Articulated Plan for Full Prescriptive Authority Overview The Articulated Plan (Plan) is required for Full Prescriptive Authority and documents how the Advanced Practice Nurse with Full Prescriptive Authority (RXN) intends to maintain ongoing collaboration with physicians and other health care professionals in their community; in addition the Plan incorporates generally accepted standards for safe prescribing which guide the advanced practice nurses’ independent prescriptive practice. Essentially, the Plan is an agreement with the Colorado State Board of Nursing (Board), developed by the Advanced Practice Nurse applying for Full Prescriptive Authority (RXN), in which the RXN agrees to follow four generally accepted standards for safe prescribing as set forth in the Colorado Nurse Practice Act 12-38-111.6(4.5)(II): 1. A mechanism for consultation and referral with other health care providers for issues regarding prescriptive authority. 2. A quality assurance plan for safe prescribing. 3. Decision support tools for safe prescribing. 4. Ongoing continuing education in pharmacology and safe prescribing. The Plan is not submitted to the Board but its creation is attested to on the application for Full Prescriptive Authority, click here to access the attestation form. As an independent prescriber you must personally retain the original Plan; review the Plan annually and update the Plan when there is a change in your clinical practice setting(s) or when there is a significant change to any or all of the four prescribing standards. Please do not submit the actual Plan, annual reviews or report Plan updates to the Board, however the Plan is subject to review by the Board, and the RXN shall provide the Plan to the board upon request. For the New APN Prescriber, the Plan is required for Full Prescriptive Authority (RXN) developed by the APN with Provisional Prescriptive Authority (RXN-P) at the end of the Mentorship. The Mentorship must be completed and the Plan developed within 3 years of being granted RXN-P. The Plan must be signed by the Mentor and the RXN-P. The Mentor’s signature verifies development of the Plan and does not create an ongoing relationship with the Mentor. Once the APN has been granted RXN no further signatures are required other than the RXN’s own signature documenting Annual Reviews and Updates. For the Experienced APN Prescriber by Endorsement, the Plan is required for Full Prescriptive Authority (RXN) and must be developed within one year of the date Provisional RXN by endorsement was granted. The Plan must be signed by a Colorado licensed Advanced Practice Nurse with Full Prescriptive Authority or a physician licensed in Colorado. The one time signature verifies that the Articulated Plan has been created; the signature does not create a relationship with the RXN. No further signatures are required other than the RXN’s own signature documenting Annual Reviews and Updates. STANDARDS FOR SAFE PRESCRIBING Consultation and Referral Mechanisms: Documents a mechanism for consultation or collaboration with physicians and other appropriate health care providers and a mechanism for referral, when appropriate, to physicians and other appropriate health care providers for issues regarding prescribing and includes: • A written statement how the RXN will maintain ongoing collaboration with other health care professionals regarding issues related to prescriptive authority and safe prescribing. • A list of resources or contacts available to assist the RXN with regard to issues relating to safe prescribing and prescriptive authority and,

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A list of specific resources and contacts with physicians and other appropriate health care providers available to the RXN for consultation in regard to issues related to safe prescribing and prescriptive practice and referral sources to which the RXN can refer clients/patients.

Quality Assurance Plan for Safe Prescribing. An individualized process by which an RXN seeks to periodically evaluate the efficacy and quality of his or her prescribing practices as an independent prescriber. The Plan should include frequency of audits within an identified period of time. Processes to evaluate the quality of your prescribing practice may include, but are not limited to: • Peer review of prescribing practice. • Practice setting utilization review. • Periodic chart audits performed by RXN or independent party. • Review of prescription audits such as: o Colorado Prescription Drug Monitoring Program. o Pharmacy and Therapeutics Committee. o Prescribing critical incident reviews. Decision Support Tools. An assistive tool commonly recognized by healthcare professionals as a valid resource for information on prescribing and pharmaceutical agents to aid the RXN in making appropriate judgments regarding safe prescribing. Such tools may include, but are not limited to: • Electronic prescribing databases. • Clinical guidelines. • Evidenced-based prescribing guides. • Pharmaceutical reference guides. • Professional journals, treatises and textbooks. Ongoing Continuing Education in Pharmacology and Safe Prescribing. Such documentation shall include a personal record of the RXN’s participation in programs with content in pharmacology and safe prescribing within the RXN’s Role and, if applicable, Population Focus. Continuing education credits or certificates of completion must be awarded. The RXN shall maintain no more than five (5) years of documentation of ongoing continuing education in the Articulated Plan (use additional pages as needed). Such documentation should include: • Date • Title of program • Instructor/Presenter/Author Resources for Developing an Articulated Plan The State Board of Nursing Chapter 15 Rules and Regulation for Prescriptive Authority for Advanced Practice Registered Nurses, Section 6 sets forth the rules for developing the Articulated Plan (Plan) click here to access the Chapter 15 Rules. In addition, the Articulated Plan Template and Articulated Plan Examples have been developed to provide guidance as you create your Plan, the examples provided are neither required nor inclusive and not all of the examples will be relevant to your clinical practice.

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