Restoring in-facility prescriptive authority in 2017 was a significant win for CRNAs and patients alike, and healthcare consumers stand to benefit from enhanced services from CRNAs. The AZANA heard from many AANA members on the problems created by 'legislative snafu' that occurred in 2012.
The Problem Created in 2012:
CRNAs have long held the ability to order and prescribe controlled substances for provision of anesthesia services. In 2012, CRNAs’ scope of practice was moved from rule to statute, and rather than codifying their “prescribing authority,” the language stated that they may “issue a medication order.” This was based on a compromise approach with other stakeholder groups. This language was agreed upon because CRNAs provided in-facility prescribing, rather than the traditional prescribing medications for patients to fill at an outpatient pharmacy.
The DEA interpreted this language change in 2012 to mean that CRNAs do not have any prescribing authority (in facility or traditional), and asked for Arizona’s CRNAs to surrender their DEA numbers. Because of this inadvertent change, Arizona is the one of the only state in the country in which CRNAs cannot obtain DEA numbers, causing a slew of problems for patients and CRNAs.
The Solution AZANA Successfully Advocated for in 2017:
DEA numbers and prescribing authority are beneficial, and in some cases required, for CRNAs caring for patients in hospitals, office-based settings, and federal health agencies in Arizona. CRNAs are not, and never have been, required to have a physician "co-sign" orders, anesthetic plans, or charting, and restoring prescriptive authority provides additional evidence for what was already known about CRNA practice.
AZANA agreed that SB 1336 would not grant prescriptive authority to allow a "traditional" prescription, since this is typically the responsibility of the physician or surgeon performing the procedure or surgery.
There are 4 main areas of impact:
In hospitals, certain hospitals took the 2012 as a requirement for CRNAs to have their orders 'co-signed' by a physician. This was an improper interpretation of the statute, but none the less it occurred. Now that SB 1336 is law, these hospitals can confidently remove a barrier to timely care.
In ASCs, where CRNAs serve in a leadership position they may be asked to provide their DEA number for the facility to purchase controlled substances for administration in the perioperative period.
In office-based practices after 2012, CRNAs were prevented from ordering the needed supplies for anesthesia care, including not only medications, but basic supplies. This forced office-based CRNAs to ask the office or surgeon to order anesthesia supplies, which forced physician offices to increase their costs and order items unfamiliar to them; it created a competitive barrier for CRNAs. Now that SB 1336 is the law, CRNAs will be able to apply for DEA numbers and order the supplies they need to operate their office-based practice.
In federal health facilities, some AANA members told us they were being forced to apply for a licence and DEA number in another state, just so they could work in Arizona. This added undue burdens and costs on our members, and we took their story to the legislature. The update in scope of practice will allow these CRNAs to apply for DEA numbers and prevent them from having to pay for and gain licensure in a surrounding state; it will also incentivize these CRNAs to stay and live in Arizona.
AZANA continues in its mission to promote patient safety and our the ability of our members to offer their services to patients. Passing SB 1336 and restoring prescriptive authority is one more "win" for both patients and CRNAs.