(a) An APRN with full licensure and a valid prescriptive authorization number may order or prescribe a drug or device at a facility based practice pursuant to a prescriptive authority agreement or through protocols or other written authorization developed in accordance with facility medical staff policies.      
        (1) If ordering or prescribing at a facility based practice pursuant to a prescriptive authority agreement, the APRN must maintain a prescriptive authority agreement that meets the requirements of §222.5 (relating to Prescriptive Authority Agreement) of this chapter.       
        (2) If ordering or prescribing at a facility based practice pursuant to protocols or other written authorization developed in accordance with facility medical staff policies, the APRN must:                  (A) review the authorizing documents with the appropriate medical staff at least annually;                   (B) order or prescribe drugs and devices in a hospital based facility in which the delegating physician is the medical director, the chief of medical staff, the chair of the credentialing committee, or a department chair, or a physician who consents to the request of the medical director or chief of the medical staff to delegate;                   (C) order or prescribe drugs and devices in a long term care facility in which the delegating physician is the medical director; and                   (D) order or prescribe drugs and devices for the care or treatment of only those patients for whom physicians have given their prior consent.         
      (b) Protocols or other written authorization is authorization to provide medical aspects of patient care that are agreed upon and signed by the APRN and the physician, reviewed and signed at least annually, and maintained in the practice setting of the APRN. Protocols or other written authorization shall be defined to promote the exercise of professional judgment by the APRN commensurate with his/her education and experience. Protocols or other written authorization need not describe the exact steps that the APRN must take with respect to each specific condition, disease, or symptom and may state types or categories of drugs or devices that may be ordered or prescribed.     
      (c) A facility based physician may not be prohibited from delegating the prescribing or ordering of drugs or devices to an APRN under §157.0512, Occupations Code or §222.5 of this chapter at other practice locations, including hospitals or long term care facilities, provided that the delegation at those locations complies with all of the requirements of §157.0512 and §222.5 of this chapter.     
     Source Note:        The provisions of this §222.6 adopted to be effective November 20, 2013, 38 TexReg 8212