FNP Family Nurse Practitioner or PA Physician Assistant - Urgent Care

Physician Assistant or FNP/ NURSE PRACTITIONER RESPONSIBILITIES AND STANDARDIZED PROCEDURES

This document establishes the legal authority for the PA or NP role AFC Urgent Care Ladera Ranch or Anaheim, to perform certain functions and procedures conducted at an Urgent Care Clinic.

These standardized procedures are in accordance with the Nurse Practice Act and PA Act  in the California Business and Professions 

AUTHORIZED PROCEDURES AND DUTIES

The Nurse Practitioner or Physician Assistant is authorized to do the following patient related activities without the Physician’s approval or observation:

● Obtain patient medical history and perform physical examinations for presenting problem(s) within the established scope of practice

• Perform DOT and Other Physicals as needed 

● Laboratory tests: Blood finger sticks, throat swabs, nasal swabs, skin/wound swabs for culture, swabs for STI testing, urine tests, hemoccult test, and serum blood draws. This also includes all Clia-Waived laboratory tests offered as POC testing at AFC Urgent Care Ladera Ranch.

● Counsel patients and their families on health promotion, diagnosis, and medical management

● Evaluate, diagnose, and treat conditions within the established scope of practice

● Maintaining medical records in electronic medical record

● EKG

● X-Ray

○ Initial soft read

● Spirometry

● Audiometry

● IV placement

● Administration of IV medication

● IM injection of medications

● Administration of Vaccines

AUTHORIZED DIAGNOSIS AND MANAGEMENT

Nurse Practitioners and Physican Assistant are authorized to evaluate, diagnose, and treat minor medical injuries and illness for adults and children over the age of two weeks including but not limited to:

● Animal Bites (minor)

● Ear infections

● Otitis Externa

● Otitis Media

● Eye disorders

● Blepharitis

● Chalazion

● Conjunctivitis

● Hordeolum

● Headaches (minor)

● Sinusitis

● Health screening

○ Blood pressure evaluation/treatment

○ Diabetes screening/treatment

○ Pregnancy screening (urine test)

○ STI screening/treatment

● Respiratory disorders

○ Allergic rhinitis

○ Covid

○ Bronchitis

○ Influenza

○ Pharyngitis

○ Pneumonia

○ Viral URI

○ RSV

● Skin, hair, and soft tissue disorders

○ Acne

○ Burns (minor)

○ Cellulitis

○ Dermatitis

○ Herpes Simplex

○ Impetigo

○ Insect bites and stings

○ Pediculosis

○ Tinea pedis

○ Tinea corpus

○ Laceration evaluation and repair

• Simple Interrupted

• Running Stitch

• Corner Stitch

● Strains and sprains (minor)

○ To include all extremities and trunk/back/neck

• Splinting/sling

● Urinary tract infection

○ Male and Female

The Nurse Practitioner is authorized to diagnose and prescribe under the protocols established in this document without the direct (on-site) supervision or approval of the delegating or alternate Physicians.

EMERGENCY CARE

Whenever necessary, the Nurse Practitioner shall attempt to sustain life. This includes, but is not limited to:

● Establishing and maintaining airway

● Assist breathing

● Cardiopulmonary resuscitation

● Control of hemorrhage by external pressure

● Injection (subcutaneous) of epinephrine for anaphylactic shock

● MD must be made aware of all patients requiring ER follow up/care

AUTHORIZATION TO FURNISH DRUGS AND DEVICES

The Nurse Practitioner may order/prescribe drugs and medical devices pursuant to B&P Code Section 2836.1 and must include the following criteria:

● Include the furnisher’s name and furnishing number on the prescription transmittal order form for drugs, devices, or both. Prescription pads and electronic prescription may be used as a transmittal order form as long as they contain the furnisher’s name and furnishing number. The NP’s DEA number is also required on the prescription transmittal form for Schedule II, III, IV, or V controlled substance.

● The drugs and devices furnished by Nurse Practitioners are in accordance with the standardized procedures, and established formulary.

● California law (Health and Safety Code Section 11165.1) requires all California licensed prescribers authorized to prescribe scheduled drugs to register for access to CURES 2.0 by July 1, 2016 or upon issuance of a Drug Enforcement Administration Controlled Substance Registration Certificate, whichever occurs later.

● California Law (Health and Safety Code Section 11165.4) requires all California authorized licensed prescribers of scheduled drugs to consult CURES prior to prescribing, ordering, administering, or furnishing a Schedule II–IV controlled substance:

○ The first time a patient is prescribed, ordered, administered, or furnished a controlled substance, unless one of the exemptions below apply. For purposes of this paragraph, “first time” means the initial occurrence in which a health care practitioner, in his or her role as a health care practitioner, intends to prescribe, order, administer, or furnish a Schedule II, Schedule III, or Schedule IV controlled substance to a patient and has not previously prescribed a controlled substance to the patient.

○ Within the twenty-four hour period, or the previous business day, before prescribing, ordering, administering, or furnishing a controlled substance, unless one of the exemptions below apply.

○ Before subsequently prescribing a controlled substance, if previously exempt.

○ At least once every four months if the controlled substance remains a part of the patient’s treatment plan.

○ California Law (Health and Safety Code Section 11165.4) states a health care practitioner is exempt from consulting the CURES database before prescribing, ordering, administering, or furnishing a controlled substance in any of the following circumstances related to our practice:

■ The patient is receiving hospice care

The Nurse Practitioner may accept, sign for and distribute prescription drug samples.

STANDARDS FOR CARE

Standards for adequacy of diagnosis, management, and treatment shall be consistent in accordance with the standardized procedures established at AFC Urgent Care Ladera Ranch, 27522 Antonio Pkwy, ste P3, Ladera ranch, CA 92694.

Protocols for the Management of General Health Status and Wellness exam:

● Subjective data

○ Patient concerns noted

○ Health and Social History

■ Established patients

■ Interval History

■ New patients

■ Past health history via interview, previous medical records

■ Recent interval history

○ Symptoms relevant to any chronic/acute disease process

○ Present status of current symptom(s)

● Objective data

○ Physical exam addresses chief complaint

○ Appropriate lab tests performed

● Assessment

○ Consistent with subjective and objective findings

○ Assessment of the status of any acute/chronic diagnosis

● Treatment

○ Supportive measures that are appropriate to health maintenance, i.e., immunizations, screening measures, age-related anticipatory guidance, patient education regarding health care

○ Referral to appropriate specialty

○ Addressing patient concerns

○ Guidelines for follow-up

○ Consultations

Protocol for Management of Common Acute Illness

● Subjective data:

○ Symptoms relevant to the acute illness and organ systems affected. Status of current symptoms, i.e., duration, frequency, and in relation to chronic, underlying health problems

● Objective data

○ Physical exam appropriate to acute illness signs and symptoms

○ Laboratory testing as appropriate

● Assessment

○ Consistent with subjective and objective findings

● Treatment

○ Supportive measures that are appropriate to the patient’s illness

○ Education regarding administering medications if indicated

○ Guidelines for follow-up

○ Consultations

Protocol for the Management of Chronic Illness:

● Subjective data

○ Symptoms relevant to the chronic disease process and organ systems affected

○ Status of current symptom(s), i.e., present stable or absent

● Objective data

○ Physical examination appropriate to the disease process

○ Laboratory evaluation as appropriate

● Assessment

○ Consistent with subjective and objective findings expected with diagnosis

○ Status of chronic disease

● Treatment

○ Initiation or manipulation of prescriptive medication

○ Patient education regarding the administration of prescription medication

○ Referral for physical, occupational, or psychological therapy if appropriate

○ Diet and exercise prescription as indicated by the disease process and patient condition

○ Guidelines for follow-up

○ Consultations

To perform the roles in these standardized procedures, the Nurse Practitioner must have:

● Possession of a valid California license as a Registered Nurse Certification by the state of California, Board of Registered Nursing, as a Nurse Practitioner

● Possession of a valid Furnishing Number from the State of California

● Possession of valid DEA license

● Master’s Degree in Nursing

● National certification as a Nurse Practitioner within six months of hire

● Continuing competence shall be evaluated by regular review of patient care provided by the Nurse Practitioner. The scope of supervision for the performance of the functions named in the procedure shall include:

● Regular chart review by collaborating Physicians

CONSULTATION AND REFERRAL

Consulting Supervising Physician should be available to the Nurse Practitioner by direct on-site, phone or via electronic means. Communication with a Physician should be sought for the following situations and others deemed appropriate:

● Emergent conditions requiring prompt medical intervention

● Emergent conditions requiring referral to the ER for management

● Acute decompensation of patient situation or condition

● Increase in severity of symptoms after initial treatment

● Unexplained historical, physical or laboratory findings

● Upon request of patient, Nurse Practitioners, or Physician

● Initiation of medication regimes which are currently not defined as “standard of care” dependent upon diagnosis

● Patient contacts and visits not in accordance with standardized practice and/or facility policy

● Review of specific management guidelines and complications related to treatment of disease process less familiar to the Nurse Practitioner

When a Physician is consulted, a notation, including the Physician’s name, should be noted in the chart.

SITE

The Nurse Practitioners shall perform these functions AFC Urgent Care Ladera Ranch, 27522 Antonio Pkwy, ste P3, Ladera ranch, CA 92694,.

MEDICAL RECORDS

Electronic medical records shall include the chief complaint; history; review of pertinent systems; objective findings; lab results; assessment; differential diagnoses as needed; and management plan. Management may include prescriptions, procedures, patient education, and referrals. Medical records shall be completed within 72 hours of an encounter and remain confidential.