(a) Acts that may be delegated. One or more physicians licensed by the board shall be authorized to delegate, to one or more physician assistants or advanced practice registered nurses acting under adequate physician supervision whose practice is facility-based at a hospital or licensed long-term care facility, prescribing or ordering of a drug or device if each of the physicians is: the medical director or chief of medical staff of the facility in which the physician assistant or advanced practice registered nurse practices, the chair of the facility's credentialing committee, a department chair of a facility department in which the physician assistant or advanced practice registered nurse practices, or a physician who consents to the request of the medical director or chief of medical staff to delegate the prescribing or ordering of a drug or device at the facility in which the physician assistant or advanced practice registered nurse practices.
(b) The limitations on the number of advanced practice registered nurses or physician assistants to whom a physician may delegate under §193.7(d) of this title (relating to Prescriptive Authority Agreements Generally) do not apply to a physician whose practice is facility-based under this chapter, subject to the limitations in subsection (c)(4) of this section.
(c) Limitations on authority to delegate. A physician's authority to delegate under this subsection is limited as follows:
  (1) the delegation is pursuant to a physician's order, standing medical order, standing delegation order, or other order or protocol developed in accordance with policies approved by the facility's medical staff or a committee thereof as provided in facility bylaws;
  (2) the delegation occurs in the facility in which the physician is the medical director, the chief of medical staff, the chair of the credentialing committee, a department chair, or a physician who consents to delegate under §157.054(a)(4) of the Act;
  (3) the delegation does not permit the prescribing or ordering of a drug or device for the care or treatment of the patients of any other physician without the prior consent of that physician;
  (4) delegation in a long-term care facility must be by the medical director and the medical director is limited to delegating the prescribing or ordering of a drug or device to no more than seven advanced practice registered nurses or physician assistants or their full-time equivalents; and
  (5) under this section, a facility-based physician may not delegate at more than one hospital or more than two long-term care facilities pursuant to §157.054 of the Act; however, facility-based physicians are not prohibited from delegating the prescribing or ordering or drugs or devices under §157.0512 of the Act or §193.7 and §193.8 of this title (relating to Prescriptive Authority Agreements Generally and Prescriptive Authority Agreements: Minimum Requirements), at other practice locations, including hospital or long-term care facilities, provided that the delegation at those locations complies with all requirements under §157.0512 of the Act.
  (6) Physician supervision. Physician supervision of the prescribing or ordering of a drug or device shall conform to what a reasonable, prudent physician would find consistent with sound medical judgment but may vary with the education and experience of the advanced practice registered nurse or physician assistant. A physician shall provide continuous supervision, but the constant physical presence of the physician is not required.

Source Note: The provisions of this §193.9 adopted to be effective November 7, 2013, 38 TexReg 7711