medical record.

   2. (2) Orders transmitted from protocols to inpatient medical records shall contain:

      1. (A) Name of medication, therapeutic device, or treatment;
      2. (B) Strength;
      3. (C) Dose;
      4. (D) Length of time or amount prescribed;
      5. (E) Directions for use;
      6. (F) RNP signature; and
      7. (G) Physician's name, printed, followed by notation "protocol".

5. (e) Any deviation from written protocols shall require:

   1. (1) A specific written or verbal order from the collaborating physician before the order is transmitted or implemented; and
   2. (2) Documentation in the medical record as specified in subdivisions (d)(2)(A) – (F) of this section and notation that order was by consultation, to be signed by the RNP.

6. (f) Review of protocols.

   1. (1) The RNP shall:

      1. (A) Document annual joint review with the licensed physician; and
      2. (B) Revise when necessary.
   2. (2) The RNP shall, upon request, provide the Arkansas State Board of Nursing with current protocols.

7. (g) Nothing in this part shall be construed to prohibit any registered nurse practitioner from:

   1. (1) Transmitting a prescription order orally or telephonically; or
   2. (2) Administering a legend drug pursuant to a lawful direction of a licensed physician, dentist, or advanced practice nurse who holds a certificate of prescriptive authority.

Codification Notes: "RNP" means registered nurse practitioner.