30 Miss. Code. R. 2630-2.4 - Board Review - Protocol Format

A. Before any physician shall execute a protocol to supervise a pharmacist in the care or consultation with a patient, or initiation and/or modification of prescription drug therapy, and/or ordering lab work, the supervising physician must jointly execute a written guideline or protocol with the pharmacist and thereafter file the same with the Mississippi State Board of Medical Licensure.

B. No protocol agreement authorizing the care or consultation with a patient, or initiation and/or modification of prescription drug therapy shall be executed by a physician unless the protocol shall meet at a minimum the following requirements:

1. Identifies the physician who agrees to supervise the pharmacist and the scope of the physician's active practice.

2. Describes the specific responsibilities authorized by the supervising physician.

3. Describes the method the pharmacist shall use to document decisions or recommendations the pharmacist makes to the supervising physician.

4. Describes the patient activities the supervising physician requires the pharmacist to monitor.

5. Describes the types of reports the supervising physician requires the pharmacist to report and the schedule by which the pharmacist is to submit these reports.

6. Includes a statement of the medication categories and the type of initiation and modification of drug therapy that the supervising physician authorizes the pharmacist to perform.

7. Describes the procedures or plan that the pharmacist shall follow if the pharmacist exercises initiation and modification of drug therapy.

8. Indicates the date the supervising physician's supervision ends. The duration of the protocol agreement shall not exceed one (1) year.

9. Be dated and signed by the pharmacist(s) and the supervising physician. If more than one physician agrees to supervise the pharmacist(s), each physician and pharmacist(s) shall sign and date the protocol.

10. Includes a statement that stipulates that the patient has been notified by the pharmacist(s) and the supervising physician that a protocol agreement exists.

11. Includes a statement which certifies that the physician(s) has advised their respective malpractice liability carriers concerning the protocol and supervisory relationship, and that any potential liability that may ensue as a result of implementing the protocol agreement, shall be covered by the malpractice liability insurance policies or endorsements thereto.

C. No protocol agreement authorizing the ordering of lab work by a pharmacist shall be executed by a physician unless the protocol shall meet at a minimum the following requirements:

1. Identifies the physician who agrees to supervise the pharmacist and the scope of the physician's active practice.

2. Describes the specific responsibilities authorized by the supervising physician, including the type of lab tests the supervising physician authorizes the pharmacist to order.

3. Describes the method the pharmacist shall use to document decisions or recommendations the pharmacist makes to the supervising physician.

4. Describes the patient activities the supervising physician requires the pharmacist to monitor.

5. Describes the types of reports the supervising physician requires the pharmacist to report and the schedule by which the pharmacist is to submit these reports.

6. Describes the procedures or plan that the pharmacist shall follow if the pharmacist orders lab tests.

7. Describes the process which the physician employs to periodically monitor the pharmacist's interpretation of the lab tests.

8. Indicates the date the supervising physician's supervision ends. The duration of the protocol agreement shall not exceed one (1) year.

9. Be dated and signed by the pharmacist(s) and the supervising physician. If more than one physician agrees to supervise the pharmacist(s), each physician and pharmacist(s) shall sign and date the protocol.

10. Includes a statement that stipulates that the patient has been notified by the pharmacist(s) and the supervising physician that a protocol agreement exists.

11. Includes a statement which certifies that the physician(s) has advised their respective malpractice liability carriers concerning the protocol and supervisory relationship, and that any potential liability that may ensue as a result of implementing the protocol agreement, shall be covered by the malpractice liability insurance policies or endorsements thereto.

Notes

30 Miss. Code. R. 2630-2.4

Miss. Code Ann. § 73-43-11 (1972, as amended).