A. A practitioner of medicine, osteopathy, podiatry, dentistry, or veterinarymedicine or a licensed nurse practitioner pursuant to § 54.1-2957.01, alicensed physician assistant pursuant to § 54.1-2952.1, or a TPA-certifiedoptometrist pursuant to Article 5 (§ 54.1-3222 et seq.) of Chapter 32 of thistitle shall only prescribe, dispense, or administer controlled substances ingood faith for medicinal or therapeutic purposes within the course of hisprofessional practice.
B. The prescribing practitioner's order may be on a written prescription orpursuant to an oral prescription as authorized by this chapter. Theprescriber may administer drugs and devices, or he may cause them to beadministered by a nurse, physician assistant or intern under his directionand supervision, or he may prescribe and cause drugs and devices to beadministered to patients in state-owned or state-operated hospitals orfacilities licensed as hospitals by the Board of Health or psychiatrichospitals licensed by the Department of Behavioral Health and DevelopmentalServices by other persons who have been trained properly to administer drugsand who administer drugs only under the control and supervision of theprescriber or a pharmacist or a prescriber may cause drugs and devices to beadministered to patients by emergency medical services personnel who havebeen certified and authorized to administer such drugs and devices pursuantto Board of Health regulations governing emergency medical services and whoare acting within the scope of such certification. A prescriber may authorizea licensed respiratory care practitioner as defined in § 54.1-2954 toadminister by inhalation controlled substances used in inhalation orrespiratory therapy.
C. Pursuant to an oral or written order or standing protocol, the prescriber,who is authorized by state or federal law to possess and administerradiopharmaceuticals in the scope of his practice, may authorize a nuclearmedicine technologist to administer, under his supervision,radiopharmaceuticals used in the diagnosis or treatment of disease.
D. Pursuant to an oral or written order or standing protocol issued by theprescriber within the course of his professional practice, such prescribermay authorize registered nurses and licensed practical nurses to possess (i)epinephrine for administration in treatment of emergency medical conditionsand (ii) heparin and sterile normal saline to use for the maintenance ofintravenous access lines.
Pursuant to the regulations of the Board of Health, certain emergency medicalservices technicians may possess and administer epinephrine in emergencycases of anaphylactic shock.
E. Pursuant to an oral or written order or standing protocol issued by theprescriber within the course of his professional practice, such prescribermay authorize licensed physical therapists to possess and administer topicalcorticosteroids, topical lidocaine, and any other Schedule VI topical drug.
F. Pursuant to an oral or written order or standing protocol issued by theprescriber within the course of his professional practice, such prescribermay authorize licensed athletic trainers to possess and administer topicalcorticosteroids, topical lidocaine, or other Schedule VI topical drugs, or topossess and administer epinephrine for use in emergency cases of anaphylacticshock.
G. Pursuant to an oral or written order or standing protocol issued by theprescriber within the course of his professional practice, and in accordancewith policies and guidelines established by the Department of Health pursuantto § 32.1-50.2, such prescriber may authorize registered nurses or licensedpractical nurses under the immediate and direct supervision of a registerednurse to possess and administer tuberculin purified protein derivative (PPD)in the absence of a prescriber. The Department of Health's policies andguidelines shall be consistent with applicable guidelines developed by theCenters for Disease Control and Prevention for preventing transmission ofmycobacterium tuberculosis and shall be updated to incorporate anysubsequently implemented standards of the Occupational Safety and HealthAdministration and the Department of Labor and Industry to the extent thatthey are inconsistent with the Department of Health's policies andguidelines. Such standing protocols shall explicitly describe the categoriesof persons to whom the tuberculin test is to be administered and shallprovide for appropriate medical evaluation of those in whom the test ispositive. The prescriber shall ensure that the nurse implementing suchstanding protocols has received adequate training in the practice andprinciples underlying tuberculin screening.
The Health Commissioner or his designee may authorize registered nurses,acting as agents of the Department of Health, to possess and administer, atthe nurse's discretion, tuberculin purified protein derivative (PPD) to thosepersons in whom tuberculin skin testing is indicated based on protocols andpolicies established by the Department of Health.
H. Pursuant to a written order or standing protocol issued by the prescriberwithin the course of his professional practice, such prescriber mayauthorize, with the consent of the parents as defined in § 22.1-1, anemployee of a school board who is trained in the administration of insulinand glucagon to assist with the administration of insulin or administerglucagon to a student diagnosed as having diabetes and who requires insulininjections during the school day or for whom glucagon has been prescribed forthe emergency treatment of hypoglycemia. Such authorization shall only beeffective when a licensed nurse, nurse practitioner, physician or physicianassistant is not present to perform the administration of the medication.
I. A prescriber may authorize, pursuant to a protocol approved by the Boardof Nursing, the administration of vaccines to adults for immunization, when apractitioner with prescriptive authority is not physically present, by (i)licensed pharmacists, (ii) registered nurses, or (iii) licensed practicalnurses under the immediate and direct supervision of a registered nurse. Aprescriber acting on behalf of and in accordance with established protocolsof the Department of Health may authorize the administration of vaccines toany person by a pharmacist, nurse, certified emergency medicaltechnician-intermediate, or emergency medical technician-paramedic under thedirection of an operational medical director when the prescriber is notphysically present. Emergency medical services personnel shall providedocumentation of the vaccines to be recorded in the Virginia ImmunizationInformation System.
J. A dentist may cause Schedule VI topical drugs to be administered under hisdirection and supervision by either a dental hygienist or by an authorizedagent of the dentist.
Further, pursuant to a written order and in accordance with a standingprotocol issued by the dentist in the course of his professional practice, adentist may authorize a dental hygienist under his general supervision, asdefined in § 54.1-2722, to possess and administer topical oral fluorides,topical oral anesthetics, topical and directly applied antimicrobial agentsfor treatment of periodontal pocket lesions, as well as any other Schedule VItopical drug approved by the Board of Dentistry.
In addition, a dentist may authorize a dental hygienist under his directionto administer Schedule VI nitrous oxide and oxygen inhalation analgesia and,to persons 18 years of age or older, Schedule VI local anesthesia.
K. Pursuant to an oral or written order or standing protocol issued by theprescriber within the course of his professional practice, such prescribermay authorize registered professional nurses certified as sexual assaultnurse examiners-A (SANE-A) under his supervision and when he is notphysically present to possess and administer preventive medications forvictims of sexual assault as recommended by the Centers for Disease Controland Prevention.
L. This section shall not prevent the administration of drugs by a person whohas satisfactorily completed a training program for this purpose approved bythe Board of Nursing and who administers such drugs in accordance with aprescriber's instructions pertaining to dosage, frequency, and manner ofadministration, and in accordance with regulations promulgated by the Boardof Pharmacy relating to security and record keeping, when the drugsadministered would be normally self-administered by (i) an individualreceiving services in a program licensed by the Department of BehavioralHealth and Developmental Services; (ii) a resident of the VirginiaRehabilitation Center for the Blind and Vision Impaired; (iii) a resident ofa facility approved by the Board or Department of Juvenile Justice for theplacement of children in need of services or delinquent or alleged delinquentyouth; (iv) a program participant of an adult day-care center licensed by theDepartment of Social Services; (v) a resident of any facility authorized oroperated by a state or local government whose primary purpose is not toprovide health care services; (vi) a resident of a private children'sresidential facility, as defined in § 63.2-100 and licensed by the Departmentof Social Services, Department of Education, or Department of BehavioralHealth and Developmental Services; or (vii) a student in a school forstudents with disabilities, as defined in § 22.1-319 and licensed by theBoard of Education.
M. Medication aides registered by the Board of Nursing pursuant to Article 7(§ 54.1-3041 et seq.) of Chapter 30 may administer drugs that would otherwisebe self-administered to residents of any assisted living facility licensed bythe Department of Social Services. A registered medication aide shalladminister drugs pursuant to this section in accordance with the prescriber'sinstructions pertaining to dosage, frequency, and manner of administration;in accordance with regulations promulgated by the Board of Pharmacy relatingto security and recordkeeping; in accordance with the assisted livingfacility's Medication Management Plan; and in accordance with such otherregulations governing their practice promulgated by the Board of Nursing.
N. In addition, this section shall not prevent the administration of drugs bya person who administers such drugs in accordance with a physician'sinstructions pertaining to dosage, frequency, and manner of administrationand with written authorization of a parent, and in accordance with schoolboard regulations relating to training, security and record keeping, when thedrugs administered would be normally self-administered by a student of aVirginia public school. Training for such persons shall be accomplishedthrough a program approved by the local school boards, in consultation withthe local departments of health.
O. In addition, this section shall not prevent the administration of drugs bya person to a child in a child day program as defined in § 63.2-100 andregulated by the State Board of Social Services or the Child Day CareCouncil, provided such person (i) has satisfactorily completed a trainingprogram for this purpose approved by the Board of Nursing and taught by aregistered nurse, licensed practical nurse, doctor of medicine or osteopathicmedicine, or pharmacist; (ii) has obtained written authorization from aparent or guardian; (iii) administers drugs only to the child identified onthe prescription label in accordance with the prescriber's instructionspertaining to dosage, frequency, and manner of administration; and (iv)administers only those drugs that were dispensed from a pharmacy andmaintained in the original, labeled container that would normally beadministered by a parent or guardian to the child.
P. In addition, this section shall not prevent the administration ordispensing of drugs and devices by persons if they are authorized by theState Health Commissioner in accordance with protocols established by theState Health Commissioner pursuant to § 32.1-42.1 when (i) the Governor hasdeclared a disaster or a state of emergency or the United States Secretary ofHealth and Human Services has issued a declaration of an actual or potentialbioterrorism incident or other actual or potential public health emergency;(ii) it is necessary to permit the provision of needed drugs or devices; and(iii) such persons have received the training necessary to safely administeror dispense the needed drugs or devices. Such persons shall administer ordispense all drugs or devices under the direction, control and supervision ofthe State Health Commissioner.
Q. Nothing in this title shall prohibit the administration of normallyself-administered drugs by unlicensed individuals to a person in his privateresidence.
R. This section shall not interfere with any prescriber issuing prescriptionsin compliance with his authority and scope of practice and the provisions ofthis section to a Board agent for use pursuant to subsection G of §18.2-258.1. Such prescriptions issued by such prescriber shall be deemed tobe valid prescriptions.
S. Nothing in this title shall prevent or interfere with dialysis caretechnicians or dialysis patient care technicians who are certified by anorganization approved by the Board of Health Professions or personsauthorized for provisional practice pursuant to Chapter 27.01 (§ 54.1-2729.1et seq.) of this title, in the ordinary course of their duties in aMedicare-certified renal dialysis facility, from administering heparin,topical needle site anesthetics, dialysis solutions, sterile normal salinesolution, and blood volumizers, for the purpose of facilitating renaldialysis treatment, when such administration of medications occurs under theorders of a licensed physician, nurse practitioner or physician assistant andunder the immediate and direct supervision of a licensed registered nurse.Nothing in this chapter shall be construed to prohibit a patient caredialysis technician trainee from performing dialysis care as part of andwithin the scope of the clinical skills instruction segment of a superviseddialysis technician training program, provided such trainee is identified asa "trainee" while working in a renal dialysis facility.
The dialysis care technician or dialysis patient care technicianadministering the medications shall have demonstrated competency as evidencedby holding current valid certification from an organization approved by theBoard of Health Professions pursuant to Chapter 27.01 (§ 54.1-2729.1 et seq.)of this title.
T. Persons who are otherwise authorized to administer controlled substancesin hospitals shall be authorized to administer influenza or pneumococcalvaccines pursuant to § 32.1-126.4.
U. Pursuant to a specific order for a patient and under his direct andimmediate supervision, a prescriber may authorize the administration ofcontrolled substances by personnel who have been properly trained to assist adoctor of medicine or osteopathic medicine, provided the method does notinclude intravenous, intrathecal, or epidural administration and theprescriber remains responsible for such administration.
V. A nurse or a dental hygienist may possess and administer topical fluoridevarnish to the teeth of children aged six months to three years pursuant toan oral or written order or a standing protocol issued by a doctor ofmedicine, osteopathic medicine, or dentistry that conforms to standardsadopted by the Virginia Department of Health.
W. A prescriber, acting in accordance with guidelines developed pursuant to §32.1-46.02, may authorize the administration of influenza vaccine to minorsby a licensed pharmacist, registered nurse, licensed practical nurse underthe direction and immediate supervision of a registered nurse, certifiedemergency medical technician-intermediate, or emergency medicaltechnician-paramedic when the prescriber is not physically present.
(Code 1950, § 54-497; 1956, c. 225; 1970, c. 650, § 54-524.65; 1973, c. 468;1976, cc. 358, 614; 1977, c. 302; 1978, c. 224; 1980, cc. 270, 287; 1983, cc.456, 528; 1984, cc. 141, 555; 1986, c. 81; 1987, c. 226; 1988, c. 765; 1990,c. 309; 1991, cc. 141, 519, 524, 532; 1992, cc. 610, 760, 793; 1993, cc. 15,810, 957, 993; 1994, c. 53; 1995, cc. 88, 529; 1996, cc. 152, 158, 183, 406,408, 490; 1997, cc. 272, 566, 806, 906; 1998, c. 112; 1999, c. 570; 2000, cc.135, 498, 861, 881, 935; 2003, cc. 465, 497, 515, 794, 995, 1020; 2005, cc.113, 610, 924; 2006, cc. 75, 432, 686, 858; 2007, cc. 17, 699, 702, 783;2008, cc. 85, 694; 2009, cc. 48, 110, 506, 813, 840; 2010, cc. 179, 245, 252.)
A. A practitioner of medicine, osteopathy, podiatry, dentistry, or veterinarymedicine or a licensed nurse practitioner pursuant to § 54.1-2957.01, alicensed physician assistant pursuant to § 54.1-2952.1, or a TPA-certifiedoptometrist pursuant to Article 5 (§ 54.1-3222 et seq.) of Chapter 32 of thistitle shall only prescribe, dispense, or administer controlled substances ingood faith for medicinal or therapeutic purposes within the course of hisprofessional practice.
B. The prescribing practitioner's order may be on a written prescription orpursuant to an oral prescription as authorized by this chapter. Theprescriber may administer drugs and devices, or he may cause them to beadministered by a nurse, physician assistant or intern under his directionand supervision, or he may prescribe and cause drugs and devices to beadministered to patients in state-owned or state-operated hospitals orfacilities licensed as hospitals by the Board of Health or psychiatrichospitals licensed by the Department of Behavioral Health and DevelopmentalServices by other persons who have been trained properly to administer drugsand who administer drugs only under the control and supervision of theprescriber or a pharmacist or a prescriber may cause drugs and devices to beadministered to patients by emergency medical services personnel who havebeen certified and authorized to administer such drugs and devices pursuantto Board of Health regulations governing emergency medical services and whoare acting within the scope of such certification. A prescriber may authorizea licensed respiratory care practitioner as defined in § 54.1-2954 toadminister by inhalation controlled substances used in inhalation orrespiratory therapy.
C. Pursuant to an oral or written order or standing protocol, the prescriber,who is authorized by state or federal law to possess and administerradiopharmaceuticals in the scope of his practice, may authorize a nuclearmedicine technologist to administer, under his supervision,radiopharmaceuticals used in the diagnosis or treatment of disease.
D. Pursuant to an oral or written order or standing protocol issued by theprescriber within the course of his professional practice, such prescribermay authorize registered nurses and licensed practical nurses to possess (i)epinephrine for administration in treatment of emergency medical conditionsand (ii) heparin and sterile normal saline to use for the maintenance ofintravenous access lines.
Pursuant to the regulations of the Board of Health, certain emergency medicalservices technicians may possess and administer epinephrine in emergencycases of anaphylactic shock.
E. Pursuant to an oral or written order or standing protocol issued by theprescriber within the course of his professional practice, such prescribermay authorize licensed physical therapists to possess and administer topicalcorticosteroids, topical lidocaine, and any other Schedule VI topical drug.
F. Pursuant to an oral or written order or standing protocol issued by theprescriber within the course of his professional practice, such prescribermay authorize licensed athletic trainers to possess and administer topicalcorticosteroids, topical lidocaine, or other Schedule VI topical drugs, or topossess and administer epinephrine for use in emergency cases of anaphylacticshock.
G. Pursuant to an oral or written order or standing protocol issued by theprescriber within the course of his professional practice, and in accordancewith policies and guidelines established by the Department of Health pursuantto § 32.1-50.2, such prescriber may authorize registered nurses or licensedpractical nurses under the immediate and direct supervision of a registerednurse to possess and administer tuberculin purified protein derivative (PPD)in the absence of a prescriber. The Department of Health's policies andguidelines shall be consistent with applicable guidelines developed by theCenters for Disease Control and Prevention for preventing transmission ofmycobacterium tuberculosis and shall be updated to incorporate anysubsequently implemented standards of the Occupational Safety and HealthAdministration and the Department of Labor and Industry to the extent thatthey are inconsistent with the Department of Health's policies andguidelines. Such standing protocols shall explicitly describe the categoriesof persons to whom the tuberculin test is to be administered and shallprovide for appropriate medical evaluation of those in whom the test ispositive. The prescriber shall ensure that the nurse implementing suchstanding protocols has received adequate training in the practice andprinciples underlying tuberculin screening.
The Health Commissioner or his designee may authorize registered nurses,acting as agents of the Department of Health, to possess and administer, atthe nurse's discretion, tuberculin purified protein derivative (PPD) to thosepersons in whom tuberculin skin testing is indicated based on protocols andpolicies established by the Department of Health.
H. Pursuant to a written order or standing protocol issued by the prescriberwithin the course of his professional practice, such prescriber mayauthorize, with the consent of the parents as defined in § 22.1-1, anemployee of a school board who is trained in the administration of insulinand glucagon to assist with the administration of insulin or administerglucagon to a student diagnosed as having diabetes and who requires insulininjections during the school day or for whom glucagon has been prescribed forthe emergency treatment of hypoglycemia. Such authorization shall only beeffective when a licensed nurse, nurse practitioner, physician or physicianassistant is not present to perform the administration of the medication.
I. A prescriber may authorize, pursuant to a protocol approved by the Boardof Nursing, the administration of vaccines to adults for immunization, when apractitioner with prescriptive authority is not physically present, by (i)licensed pharmacists, (ii) registered nurses, or (iii) licensed practicalnurses under the immediate and direct supervision of a registered nurse. Aprescriber acting on behalf of and in accordance with established protocolsof the Department of Health may authorize the administration of vaccines toany person by a pharmacist, nurse, certified emergency medicaltechnician-intermediate, or emergency medical technician-paramedic under thedirection of an operational medical director when the prescriber is notphysically present. Emergency medical services personnel shall providedocumentation of the vaccines to be recorded in the Virginia ImmunizationInformation System.
J. A dentist may cause Schedule VI topical drugs to be administered under hisdirection and supervision by either a dental hygienist or by an authorizedagent of the dentist.
Further, pursuant to a written order and in accordance with a standingprotocol issued by the dentist in the course of his professional practice, adentist may authorize a dental hygienist under his general supervision, asdefined in § 54.1-2722, to possess and administer topical oral fluorides,topical oral anesthetics, topical and directly applied antimicrobial agentsfor treatment of periodontal pocket lesions, as well as any other Schedule VItopical drug approved by the Board of Dentistry.
In addition, a dentist may authorize a dental hygienist under his directionto administer Schedule VI nitrous oxide and oxygen inhalation analgesia and,to persons 18 years of age or older, Schedule VI local anesthesia.
K. Pursuant to an oral or written order or standing protocol issued by theprescriber within the course of his professional practice, such prescribermay authorize registered professional nurses certified as sexual assaultnurse examiners-A (SANE-A) under his supervision and when he is notphysically present to possess and administer preventive medications forvictims of sexual assault as recommended by the Centers for Disease Controland Prevention.
L. This section shall not prevent the administration of drugs by a person whohas satisfactorily completed a training program for this purpose approved bythe Board of Nursing and who administers such drugs in accordance with aprescriber's instructions pertaining to dosage, frequency, and manner ofadministration, and in accordance with regulations promulgated by the Boardof Pharmacy relating to security and record keeping, when the drugsadministered would be normally self-administered by (i) an individualreceiving services in a program licensed by the Department of BehavioralHealth and Developmental Services; (ii) a resident of the VirginiaRehabilitation Center for the Blind and Vision Impaired; (iii) a resident ofa facility approved by the Board or Department of Juvenile Justice for theplacement of children in need of services or delinquent or alleged delinquentyouth; (iv) a program participant of an adult day-care center licensed by theDepartment of Social Services; (v) a resident of any facility authorized oroperated by a state or local government whose primary purpose is not toprovide health care services; (vi) a resident of a private children'sresidential facility, as defined in § 63.2-100 and licensed by the Departmentof Social Services, Department of Education, or Department of BehavioralHealth and Developmental Services; or (vii) a student in a school forstudents with disabilities, as defined in § 22.1-319 and licensed by theBoard of Education.
M. Medication aides registered by the Board of Nursing pursuant to Article 7(§ 54.1-3041 et seq.) of Chapter 30 may administer drugs that would otherwisebe self-administered to residents of any assisted living facility licensed bythe Department of Social Services. A registered medication aide shalladminister drugs pursuant to this section in accordance with the prescriber'sinstructions pertaining to dosage, frequency, and manner of administration;in accordance with regulations promulgated by the Board of Pharmacy relatingto security and recordkeeping; in accordance with the assisted livingfacility's Medication Management Plan; and in accordance with such otherregulations governing their practice promulgated by the Board of Nursing.
N. In addition, this section shall not prevent the administration of drugs bya person who administers such drugs in accordance with a physician'sinstructions pertaining to dosage, frequency, and manner of administrationand with written authorization of a parent, and in accordance with schoolboard regulations relating to training, security and record keeping, when thedrugs administered would be normally self-administered by a student of aVirginia public school. Training for such persons shall be accomplishedthrough a program approved by the local school boards, in consultation withthe local departments of health.
O. In addition, this section shall not prevent the administration of drugs bya person to a child in a child day program as defined in § 63.2-100 andregulated by the State Board of Social Services or the Child Day CareCouncil, provided such person (i) has satisfactorily completed a trainingprogram for this purpose approved by the Board of Nursing and taught by aregistered nurse, licensed practical nurse, doctor of medicine or osteopathicmedicine, or pharmacist; (ii) has obtained written authorization from aparent or guardian; (iii) administers drugs only to the child identified onthe prescription label in accordance with the prescriber's instructionspertaining to dosage, frequency, and manner of administration; and (iv)administers only those drugs that were dispensed from a pharmacy andmaintained in the original, labeled container that would normally beadministered by a parent or guardian to the child.
P. In addition, this section shall not prevent the administration ordispensing of drugs and devices by persons if they are authorized by theState Health Commissioner in accordance with protocols established by theState Health Commissioner pursuant to § 32.1-42.1 when (i) the Governor hasdeclared a disaster or a state of emergency or the United States Secretary ofHealth and Human Services has issued a declaration of an actual or potentialbioterrorism incident or other actual or potential public health emergency;(ii) it is necessary to permit the provision of needed drugs or devices; and(iii) such persons have received the training necessary to safely administeror dispense the needed drugs or devices. Such persons shall administer ordispense all drugs or devices under the direction, control and supervision ofthe State Health Commissioner.
Q. Nothing in this title shall prohibit the administration of normallyself-administered drugs by unlicensed individuals to a person in his privateresidence.
R. This section shall not interfere with any prescriber issuing prescriptionsin compliance with his authority and scope of practice and the provisions ofthis section to a Board agent for use pursuant to subsection G of §18.2-258.1. Such prescriptions issued by such prescriber shall be deemed tobe valid prescriptions.
S. Nothing in this title shall prevent or interfere with dialysis caretechnicians or dialysis patient care technicians who are certified by anorganization approved by the Board of Health Professions or personsauthorized for provisional practice pursuant to Chapter 27.01 (§ 54.1-2729.1et seq.) of this title, in the ordinary course of their duties in aMedicare-certified renal dialysis facility, from administering heparin,topical needle site anesthetics, dialysis solutions, sterile normal salinesolution, and blood volumizers, for the purpose of facilitating renaldialysis treatment, when such administration of medications occurs under theorders of a licensed physician, nurse practitioner or physician assistant andunder the immediate and direct supervision of a licensed registered nurse.Nothing in this chapter shall be construed to prohibit a patient caredialysis technician trainee from performing dialysis care as part of andwithin the scope of the clinical skills instruction segment of a superviseddialysis technician training program, provided such trainee is identified asa "trainee" while working in a renal dialysis facility.
The dialysis care technician or dialysis patient care technicianadministering the medications shall have demonstrated competency as evidencedby holding current valid certification from an organization approved by theBoard of Health Professions pursuant to Chapter 27.01 (§ 54.1-2729.1 et seq.)of this title.
T. Persons who are otherwise authorized to administer controlled substancesin hospitals shall be authorized to administer influenza or pneumococcalvaccines pursuant to § 32.1-126.4.
U. Pursuant to a specific order for a patient and under his direct andimmediate supervision, a prescriber may authorize the administration ofcontrolled substances by personnel who have been properly trained to assist adoctor of medicine or osteopathic medicine, provided the method does notinclude intravenous, intrathecal, or epidural administration and theprescriber remains responsible for such administration.
V. A nurse or a dental hygienist may possess and administer topical fluoridevarnish to the teeth of children aged six months to three years pursuant toan oral or written order or a standing protocol issued by a doctor ofmedicine, osteopathic medicine, or dentistry that conforms to standardsadopted by the Virginia Department of Health.
W. A prescriber, acting in accordance with guidelines developed pursuant to §32.1-46.02, may authorize the administration of influenza vaccine to minorsby a licensed pharmacist, registered nurse, licensed practical nurse underthe direction and immediate supervision of a registered nurse, certifiedemergency medical technician-intermediate, or emergency medicaltechnician-paramedic when the prescriber is not physically present.
(Code 1950, § 54-497; 1956, c. 225; 1970, c. 650, § 54-524.65; 1973, c. 468;1976, cc. 358, 614; 1977, c. 302; 1978, c. 224; 1980, cc. 270, 287; 1983, cc.456, 528; 1984, cc. 141, 555; 1986, c. 81; 1987, c. 226; 1988, c. 765; 1990,c. 309; 1991, cc. 141, 519, 524, 532; 1992, cc. 610, 760, 793; 1993, cc. 15,810, 957, 993; 1994, c. 53; 1995, cc. 88, 529; 1996, cc. 152, 158, 183, 406,408, 490; 1997, cc. 272, 566, 806, 906; 1998, c. 112; 1999, c. 570; 2000, cc.135, 498, 861, 881, 935; 2003, cc. 465, 497, 515, 794, 995, 1020; 2005, cc.113, 610, 924; 2006, cc. 75, 432, 686, 858; 2007, cc. 17, 699, 702, 783;2008, cc. 85, 694; 2009, cc. 48, 110, 506, 813, 840; 2010, cc. 179, 245, 252.)
A. A practitioner of medicine, osteopathy, podiatry, dentistry, or veterinarymedicine or a licensed nurse practitioner pursuant to § 54.1-2957.01, alicensed physician assistant pursuant to § 54.1-2952.1, or a TPA-certifiedoptometrist pursuant to Article 5 (§ 54.1-3222 et seq.) of Chapter 32 of thistitle shall only prescribe, dispense, or administer controlled substances ingood faith for medicinal or therapeutic purposes within the course of hisprofessional practice.
B. The prescribing practitioner's order may be on a written prescription orpursuant to an oral prescription as authorized by this chapter. Theprescriber may administer drugs and devices, or he may cause them to beadministered by a nurse, physician assistant or intern under his directionand supervision, or he may prescribe and cause drugs and devices to beadministered to patients in state-owned or state-operated hospitals orfacilities licensed as hospitals by the Board of Health or psychiatrichospitals licensed by the Department of Behavioral Health and DevelopmentalServices by other persons who have been trained properly to administer drugsand who administer drugs only under the control and supervision of theprescriber or a pharmacist or a prescriber may cause drugs and devices to beadministered to patients by emergency medical services personnel who havebeen certified and authorized to administer such drugs and devices pursuantto Board of Health regulations governing emergency medical services and whoare acting within the scope of such certification. A prescriber may authorizea licensed respiratory care practitioner as defined in § 54.1-2954 toadminister by inhalation controlled substances used in inhalation orrespiratory therapy.
C. Pursuant to an oral or written order or standing protocol, the prescriber,who is authorized by state or federal law to possess and administerradiopharmaceuticals in the scope of his practice, may authorize a nuclearmedicine technologist to administer, under his supervision,radiopharmaceuticals used in the diagnosis or treatment of disease.
D. Pursuant to an oral or written order or standing protocol issued by theprescriber within the course of his professional practice, such prescribermay authorize registered nurses and licensed practical nurses to possess (i)epinephrine for administration in treatment of emergency medical conditionsand (ii) heparin and sterile normal saline to use for the maintenance ofintravenous access lines.
Pursuant to the regulations of the Board of Health, certain emergency medicalservices technicians may possess and administer epinephrine in emergencycases of anaphylactic shock.
E. Pursuant to an oral or written order or standing protocol issued by theprescriber within the course of his professional practice, such prescribermay authorize licensed physical therapists to possess and administer topicalcorticosteroids, topical lidocaine, and any other Schedule VI topical drug.
F. Pursuant to an oral or written order or standing protocol issued by theprescriber within the course of his professional practice, such prescribermay authorize licensed athletic trainers to possess and administer topicalcorticosteroids, topical lidocaine, or other Schedule VI topical drugs, or topossess and administer epinephrine for use in emergency cases of anaphylacticshock.
G. Pursuant to an oral or written order or standing protocol issued by theprescriber within the course of his professional practice, and in accordancewith policies and guidelines established by the Department of Health pursuantto § 32.1-50.2, such prescriber may authorize registered nurses or licensedpractical nurses under the immediate and direct supervision of a registerednurse to possess and administer tuberculin purified protein derivative (PPD)in the absence of a prescriber. The Department of Health's policies andguidelines shall be consistent with applicable guidelines developed by theCenters for Disease Control and Prevention for preventing transmission ofmycobacterium tuberculosis and shall be updated to incorporate anysubsequently implemented standards of the Occupational Safety and HealthAdministration and the Department of Labor and Industry to the extent thatthey are inconsistent with the Department of Health's policies andguidelines. Such standing protocols shall explicitly describe the categoriesof persons to whom the tuberculin test is to be administered and shallprovide for appropriate medical evaluation of those in whom the test ispositive. The prescriber shall ensure that the nurse implementing suchstanding protocols has received adequate training in the practice andprinciples underlying tuberculin screening.
The Health Commissioner or his designee may authorize registered nurses,acting as agents of the Department of Health, to possess and administer, atthe nurse's discretion, tuberculin purified protein derivative (PPD) to thosepersons in whom tuberculin skin testing is indicated based on protocols andpolicies established by the Department of Health.
H. Pursuant to a written order or standing protocol issued by the prescriberwithin the course of his professional practice, such prescriber mayauthorize, with the consent of the parents as defined in § 22.1-1, anemployee of a school board who is trained in the administration of insulinand glucagon to assist with the administration of insulin or administerglucagon to a student diagnosed as having diabetes and who requires insulininjections during the school day or for whom glucagon has been prescribed forthe emergency treatment of hypoglycemia. Such authorization shall only beeffective when a licensed nurse, nurse practitioner, physician or physicianassistant is not present to perform the administration of the medication.
I. A prescriber may authorize, pursuant to a protocol approved by the Boardof Nursing, the administration of vaccines to adults for immunization, when apractitioner with prescriptive authority is not physically present, by (i)licensed pharmacists, (ii) registered nurses, or (iii) licensed practicalnurses under the immediate and direct supervision of a registered nurse. Aprescriber acting on behalf of and in accordance with established protocolsof the Department of Health may authorize the administration of vaccines toany person by a pharmacist, nurse, certified emergency medicaltechnician-intermediate, or emergency medical technician-paramedic under thedirection of an operational medical director when the prescriber is notphysically present. Emergency medical services personnel shall providedocumentation of the vaccines to be recorded in the Virginia ImmunizationInformation System.
J. A dentist may cause Schedule VI topical drugs to be administered under hisdirection and supervision by either a dental hygienist or by an authorizedagent of the dentist.
Further, pursuant to a written order and in accordance with a standingprotocol issued by the dentist in the course of his professional practice, adentist may authorize a dental hygienist under his general supervision, asdefined in § 54.1-2722, to possess and administer topical oral fluorides,topical oral anesthetics, topical and directly applied antimicrobial agentsfor treatment of periodontal pocket lesions, as well as any other Schedule VItopical drug approved by the Board of Dentistry.
In addition, a dentist may authorize a dental hygienist under his directionto administer Schedule VI nitrous oxide and oxygen inhalation analgesia and,to persons 18 years of age or older, Schedule VI local anesthesia.
K. Pursuant to an oral or written order or standing protocol issued by theprescriber within the course of his professional practice, such prescribermay authorize registered professional nurses certified as sexual assaultnurse examiners-A (SANE-A) under his supervision and when he is notphysically present to possess and administer preventive medications forvictims of sexual assault as recommended by the Centers for Disease Controland Prevention.
L. This section shall not prevent the administration of drugs by a person whohas satisfactorily completed a training program for this purpose approved bythe Board of Nursing and who administers such drugs in accordance with aprescriber's instructions pertaining to dosage, frequency, and manner ofadministration, and in accordance with regulations promulgated by the Boardof Pharmacy relating to security and record keeping, when the drugsadministered would be normally self-administered by (i) an individualreceiving services in a program licensed by the Department of BehavioralHealth and Developmental Services; (ii) a resident of the VirginiaRehabilitation Center for the Blind and Vision Impaired; (iii) a resident ofa facility approved by the Board or Department of Juvenile Justice for theplacement of children in need of services or delinquent or alleged delinquentyouth; (iv) a program participant of an adult day-care center licensed by theDepartment of Social Services; (v) a resident of any facility authorized oroperated by a state or local government whose primary purpose is not toprovide health care services; (vi) a resident of a private children'sresidential facility, as defined in § 63.2-100 and licensed by the Departmentof Social Services, Department of Education, or Department of BehavioralHealth and Developmental Services; or (vii) a student in a school forstudents with disabilities, as defined in § 22.1-319 and licensed by theBoard of Education.
M. Medication aides registered by the Board of Nursing pursuant to Article 7(§ 54.1-3041 et seq.) of Chapter 30 may administer drugs that would otherwisebe self-administered to residents of any assisted living facility licensed bythe Department of Social Services. A registered medication aide shalladminister drugs pursuant to this section in accordance with the prescriber'sinstructions pertaining to dosage, frequency, and manner of administration;in accordance with regulations promulgated by the Board of Pharmacy relatingto security and recordkeeping; in accordance with the assisted livingfacility's Medication Management Plan; and in accordance with such otherregulations governing their practice promulgated by the Board of Nursing.
N. In addition, this section shall not prevent the administration of drugs bya person who administers such drugs in accordance with a physician'sinstructions pertaining to dosage, frequency, and manner of administrationand with written authorization of a parent, and in accordance with schoolboard regulations relating to training, security and record keeping, when thedrugs administered would be normally self-administered by a student of aVirginia public school. Training for such persons shall be accomplishedthrough a program approved by the local school boards, in consultation withthe local departments of health.
O. In addition, this section shall not prevent the administration of drugs bya person to a child in a child day program as defined in § 63.2-100 andregulated by the State Board of Social Services or the Child Day CareCouncil, provided such person (i) has satisfactorily completed a trainingprogram for this purpose approved by the Board of Nursing and taught by aregistered nurse, licensed practical nurse, doctor of medicine or osteopathicmedicine, or pharmacist; (ii) has obtained written authorization from aparent or guardian; (iii) administers drugs only to the child identified onthe prescription label in accordance with the prescriber's instructionspertaining to dosage, frequency, and manner of administration; and (iv)administers only those drugs that were dispensed from a pharmacy andmaintained in the original, labeled container that would normally beadministered by a parent or guardian to the child.
P. In addition, this section shall not prevent the administration ordispensing of drugs and devices by persons if they are authorized by theState Health Commissioner in accordance with protocols established by theState Health Commissioner pursuant to § 32.1-42.1 when (i) the Governor hasdeclared a disaster or a state of emergency or the United States Secretary ofHealth and Human Services has issued a declaration of an actual or potentialbioterrorism incident or other actual or potential public health emergency;(ii) it is necessary to permit the provision of needed drugs or devices; and(iii) such persons have received the training necessary to safely administeror dispense the needed drugs or devices. Such persons shall administer ordispense all drugs or devices under the direction, control and supervision ofthe State Health Commissioner.
Q. Nothing in this title shall prohibit the administration of normallyself-administered drugs by unlicensed individuals to a person in his privateresidence.
R. This section shall not interfere with any prescriber issuing prescriptionsin compliance with his authority and scope of practice and the provisions ofthis section to a Board agent for use pursuant to subsection G of §18.2-258.1. Such prescriptions issued by such prescriber shall be deemed tobe valid prescriptions.
S. Nothing in this title shall prevent or interfere with dialysis caretechnicians or dialysis patient care technicians who are certified by anorganization approved by the Board of Health Professions or personsauthorized for provisional practice pursuant to Chapter 27.01 (§ 54.1-2729.1et seq.) of this title, in the ordinary course of their duties in aMedicare-certified renal dialysis facility, from administering heparin,topical needle site anesthetics, dialysis solutions, sterile normal salinesolution, and blood volumizers, for the purpose of facilitating renaldialysis treatment, when such administration of medications occurs under theorders of a licensed physician, nurse practitioner or physician assistant andunder the immediate and direct supervision of a licensed registered nurse.Nothing in this chapter shall be construed to prohibit a patient caredialysis technician trainee from performing dialysis care as part of andwithin the scope of the clinical skills instruction segment of a superviseddialysis technician training program, provided such trainee is identified asa "trainee" while working in a renal dialysis facility.
The dialysis care technician or dialysis patient care technicianadministering the medications shall have demonstrated competency as evidencedby holding current valid certification from an organization approved by theBoard of Health Professions pursuant to Chapter 27.01 (§ 54.1-2729.1 et seq.)of this title.
T. Persons who are otherwise authorized to administer controlled substancesin hospitals shall be authorized to administer influenza or pneumococcalvaccines pursuant to § 32.1-126.4.
U. Pursuant to a specific order for a patient and under his direct andimmediate supervision, a prescriber may authorize the administration ofcontrolled substances by personnel who have been properly trained to assist adoctor of medicine or osteopathic medicine, provided the method does notinclude intravenous, intrathecal, or epidural administration and theprescriber remains responsible for such administration.
V. A nurse or a dental hygienist may possess and administer topical fluoridevarnish to the teeth of children aged six months to three years pursuant toan oral or written order or a standing protocol issued by a doctor ofmedicine, osteopathic medicine, or dentistry that conforms to standardsadopted by the Virginia Department of Health.
W. A prescriber, acting in accordance with guidelines developed pursuant to §32.1-46.02, may authorize the administration of influenza vaccine to minorsby a licensed pharmacist, registered nurse, licensed practical nurse underthe direction and immediate supervision of a registered nurse, certifiedemergency medical technician-intermediate, or emergency medicaltechnician-paramedic when the prescriber is not physically present.
(Code 1950, § 54-497; 1956, c. 225; 1970, c. 650, § 54-524.65; 1973, c. 468;1976, cc. 358, 614; 1977, c. 302; 1978, c. 224; 1980, cc. 270, 287; 1983, cc.456, 528; 1984, cc. 141, 555; 1986, c. 81; 1987, c. 226; 1988, c. 765; 1990,c. 309; 1991, cc. 141, 519, 524, 532; 1992, cc. 610, 760, 793; 1993, cc. 15,810, 957, 993; 1994, c. 53; 1995, cc. 88, 529; 1996, cc. 152, 158, 183, 406,408, 490; 1997, cc. 272, 566, 806, 906; 1998, c. 112; 1999, c. 570; 2000, cc.135, 498, 861, 881, 935; 2003, cc. 465, 497, 515, 794, 995, 1020; 2005, cc.113, 610, 924; 2006, cc. 75, 432, 686, 858; 2007, cc. 17, 699, 702, 783;2008, cc. 85, 694; 2009, cc. 48, 110, 506, 813, 840; 2010, cc. 179, 245, 252.)
