1. (a) The APRN, applying for a certificate of prescriptive authority, shall:

   1. (1) Acknowledge in the application that he or she is familiar with all state and federal laws and rules regarding prescribing; and
   2. (2) Agree to comply with these laws and rules.

2. (b)

   1. (1) An advanced practice registered nurse with a certificate of prescriptive authority may receive and prescribe legend drugs, medicines, or therapeutic devices appropriate to the APRN’s area of practice.

   2. (2) The prescriptive authority for controlled drugs shall extend to:

      1. (A) Drugs listed in Schedules II – V; and
      2. (B) Hydrocodone combination products, which were reclassified from Schedule III to Schedule II as of October 6, 2014.

3. (c) Prescribing stipulations are as follows:

   1. (1) Legend drugs, therapeutic devices, controlled substances (Schedules II–V), and hydrocodone combination products, which were reclassified from Schedule III to Schedule II as of October 6, 2014, will be prescribed, administered, or ordered as established in protocols provided that the APRN has an assigned Drug Enforcement Administration registration number that is entered on each written prescription for a controlled substance;

   2. (2) Except as provided below, the APRN shall provide a prescription for an opioid antagonist when prescribing or dispensing an opioid when the patient doesn’t have an existing prescription for an opioid antagonist and:

      1. (A) The opioid dosage prescribed is equal to or in excess of fifty morphine milligram equivalents (50 MME) per day;
      2. (B) A benzodiazepine has been prescribed for the patient in the past or will be prescribed at the same time as the opioid; or
      3. (C) The patient has a history of opioid use disorder or drug overdose;
   3. (3) The APRN may directly or by standing order prescribe, dispense, and supply an opioid antagonist to any person authorized in Arkansas Code § 20-13-1804;
   4. (4) The APRN shall provide patient counseling that addresses the use of an opioid antagonist for overdose prevention;
   5. (5) Prescribing an opioid antagonist does not apply to a patient receiving hospice or other end-of-life care;
   6. (6) If a healthcare professional does not believe that it is in the best interest of a patient to coprescribe an opioid antagonist, the APRN shall document in the medical record the reasons for not coprescribing the opioid antagonist;

   7. (7)

      1. (A) Except for hydrocodone combination products, the APRN shall not prescribe Schedule II opioids for more than a five-day period.
      2. (B) If additional Schedule II opioids are needed for management of pain, the patient shall be referred to a physician;

   8. (8) The APRN is authorized to prescribe Schedule II drugs that are classified as stimulants once the following criteria are met:

      1. (A) The prescription was originally initiated by a physician;
      2. (B) The physician has evaluated the patient within six (6) months before the APRN issues a prescription; and
      3. (C) The prescription by the APRN is to treat the same condition as the original prescription;
   9. (9) The APRN shall not prescribe Schedule II controlled substances for his or her own use or for the use of his or her immediate family;
   10. (10) The APRN shall file his or her Drug Enforcement Administration registration number with the Arkansas State Board of Nursing upon receipt;
   11. (11) Advanced practice registered nurses shall not delegate to unlicensed ancillary staff the calling in of prescriptions to the pharmacy; and

   12. (12)

       1. (A) The APRN who does not have full practice authority shall notify the board in writing within seven (7) days following termination of the collaborative practice agreement.
       2. (B) A new collaborative practice agreement is required to be on file prior to reactivating prescriptive authority.

4. (d)

   1. (1) The APRN who does not have full practice authority may prescribe a legend drug, medicine, or therapeutic devices not included in the written protocols only as follows:

      1. (A) Upon a specific written or verbal order obtained from a physician or podiatrist before the prescription or order is issued by the APRN; and
      2. (B) Include documentation of consultation as described above in the client’s medical record to be signed by the APRN.
   2. (2) Schedule I controlled substances shall not be prescribed under the APRN’s certificate of prescriptive authority.

5. (e) The APRN shall note prescriptions on the client’s medical record and include the following information:

   1. (1) Medication and strength;
   2. (2) Dose;
   3. (3) Amount prescribed;
   4. (4) Directions for use;
   5. (5) Number of refills; and
   6. (6) Initials or signature of APRN.

6. (f) The APRN will keep accurate records to include:

   1. (1) The medical history;
   2. (2) Physical examination;
   3. (3) Other evaluations and consultations;
   4. (4) Treatment plan objective;
   5. (5) Informed consent noted in the patient record;
   6. (6) Treatment;
   7. (7) Medications given;
   8. (8) Agreements with the patient; and
   9. (9) Periodic reviews.

7. (g)

   1. (1) The APRN will periodically review the course of scheduled drug treatment of the patient and any new information about etiology of the pain.

   2. (2) If the patient has not improved, the APRN may assess the appropriateness of:

      1. (A) Continued prescribing of scheduled medications or dangerous drugs; or
      2. (B) Trial of other modalities.

8. (h) The APRN will:

   1. (1) Obtain written informed consent from those patients he or she is concerned may abuse controlled substances; and

   2. (2) Discuss the risks and benefits of the use of controlled substances with:

      1. (A) The patient; or
      2. (B) His or her guardian or authorized representatives.
9. (i) Advanced practice registered nurses in the category of certified registered nurse anesthetists shall not be required to have prescriptive authority to provide anesthesia care, including the administration of drugs or medicines necessary for such care.

10. (j) Advanced practice registered nurses who prescribe prior to obtaining a certificate of prescriptive authority shall be:

    1. (1) Considered illegal practitioners; and
    2. (2) Subject to the penalties provided for violation of the Nurse Practice Act.

Codification Notes: “APRN” means advanced practice registered nurse.