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4731-4-02 Supplemental functions.
(A)
A supplemental physician assistant utilization plan is required for all
functions beyond the scope of the services authorized under a standard
utilization plan. Functions that
may be approved pursuant to a supplemental physician assistant utilization plan
include, but are not limited to, the following:
(1)
Insertion of central venous catheter under direct supervision;
(2)
Emergency insertion of chest tube under direct supervision;
(3)
Removal of chest tube;
(4)
Removal of intra-aortic balloon pump;
(5) Removal of norplant capsules;
(6) Performance of non invasive cardiovascular studies;
(7) Performance of penile duplex ultrasound;
(8)
Removal of Swan-Ganz catheter;
(9)
Change of tracheostomy more than 72 hours after placement;
(10)
Performance
of bone marrow aspirations from the posterior iliac crest;
(11)
Performance
of bone marrow IV infusion;
(12)
Performance
of bone marrow biopsy from the posterior iliac crest;
(13)
Performance
of cystogram;
(14)
Performance
of nephrostogram after physician placement of nephrostomy tube;
(15) Performance
of urodynamic studies under direct supervision;
(16) Instillation
of intravesical chemotherapeutic agents using agents as ordered by the
supervising physician;
(17) Fitting/insertion
of family planning devices other than IUD (e.g., diaphragms, cervical caps);
(18) Removal
of cervical polyps;
(19) Performance
of nerve conduction testing with onsite supervision;
(20) Insertion
of IUD;
(21) Performance
of endometrial biopsy;
(22) Insertion
of arterial lines in the operating room suite or intensive care unit;
(23) Insertion
of filliform and follower catheters;
(24) Performance
of diagnostic arthrocentesis of the
knee;
(25) Performance
of endotracheal intubation with successful completion of an ACLS course;
(26)
Vein
and artery harvesting as part of cardiovascular surgery using open or endoscopic
techniques;
(27)
Performance
of lumbar punctures;
(28)
Dislocation
reduction of fingers or toes; and
(29)
Application
of light based medical devices for the purpose of hair removal.
(B)(1) The Board
will consider on a case by case basis supplemental functions, including those
functions listed in paragraph (A), submitted for approval as part of a
supplemental physician assistant utilization plan application. The application shall include, but shall not be limited to, the following information for the
board’s consideration:
(a)
Documentation of the supervising physician’s normal course of practice,
and experience and training to perform the requested supplemental function, to
include whether the supervising physician is board certified;
(b)
Documentation of the privileges held by the supervising physician for the
prior five years at each health care facility in which the physician holds or
has held privileges;
(c)
The minimum education, training and experience which will be required for
any physician assistant serving under the plan;
(d)
The location or locations in which the function will be performed;
(e) If the function will be performed in any health care facility, including
a hospital, ambulatory surgical center, or similar facility, the credentialing
criteria the health care facility will use in granting privileges for the
specific function to be performed by the physician assistant
and the peer review process the facility will utilize to review the
performance of that function;
(f)
The level of supervision under which the function will be performed;
(g)
The quality assurance process that will apply to the physician assistant
that shall, at a minimum, document each time the procedure is performed, the
outcome, the regular review of such documentation by the supervising physician
and plans for ongoing performance improvement.
(2)
If the function is not listed in paragraph (A) of this rule, the
application shall also include the following information for the board’s
consideration:
(a) If the function will be performed in any health care facility, including
a hospital, ambulatory surgical center, or similar facility, the number of
procedures per year the health care facility requires the supervising physician
to perform in order to maintain privileges to perform the function;
(b)
If the function will be performed in any health care facility, including
a hospital, ambulatory surgical center, or similar facility, the number of
procedures per year the health care facility requires the physician assistant to
perform in order to maintain privileges to perform the function;
(c)
Any formal postgraduate physician assistant training that will be
provided to the physician assistant and the minimum number of procedures
performed under the direct observation of the board approved supervising
physician trainer in order to be certified by that physician trainer as
competent;
(d)
If the function is a diagnostic procedure, whether a permanent visual
record is maintained for the supervising physician’s review and
interpretation;
(e)
A listing of all significant complications associated with the requested
procedure and the processes in place to document and address those
complications, should they occur;
(f)
Any peer-reviewed articles on physician assistant or other ancillary
personnel performance of the requested function and rate of complications. (3)
The board may take the following factors into consideration:
(a)
The need for complex observations or critical decision making during the
performance of the task;
(b)
The complications to be expected if the task is not performed properly;
(c)
Whether medical judgment requiring the exclusive expertise and training
of a physician must ordinarily be exercised during the performance of the
function; and,
(d)
Whether the performance of the function is otherwise prohibited by
statute or rule.
(C)
When the board approves a function not listed in paragraph (A) of this
rule, it may require that the supervising physician submit quarterly reports for
one year following the date the function was approved by the board. The reports shall list the number of times such procedure was
performed by the physician assistant, and any complications that occurred.
Effective: 10/31/00 |
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