Public Health Law Map - Beta 5 - Medical and Public Health Law Site

the physician is directly supervising the nurse’s work. The satisfactory completion of
the nurse’s work will be documented as part of the operative report.
In office practice, neither the voice orders nor their satisfactory completion will
necessarily be documented in the patient’s chart. This makes it difficult to determine
whether the physician has given a direct order, or the NPPs are acting out of routine.
Unless these routine actions are carried out according to a strict protocol, the
physician will not be able to ensure that the proper nursing functions have been
carried out. If the physician is sued over a question about the nurse’s actions, there
will be no record to establish what was done to the patient.
a) NPP Protocols: Strict Protocols
Protocols that are used to allow NPPs to do tasks that are generally reserved for
licensed physicians must be much more rigid and specific than physician protocols
or teaching protocols. The exercise of medical judgment remains with the
physician who authorized the protocols. The NPP must follow the protocol to the
letter, without deviation or the exercise of independent judgment. If state law
allows NPPs to practice medicine without supervision, strict protocols are not
necessary, but even in such a state, strict protocols are desirable for risk
management, quality assurance, and compliance with federal laws.
9. Sample Protocol
This section works through a sample protocol (see Appendix 10–A) for strep throat
to aid readers in understanding how to produce and use legal strict protocols for
NPPs. In some states it may not be necessary for NPPs to act under strict protocol.
Nevertheless, in any jurisdiction, physicians should use caution in authorizing
practice by nonphysicians without strict protocols.
a) Diagnostic Criteria
This section defines the condition that triggers the use of the particular protocol.
There may be more than one set of criteria that trigger the same protocol. The
criteria will be very specific. A differential diagnosis has no place in a strict
protocol:
Diagnostic Criteria for Strep Throat
1. Positive strep culture or rapid strep test on pharyngeal swab
2. Sore throat or cervical adenopathy in a household or day care contact to a
laboratory- confirmed case of strep throat
3. Asymptomatic member of a household with two or more laboratory- confirmed
cases of strep throat
408