Delaware RegisterRegulations of Issue Date: December 1, 2004Volume 8 - Issue 6 Pages 740 - 934IN THIS ISSUE: Regulations: ErrataProposedFinalGovernorExecutive OrdersAppointmentsGeneral NoticesCalendar of Events & Hearing NoticesPursuant to 29 Del. C. Chapter 11, Subchapter III, this issue of the Register contains all documents required to be published, and received, on or before November 15, 2004. DELAWARE REGISTER OF REGULATIONS The Delaware Register of Regulations is an official State publication established by authority of 69 Del. Laws, c. 107 and is published on the first of each month throughout the year. The Delaware Register will publish any regulations that are proposed to be adopted, amended or repealed and any emergency regulations promulgated. The Register will also publish some or all of the following information: •Governor’s Executive Orders •Governor’s Appointments •Attorney General’s Opinions in full text •Agency Hearing and Meeting Notices •Other documents considered to be in the public interest. CITATION TO THE DELAWARE REGISTER The Delaware Register of Regulations is cited by volume, issue, page number and date. An example would be: 6 DE Reg. 1541-1542 (06/01/03) Refers to Volume 6, pages 1541-1542 of the Delaware Register issued on June 1, 2003. SUBSCRIPTION INFORMATION The cost of a yearly subscription (12 issues) for the Delaware Register of Regulations is $135.00. Single copies are available at a cost of $12.00 per issue, including postage. For more information contact the Division of Research at 302-744-4114 or 1-800-282-8545 in Delaware. CITIZEN PARTICIPATION IN THE REGULATORY PROCESS Delaware citizens and other interested parties may participate in the process by which administrative regulations are adopted, amended or repealed, and may initiate the process by which the validity and applicability of regulations is determined. Under 29 Del.C. §10115 whenever an agency proposes to formulate, adopt, amend or repeal a regulation, it shall file notice and full text of such proposals, together with copies of the existing regulation being adopted, amended or repealed, with the Registrar for publication in the Register of Regulations pursuant to §1134 of this title. The notice shall describe the nature of the proceedings including a brief synopsis of the subject, substance, issues, possible terms of the agency action, a reference to the legal authority of the agency to act, and reference to any other regulations that may be impacted or affected by the proposal, and shall state the manner in which persons may present their views; if in writing, of the place to which and the final date by which such views may be submitted; or if at a public hearing, the date, time and place of the hearing. If a public hearing is to be held, such public hearing shall not be scheduled less than 20 days following publication of notice of the proposal in the Register of Regulations. If a public hearing will be held on the proposal, notice of the time, date, place and a summary of the nature of the proposal shall also be published in at least 2 Delaware newspapers of general circulation. The notice shall also be mailed to all persons who have made timely written requests of the agency for advance notice of its regulation-making proceedings. The opportunity for public comment shall be held open for a minimum of 30 days after the proposal is published in the Register of Regulations. At the conclusion of all hearings and after receipt, within the time allowed, of all written materials, upon all the testimonial and written evidence and information submitted, together with summaries of the evidence and information by subordinates, the agency shall determine whether a regulation should be adopted, amended or repealed and shall issue its conclusion in an order which shall include: (1) A brief summary of the evidence and information submitted; (2) A brief summary of its findings of fact with respect to the evidence and information, except where a rule of procedure is being adopted or amended; (3) A decision to adopt, amend or repeal a regulation or to take no action and the decision shall be supported by its findings on the evidence and information received; (4) The exact text and citation of such regulation adopted, amended or repealed; (5) The effective date of the order; (6) Any other findings or conclusions required by the law under which the agency has authority to act; and (7) The signature of at least a quorum of the agency members. The effective date of an order which adopts, amends or repeals a regulation shall be not less than 10 days from the date the order adopting, amending or repealing a regulation has been published in its final form in the Register of Regulations, unless such adoption, amendment or repeal qualifies as an emergency under §10119. Any person aggrieved by and claiming the unlawfulness of any regulation may bring an action in the Court for declaratory relief. No action of an agency with respect to the making or consideration of a proposed adoption, amendment or repeal of a regulation shall be subject to review until final agency action on the proposal has been taken. When any regulation is the subject of an enforcement action in the Court, the lawfulness of such regulation may be reviewed by the Court as a defense in the action. Except as provided in the preceding section, no judicial review of a regulation is available unless a complaint therefor is filed in the Court within 30 days of the day the agency order with respect to the regulation was published in the Register of Regulations. CLOSING DATES AND ISSUE DATES FOR THE DELAWARE REGISTER OF REGULATIONS ISSUE CLOSING CLOSING DATE DATE TIME JANUARY 1DECEMBER 154:30 P.M. FEBRUARY 1JANUARY 174:30 P.M. MARCH 1FEBRUARY 154:30 P.M. APRIL 1MARCH 154:30 P.M. MAY 1APRIL 154?30 P.M. DIVISION OF RESEARCH STAFF: Deborah A. Porter, Interim Supervisor; Sandra F. Clark, Administrative Specialist II; Kathleen Morris, Unit Operations Support Specialist; Jeffrey W. Hague, Registrar of Regulations; Steve Engebretsen, Assistant Registrar; Victoria Schultes, Administrative Specialist II; Rochelle Yerkes, Administrative Specialist II; Rhonda McGuigan, Administrative Specialist I; Ruth Ann Melson, Legislative Librarian; Lisa Schieffert, Research Analyst; Judi Abbott, Administrative Specialist I; Alice W. Stark, Legislative Attorney; Ted Segletes, Paralegal; Deborah J. Messina, Print Shop Supervisor; Marvin L. Stayton, Printer; Don Sellers, Printer. Cumulative Tables........................................................ 745 ERRATA DEPARTMENT OF ADMINISTRATIVE SERVICES DIVISION OF PROFESSIONAL REGULATION 1700 Board of Medical Practice................................... 750 PROPOSED DEPARTMENT OF ADMINISTRATIVE SERVICES DIVISION OF PROFESSIONAL REGULATION 1900 Board of Nursing................................................. 757 2600 Board of Physical Therapists & Athletic Trainers................................................................ 772 2700 Board of Professional Land Surveyors................ 774 3100 Board of Funeral Services................................... 777 3500 Board of Examiners of Psychologists................. 779 3600 Board of Geologists............................................. 785 3700 Board of Speech/Language Pathologists, Audiologists & Hearing Aid Dispensers............... 786 3800 State Committee on Dietetics/Nutrition.............. 787 5100 Board of Cosmetology & Barbering................... 788 5200 Board of Nursing Home Administrators............. 790 5300 Board of Massage and Bodywork....................... 796 DEPARTMENT OF AGRICULTURE HARNESS RACING COMMISSION Rule 8.9 Prerace Testing By Blood Gas Analyzer or Similar Equipment, and 8.10 Quarantine Procedure for Carbon Dioxide Positive Tests (Prerace or Postrace).................................... 798 DEPARTMENT OF EDUCATION 250 Procedures Related to the Collection, Maintenance & Disclosure of Student Data.......... 800 278 Non-Public School Educator Licensure and Certification.................................................... 811 714 Professional Employee Work Stoppage or Strike................................................................ 820 725 School Administrator Contracts/Agreements........ 821 805 The School Health Tuberculosis (TB) Control Program.................................................... 822 PROFESSIONAL STANDARDS BOARD 307 Certification Administrative – Director of Special Education................................................. 825 309 Certification Administrative - Supervisor of Special Education, Repeal of........................... 827 1501 Knowledge, Skills And Responsibility Based Supplements For Educators.................................. 828 1531 Certification Administrative - School Leader I................................................................ 832 1540 Standard Certificate Science Teacher................. 834 1542 Standard Certificate Science Teacher Middle Level......................................................... 837 1584 Permits Paraeducators......................................... 839 DEPARTMENT OF FINANCE OFFICE OF THE STATE LOTTERY Rule 4.2 Licensing of Technology Providers; Rule 6.34 & 6.35 Agents: Duties; Rule 7.16.2 Game Requirements.................................. 842 DIVISION OF PUBLIC HEALTH 4203 Cancer Treatment Program Regulations............. 850 DIVISION OF SOCIAL SERVICES Provider Contractual/Programmatic Responsibilities, Section 1.6............................................................ 854 DSSM; Sections 20011.1, 2001.1.1 and 2001.1.2, Redeterminations.................................................. 855 9032.6 Residency (Including Homelessness Definition)..................................................... 857 DEPARTMENT OF NATURAL RESOURCES AND ENVIRONMENTAL CONTROL DIVISION OF FISH AND WILDLIFE Non-Tidal Finfish; 3308 Fish Stocking Practices................................ 858 Tidal Finfish; 3502 Striped Bass Spawning Season and Area Restrictions. .................................................. 858 3505 Striped Bass Commercial Fishing Seasons; Quotas; Tagging & Reporting Requirements................................................. 858 3553 River Herring Creel Limit........................... 858 DIVISION OF WATER RESOURCES Regulations Governing the Design, Installation and Operation of On-Site Wastewater Treatment & Disposal Systems.............................................. 861 DEPARTMENT OF ADMINISTRATIVE SERVICES DIVISION OF PROFESSIONAL REGULATION 1900 Board of Nursing................................................. 864 2500 Board of Pharmacy.............................................. 879 3900 Board of Clinical Social Work Examiners.......... 880 DEPARTMENT OF EDUCATION 742 Compensation of District Personnel Under Specific Project Proposals..................................... 884 925 Children with Disabilities...................................... 886 PROFESSIONAL STANDARDS BOARD 1554 Standard Certificate Reading Specialist.............. 899 DIVISION OF SOCIAL SERVICES DSSM 9026.1, Food Stamp Program........................... 901 GOVERNOR Executive Order No. 61; Green Infrastructure............. 905 Appointments............................................................... 907 GENERAL NOTICES DEPARTMENT OF EDUCATION State Board of Education’s Procedures Manual........... 911 DEPARTMENT OF INSURANCE Agents Bulletin No. 13, Continuing Education Changes under Amended Reg. 504....................... 926 CALENDAR OF EVENTS/HEARING NOTICES Dept. of Administrative Services, Div. of Professional Regulation, Notices of Public Hearings: Board of Nursing........................................... 928 Board of Physical Therapists and Athletic Trainers.................................................. 928 Board of Professional Land Surveyors.......... 928 Board of Funeral Services............................. 928 Board of Examiners of Psychologists........... 929 Board of Geologists....................................... 929 Board of Speech/Language Pathologists, Audiologists & Hearing Aid Dispensers...... 929 State Committee on Dietetics/Nutrition........ 929 Board of Cosmetology................................... 930 Board of Nursing Home Administrators....... 930 Board of Massage & Bodywork.................... 930 Dept. of Agriculture, Harness Racing Commission Notice of Public Hearing...................................... 930 State Board of Education, Monthly Meeting............... 931 Dept. of Finance, Office of the State Lottery, Notice of Public Hearing...................................... 931 Dept. of Health & Social Service, Div. of Public Health, Notice of Public Hearing......................... 931 Div of ocial Services, Notice of Public Comment Period............................. ...... 931, 932 Regulations Governing the Design, Installation and Operation of On-Site Wastewater Treatment & Disposal Systems 933 DNREC, Div. of Fish & Wildlife Notices of Public Hearings: Non-Tidal Finfish Reg. 3308......................... 932 Tidal-Finfish Regs. 3502, 3505 & 3553........ 933 Div. of Water Resources, Regulations Governing the Design, Installation and Operation of On-Site Wastewater Treatment & Disposal Systems, ................... 933 DELAWARE MANUFACTURED HOME RELOCATION TRUST FUND 201 Delaware Manufactured Home Relocation Trust Fund Regulations......................................8 DE Reg. 619 (Prop.) DELAWARE RIVER BASIN COMMISSION Proposed Amendment to the Water Quality Regulations, Water Code and Comprehensive Plan to Classify the Lower Delaware River as Special Protection Waters.............................8 DE Reg. 513 (Prop.) Proposed Amendment to the Water Quality Regulations, WAter Code and Comprehensive Plan to Establish Pollutant Minimization Plan Requirements for Point and Non-Point Source Discharges of Toxic Pollutants Following Issuance of a TMDL by either the U.S. Environmental Protection Agency or a Member State, or an Assimilative Capacity Determination by the Delaware River Basin Commission.....................................................8 DE Reg. 515 (Prop.) DELAWARE STATE FIRE PREVENTION COMMISSION State Fire Prevention Regulations....................................................................................................8 DE Reg. 6 (Prop.) 8 DE Reg. 416 (Final) DEPARTMENT OF ADMINISTRATIVE SERVICES DIVISION OF PROFESSIONAL REGULATION (TITLE 24 DELAWARE ADMINISTRATIVE CODE) 200 Board of Landscape Architects........................................................................................8 DE Reg. 625 (Prop.) 700 Board of Chiropractic......................................................................................................8 DE Reg. 627 (Prop.) 1400 Board of Electrical Examiners.......................................................................................8 DE Reg. 627 (Prop.) 1700 Board of Medical Practice.............................................................................................8 DE Reg. 628 (Prop.) 1770 Board of Medical Practice Respiratory Care Advisory Council....................................8 DE Reg. 635 (Prop.) 1800 Board of Plumbing Examiners.......................................................................................8 DE Reg. 639 (Prop.) 1900 Board of Nursing...........................................................................................................8 DE Reg. 377 (Prop.) 2000 Board of Occupational Therapy Practice, Rule 7.0, Crimes Substantially Related to the Practice of Occupational Therapy....................................................8 DE Reg. 518 (Prop.) 2100 Board of Examiners in Optometry.........................................................................8 DE Reg. 16 (Prop.) 8 DE Reg. 536 (Final) 8 DE Reg. 640 (Prop.) 2500 Board of Pharmacy, Rule 16.0, Crimes Substantially Related to the Practice of Pharmacy.................................................................................................................8 DE Reg. 517 (Prop.) 3300 Board of Veterinary Medicine........................................................................................8 DE Reg. 645 (Prop.) 3900 Board of Clinical Social Work Examiners....................................................................8 DE Reg. 218 (Prop.) 5300 Board of Massage and Bodywork..................................................................................8 DE Reg. 390 (Prop.) 8 DE Reg. 692 (Final) Gaming Control Board, Bingo, Charitable Gambling and Raffles.........................................8 DE Reg. 531 (Final) PUBLIC INTEGRITY COMMISSION Public Integrity Commission, Rules of...................................................................................8 DE Reg. 710 (Final) PUBLIC SERVICE COMMISSION Reg. Docket No. 54, Concerning the Jurisdiction of the Public Service Commission to Grant and Revoke Certificates of Public Convenience and Necessity to Provide Wastewater Services........................................................................................................8 DE Reg. 646 (Prop.) DEPARTMENT OF AGRICULTURE HARNESS RACING COMMISSION Rule 8.3.3.5, Erythropietin......................................................................................................8 DE Reg. 329 (Final) Rule 8.8 Prohibited Substances Protests; Testing...................................................................8 DE Reg. 698 (Final) Standardbred Breeder’s Fund Regulations.............................................................................8 DE Reg. 336 (Final) THOROUGHBRED RACING COMMISSION Rule 11.14.6 Scratches....................................................................................................8 DE Reg. 652 (Prop.) Rule 19.3.2, Application for Review..............................................................................8 DE Reg. 652 (Prop.) DEPARTMENT OF EDUCATION (TITLE 14 DELAWARE ADMINISTRATIVE CODE) 101 Delaware Student Testing Program.................................................................................8 DE Reg. 17 (Prop.) 8 DE Reg. 425 (Final) 106 Teacher Appraisal Process Delaware Performance Appraisal System (DPAS II)..........8 DE Reg. 23 (Prop.) 8 DE Reg. 431 (Final) 107 Specialist Appraisal Process Delaware Performance Appraisal System (DPAS II)......8 DE Reg. 23 (Prop.) 8 DE Reg. 431 (Final) 108 Administrator Appraisal Process Delaware Performance Appraisal System (DPAS II)........8 DE Reg. 23 (Prop.) 8 DE Reg. 431 (Final) 260 General Appeal Procedure for the Child and Adult Care Food Program of the United States Department of Agriculture CACFP/USDA ....................................................8 DE Reg. 221 (Prop.) 8 DE Reg. 537 (Final) 501 State Content Standards..........................................................................................................8 DE Reg. 36 (Prop.) 8 DE Reg. 445 (Final) 610 Treatment of Severe Discipline Problems Component (14 Del.C. §1604 of Chapter 16, Comprehensive School Discipline Improvement Program August 1998...............................8 DE Reg. 657 (Prop.) 618 (Formerly Reg. 879) School Safety Audit..............................................................................8 DE Reg. 344 (Final) 620 (Formerly Reg. 880) School Crisis Response Plans...............................................................8 DE Reg. 344 (Final) 705 Training Camp and Special Duty in the National Guard and/or Reserves.............................................................................................8 DE Reg. 396 (Prop.) 8 DE Reg. 700 (Final) 706 Credit for Experience for Full Time Service in the Armed Forces................................................................................................................8 DE Reg. 397 (Prop.) 8 DE Reg. 701 (Final) 718 Health Examinations for School District Employees.....................................................8 DE Reg. 37 (Prop.) 8 DE Reg. 399 (Prop.) 8 DE Reg. 702 (Final) 742 Compensation of District Personnel Under Specific Project Proposals............................... 8 DE Reg. 520 (Prop.) 805 The School Health Tuberculosis (TB) Control Program................................................8 DE Reg. 38 (Prop.) 8 DE Reg. 400 (Prop.) 851 K-12 Compreshensive Health Education Program.................................................................8 DE Reg. 661 (Prop.) 852 Child Nutrition.......................................................................................................................8 DE Reg. 224 (Prop.) 8 DE Reg. 540 (Final) 885 Safe Management and Disposal of Surplus Chemicals in the Delaware Public School System................................................................................................................................8 DE Reg. 345 (Final) 925 Children with Disabilities.......................................................................................................8 DE Reg. 225 (Prop.) 8 DE Reg. 402 (Prop.) 1105 School Transportation...................................................................................................8 DE Reg. 237 (Final) 8 DE Reg. 541 (Final) PROFESSIONAL STANDARDS BOARD 323 Certification Computer Science Teacher................................................................................8 DE Reg. 247 (Prop.) 8 DE Reg. 552 (Final) 331 (Transferred to 1566) Certification Family and Consumer Sciences Teacher........................8 DE Reg. 248 (Prop.) 8 DE Reg. 553 (Final) 368 Certification School Psychologist...................................................................................8 DE Reg. 41 (Prop.) 1501 Knowledge, Skills And Responsibility Based Supplements For Educators.................8 DE Reg. 73 (Final) 1502 Educator Mentoring..............................................................................................................8 DE Reg. 347 (Final) 1505 Professional Growth Programs.....................................................................................8 DE Reg. 78 (Final) 1509 Meritorious New Teacher Candidate Designation...............................................................8 DE Reg. 446 (Final) 1528 Foreign Language Teacher Comprehensive..................................................................8 DE Reg. 80 (Final) 1529 Foreign Language Teacher Secondary..........................................................................8 DE Reg. 80 (Final) 1533 Foreign Language Teacher Elementary........................................................................8 DE Reg. 80 (Final) 1537 Bilingual Teacher (Spanish) Secondary........................................................................8 DE Reg. 80 (Final) 1554 Standard Certificate Reading Specialist................................................................................8 DE Reg. 405 (Prop.) 1558 Bilingual Teacher (Spanish) Primary Middle Level.....................................................8 DE Reg. 80 (Final) 1566 (Formerly Reg. 331) Standard Certificate Family & Consumer Sciences Teacher..............8 DE Reg. 553 (Final) 1577 (Formerly Reg. 368) Standard Certificate-School Psychologist .........................................8 DE Reg. 448 (Final) DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF LONG TERM CARE RESIDENTS PROTECTION Assisted Living Facilities, Regulations for.....................................................................8 DE Reg. 46 (Prop.) 8 DE Reg. 85 (Final) Training & Qualifications for Nursing Assistants & Certified Nursing Assistants........8 DE Reg. 662 (Prop.) DIVISION OF PUBLIC HEALTH Regulations Pertaining to the Testing of Newborn Infants for Metabolic, Hematologic and Endocrinologic Disorders.................................................................................8 DE Reg. 100 (Final) 203 Cancer Treatment Program......................................................................................8 DE Reg. 107 (Final) 8 DE Reg. 509 (Emer.) 463 Licensing and Registration of Operators of Public Water Supply Systems.............8 DE Reg. 47 (Prop.) 8 DE Reg. 453 (Final) DIVISION OF SOCIAL SERVICES Division of Social Services Manual (DSSM) Client Cost Sharing for Pharmaceutical Services............................................................8 DE Reg. 664 (Prop.) 3003 Non-Time Limited Program-Children’s Program...................................................8 DE Reg. 670 (Prop.) 3031 Work for your Welfare............................................................................................8 DE Reg. 670 (Prop.) 5311 Notification of Time and Place of Hearing.............................................................8 DE Reg. 351 (Final) 8 DE Reg. 376 (Errata) 9026.1, Food Stamp Program..........................................................................................8 DE Reg. 521 (Prop.) 9068.1 Certification Period Length.........................................................................8 DE Reg. 113 (Final) 20700.5-20700.5.8, Acquired Brain Injury Waiver Program..........................................8 DE Reg. 250 (Prop.) 8 DE Reg. 555 (Final) 8 DE Reg. 616 (Errata) Child Care Subsidy Program: 11002.9 Definitions and Explanation Of Terms; 11004.4.1 Explanation of Certificates; 11006.4.2 Fee Paying Clients....................8 DE Reg. 407 (Prop.) DEPARTMENT OF INSURANCE 301 Audited Financial Reports......................................................................................................8 DE Reg. 252 (Prop.) 8 DE Reg. 557 (Final) 504 (Formerly Reg. No. 47) Education for Insurance Agents, Brokers, Surplus Lines Brokers and Consultants.........................................................................................................8 DE Reg. 409 (Prop.) 8 DE Reg. 703 (Final) 606, (Formerly Reg. No. 31) Proof of Automobile Insurance...............................................8 DE Reg. 55 (Prop.) 607, (Formerly Reg. No. 37) Defensive Driving Course Discount Automobiles and Motorcycles.....................................................................................................................8 DE Reg. 59 (Prop.) 8 DE Reg. 460 (Final) 1404 Long-Term Care Insurance...................................................................................................8 DE Reg. 257 (Prop.) 8 DE Reg. 562 (Final) 1501 Medicare Supplement Insurance Minimum Standards.................................................8 DE Reg. 62 (Prop.) 8 DE Reg. 465 (Final) 8 DE Reg. 672 (Prop.) DEPARTMENT OF LABOR COUNCIL ON APPRENTICESHIP & TRAINING Section 106.5, Standards of Apprenticeship...................................................................8 DE Reg. 65 (Prop.) 8 DE Reg. 468 (Final) DEPARTMENT OF NATURAL RESOURCES AND ENVIRONMENTAL CONTROL OFFICE OF THE SECRETARY Green Energy Fund Program Regulation...............................................................................8 DE Reg. 114 (Final) DIVISION OF AIR AND WASTE MANAGEMENT-AIR QUALITY MANAGEMENT SECTION 1352 Above Ground Storage Tank Regulations.....................................................................8 DE Reg. 677 (Prop.) Hazardous Waste, Regulations Governing.............................................................................8 DE Reg. 352 (Final) Reporting of a Discharge of a Pollutant or Air Contaminant.........................................8 DE Reg. 126 (Final) Solid Waste, Regulations Governing......................................................................................8 DE Reg. 354 (Final) Reg. 43, Not to Exceed Heavy duty California Engine Standards.........................................8 DE Reg. 672 (Prop.) DIVISION OF FISH & WILDLIFE 4.0 Seasons & 7.0 Deer...........................................................................................................8 DE Reg. 355 (Final) 3308 (Formerly NT-7) Fish Stocking Practices......................................................................8 DE Reg. 374 (Emer.) DIVISION OF WATER RESOURCES Design, Installation and Operation of On-Site Wastewater Treatment and Disposal Systems, Regulations Governing............................................................................................8 DE Reg. 283 (Prop.) Surface Water Quality Standards....................................................................................8 DE Reg. 154 (Final) TMDL’s for Little Assowoman Bay Watershed......................................................................8 DE Reg. 688 (Prop.) Water Pollution, Regulations Governing................................................................................8 DE Reg. 679 (Prop.) DEPARTMENT OF SAFETY AND HOMELAND SECURITY Board of Examiners of Private Investigators and Private Security Agencies................................8 DE Reg. 325 (Final) Bounty Hunter/Bail Enforcement Agents......................................................................................8 DE Reg. 689 (Prop.) Division of Highway Safety Electronic Red Light Safety Program.................................................................................... 8 DE Reg. 524 (Prop.) DIVISION OF HISTORICAL AND CULTURAL AFFAIRS Historic Preservation Tax Credit, Regulations Governing ............................................8 DE Reg. 194 (Final) uman Relations Commission 1502 Fair Housing Regulation................................................................................................8 DE Reg. 591 (Final) OFFICE OF THE STATE BANKING COMMISSIONER 708 (Formerly Reg. No. 5.770.0009) Establishment of a Branch Office by a Bank or Trust Company........................................................................................................8 DE Reg. 68 (Prop.) 8 DE Reg. 472 (Final) 714 Establishment of a Mobile Branch Office by a Bank or Trust Company................8 DE Reg. 68 (Prop.) 8 DE Reg. 473 (Final) 1113 Election by a Subsidiary Corporation of a Banking Organization of Trust Company to be Taxed in Accordance with Chapter 19 of Title 30..........................................8 DE Reg. 68 (Prop.) 8 DE Reg. 474 (Final) Division of Historical & Cultural Affairs Historic Preservation Tax Credit.............................................................................................8 DE Reg. 526 (Prop.) Appointments...............................................................................................................................8 DE Reg. 361 8 DE Reg. 479 8 DE Reg. 602 8 DE Reg. 715 Executive Order No. 56, Establishing The Infant Mortality Task Force.......................................8 DE Reg. 199 Executive Order No .57, Declaring Friday, June 11, 2004 A Legal Holiday In Remembrance Of Former President Reagan..........................................................................8 DE Reg. 360 Executive Order No. 58, Relating to the Reestablishment of the Juvenile Justice Advisory Group......................................................................................................................8 DE Reg. 477 Executive Order No. 59, Implementing the Strategies for State Policies & Spending ...............8 DE Reg. 714 MERIT EMPLOYEES RELATIONS BOARD Classification Maintenance Review Appeal Procedures...............................................................8 DE Reg. 599 (Final) DEPARTMENT OF ADMINISTRATIVE SERVIVCES DIVISION OF PROFESSIONAL REGULATION BOARD OF MEDICAL PRACTICE Statutory Authority: 24 Delaware Code, Section 1730(a)(12) (24 Del.C. §1730(a)(12)) 24 DE Admin. Code 1700 * PLEASE NOTE: THIS NOTICE OF PROPOSED REGULATORY ACTION WAS ORIGINALLY PUBLISHED IN THE NOVEMBER 2004 ISSUE OF THE REGISTER. HOWEVER, THE DATE, PLACE AND TIME OF THE PUBLIC HEARING WAS INADVERTENTLY LEFT OUT. IT IS BEING REPUBLISHED HERE WITH THE REQUIRED INFORMATION. PUBLIC NOTICE PLEASE TAKE NOTICE, pursuant to 29 Del.C. Chapter 101 and 24 Del.C. 1730(a)(12), the Delaware Board of Medical Practice proposes to revise its Rules and Regulations as mandated by Senate Bill 229. The proposed revision will add a new section that specifically identifies those crimes which are substantially related to the practice of medicine and the practice of licensed respiratory care and practice as a licensed physician's assistant. A public hearing will be held on the proposed Rule and Regulation on January 4, 2005 at 2:30 p.m. in the Second Floor Conference Room A of the Cannon Building, 861 Silver Lake Boulevard, Dover, Delaware 19904. The Board will receive and consider input in writing from any person concerning the proposed Rule and Regulation. Any written comments should be submitted to the Board in care of Gayle Franzolino at the above address. The final date to submit written comments shall be at the above scheduled public hearing. Anyone wishing to obtain a copy of the proposed Rule and Regulation or to make comments at the public hearing should notify Gayle Franzolino at the above address or by calling her at (302) 744-4520. AUTHORITY Pursuant to 74 Del. Laws c. 262, (Senate Bill No. 229 of the 142 General Assembly, 2004, as amended), the Board was directed to promulgate regulations specifically identifying those crimes which are substantially related to the practice of medicine and the practice of licensed respiratory care and practice as a licensed physician’s assistant. PURPOSE The Board of Medical Practice believes that the State of Delaware has a compelling public policy interest in ensuring that its licensed professionals not only have specified levels of educational and professional competence but also possess sufficient character and judgment necessary to practice safely in their chosen fields and to do so in a manner which will not undermine the community’s confidence in the expertise and professionalism of the members of the profession. Licensed professionals, particularly those in health care related fields, often come into contact with clients and patients and other members of the public at times when they may be sick, infirmed or otherwise extremely vulnerable to undue influence or other forms of misuse, fraud and abuse. It is therefore critical that all reasonable steps are taken to determine, to the extent possible, that the regulation of such professionals takes into consideration not only the individual’s technical competence but his or her demonstrated propensity to behave in a way that does not expose the client population to risk or diminish legitimate expectations of honest and honorable behavior by such licensed health care professionals. 1700 Board of Medical Practice 29.0Crimes Substantially Related to the Practice of Medicine and the Practice of Licensed Respiratory Care and Practice as a Licensed Physician’s Assistant The Board finds that for purposes of licensing, renewal, reinstatement and discipline, the conviction of any of the following crimes, or of the attempt to commit or a conspiracy to commit or conceal the following crimes or substantially similar crimes in another state or jurisdiction, is deemed to be substantially related to the practice of Medicine, Respiratory Care and Physician’s Assistants in the State of Delaware without regard to the place of conviction: 29.1For the purposes of this section the following definitions shall apply: “Conviction” means a verdict of guilty by whether entered by a judge or jury, or a plea of guilty or a plea of nolo contendere or other similar plea such as a “Robinson” or “Alford” plea unless the individual has been discharged under §4218 of Title 11 of the Delaware Code (probation before judgment) or under §1024 of Title 10 (domestic violence diversion program) or by §4764 of Title 16 (first offenders controlled substances diversion program). “Jurisdiction” Including all crimes prohibited by or punishable under Title 18 of the United Stated Code Annotated (U.S.C.A.) such as, but not limited to, Federal Health Care offenses. 29.2Any crime which involves the use of physical force or violence toward or upon the person of another and shall include by way of example and not of limitation the following crimes set forth in Title 11 of the Delaware Code Annotated: Assaults and Related Offenses 29.2.1§601. Offensive touching; 29.2.2§602. Menacing; 29.2.3§603. Reckless endangering in the second degree; 29.2.4§604. Reckless endangering in the first degree; 29.2.5§605. Abuse of a pregnant female in the second degree; 29.2.6§606. Abuse of a pregnant female in the first degree; 29.2.7§611. Assault in the third degree; 29.2.8§612. Assault in the second degree; 29.2.9§613. Assault in the first degree; 29.2.10§614. Assault on a sports official. 29.2.11§615. Assault by abuse or neglect; 29.2.12§621. Terroristic threatening; 29.2.13§625. Unlawfully administering drugs; 29.2.14§626. Unlawfully administering controlled substance or counterfeit substance or narcotic drugs; 29.2.15§627. Prohibited acts as to substances releasing vapors or fumes; 29.2.16§628. Vehicular assault in the second degree; 29.2.17§629. Vehicular assault in the first degree; 29.2.18§630. Vehicular homicide in the second degree; 29.2.19§630A. Vehicular homicide in the first degree; 29.2.20§631. Criminally negligent homicide; 29.2.21§632. Manslaughter; 29.2.22§633. Murder by abuse or neglect in the second degree; 29.2.23§634. Murder by abuse or neglect in the first degree; 29.2.24§635. Murder in the second degree; 29.2.25§636. Murder in the first degree; 29.2.26§645. Promoting suicide. Abortion and Related Offenses 29.2.27§651. Abortion; 29.2.28§653. Issuing abortional articles. Sexual Offenses 29.2.29§763. Sexual harassment; 29.2.30§764. Indecent exposure in the second degree; 29.2.31§765. Indecent exposure in the first degree; 29.2.32§766. Incest; 29.2.33§767. Unlawful sexual contact in the third degree; 29.2.34§768. Unlawful sexual contact in the second degree; 29.2.35§769. Unlawful sexual contact in the first degree; 29.2.36§770. Rape in the fourth degree; 29.2.37§771. Rape in the third degree; 29.2.38§772. Rape in the second degree; 29.2.39§773. Rape in the first degree; 29.2.40§776. Sexual extortion; 29.2.41§777. Bestiality; 29.2.42§778. Continuous sexual abuse of a child; 29.2.43§780. Female genital mutilation. Kidnapping and Related Offenses 29.2.44§781. Unlawful imprisonment in the second degree; 29.2.45§782. Unlawful imprisonment in the first degree; 29.2.46§783. Kidnapping in the second degree; 29.2.47§783A. Kidnapping in the first degree; 29.2.48§785. Interference with custody; Coercion 29.2.49§791. Acts constituting coercion; 29.3Any crime which involves dishonesty or false, fraudulent or aberrant behavior and shall include by way of example and not of limitation the following crimes listed in Title 11 of the Delaware Code Annotated: Arson and Related Offenses 29.3.1§801. Arson in the third degree; 29.3.2§802. Arson in the second degree; 29.3.3§803. Arson in the first degree; 29.3.4§804. Reckless burning or exploding; 29.3.5§805. Cross or religious symbol burning; Criminal Trespass and Burglary 29.3.6§820. Trespassing with intent to peer or peep into a window or door of another; 29.3.7§821. Criminal trespass in the third degree; 29.3.8§822. Criminal trespass in the second degree; 29.3.9§823. Criminal trespass in the first degree; 29.3.10§824. Burglary in the third degree; 29.3.11§825. Burglary in the second degree; 29.3.12§826. Burglary in the first degree; 29.3.13§828. Possession of burglar’s tools or instruments facilitating theft; Robbery 29.3.14§831. Robbery in the second degree; 29.3.15§832. Robbery in the first degree. 29.3.16§835. Carjacking in the second degree; 29.3.17§836. Carjacking in the first degree; Theft and Related Offenses 29.3.18§840. Shoplifting; class G felony; 29.3.19§840A. Use of illegitimate retail sales receipt or Universal Product Code Label. 29.3.20§841. Theft; 29.3.21§842. Theft; lost or mislaid property; mistaken delivery. 29.3.22§843. Theft; false pretense. 29.3.23§844. Theft; false promise. 29.3.24§845. Theft of services. 29.3.25§846. Extortion; 29.3.26§848. Misapplication of property; 29.3.27§849. Theft of rented property; 29.3.28§850. Use, possession, manufacture, distribution and sale of unlawful telecommunication and access devices. 29.3.29§851. Receiving stolen property; 29.3.30§853. Unauthorized use of a vehicle; 29.3.31§854. Identity theft; 29.3.32§859. Larceny of livestock; 29.3.33§860. Possession of shoplifter’s tools or instruments facilitating theft; Forgery and Related Offenses 29.3.34§861. Forgery; class F felony; 29.3.35§862. Possession of forgery devices; Offenses Involving Falsification of Records 29.3.36§871. Falsifying business records; 29.3.37§872. Falsifying business records; 29.3.38§873. Tampering with public records in the second degree; 29.3.39§876. Tampering with public records in the first degree; 29.3.40§877. Offering a false instrument for filing; 29.3.41§878. Issuing a false certificate; Bribery Not Involving Public Servants 29.3.42§881. Bribery; 29.3.43§882. Bribe receiving; Frauds on Creditors 29.3.44§891. Defrauding secured creditors; 29.3.45§892. Fraud in insolvency; 29.3.46§893. Interference with levied-upon property; Other Frauds and Cheats 29.3.47§900. Issuing a bad check; 29.3.48§903. Unlawful use of credit card; 29.3.49§903A. Reencoder and scanning devices; 29.3.50§906. Deceptive business practices; 29.3.51§907. Criminal impersonation; 29.3.52§907A. Criminal impersonation, accident related; 29.3.53§907B. Criminal impersonation of a police officer; 29.3.54§908. Unlawfully concealing a will; 29.3.55§909. Securing execution of documents by deception; 29.3.56§910. Debt adjusting; 29.3.57§911. Fraudulent conveyance of public lands; 29.3.58§912. Fraudulent receipt of public lands;. 29.3.59§913. Insurance fraud; 29.3.60§913A. Health care fraud; 29.3.61§914. Use of consumer identification information; 29.3.62§915. Use of credit card information; 29.3.63§915A. Credit and debit card transaction receipts; 29.3.64§916. Home improvement fraud; 29.3.65§917. New home construction fraud; Offenses Relating to Recorded Devices 29.3.66§920. Transfer of recorded sounds; 29.3.67§921. Sale of transferred recorded sounds; 29.3.68§922. Improper labeling; Computer Related Offenses 29.3.69§932. Unauthorized access. 29.3.70§933. Theft of computer services. 29.3.71§934. Interruption of computer services. 29.3.72§935. Misuse of computer system information. 29.3.73§936. Destruction of computer equipment. 29.3.74§937. Unrequested or unauthorized electronic mail or use of network or software to cause same. 29.3.75§938. Failure to promptly cease electronic communication upon request. Offenses Relating to Marriage 29.3.76§1001. Bigamy; 29.3.77§1003. Bigamous marriage contracted outside the State. 29.4Any crime which involves misuse or abuse of children or animals and shall include by way of example and not of limitation the following crimes listed in Title 11 of the Delaware Code Annotated: Child Welfare; Sexual Offenses, Animal Offenses 29.4.1§1100. Dealing in children; 29.4.2§1101. Abandonment of child; 29.4.3§1102. Endangering the welfare of a child; 29.4.4§1105. Endangering the welfare of an incompetent person; 29.4.5§1106. Unlawfully dealing with a child; 29.4.6§1107. Endangering children; 29.4.7§1108. Sexual exploitation of a child; 29.4.8§1109. Unlawfully dealing in child pornography; 29.4.9§1111. Possession of child pornography; 29.4.10§1112. Sexual offenders; prohibitions from school zones. 29.4.11§1112A .Sexual solicitation of a child; 29.4.12§1113. Criminal non-support and aggravated criminal non-support. 29.4.13§1114. Body-piercing; tattooing or branding; 29.4.14§1114A. Tongue-splitting; 29.4.15§1116. Sale or distribution of tobacco products to minors; 29.4.16§1117. Notice; 29.4.17§1119. Distribution of cigarettes through vending machines; 29.4.18§1120. Distribution of tobacco products; 29.4.19§1124. Purchase or receipt of tobacco products by minor; 29.4.20§1325. Cruelty to animals; 29.4.21§1325A. The unlawful trade in dog or cat by-products; 29.4.22§1326. Animals; fighting and baiting prohibited; 29.4.23§1327. Maintaining a dangerous animal; 29.5Any crime which involves offenses against the public order the commission of which may tend to bring discredit upon the profession and which are thus substantially related to one’s fitness to practice such profession and shall include by way of example and not of limitation the following crimes listed in Title 11 of the Delaware Code Annotated: Bribery and Improper Influence 29.5.1§1201. Bribery; 29.5.2§1203. Receiving a bribe; 29.5.3§1205. Giving unlawful gratuities; 29.5.4§1206. Receiving unlawful gratuities; 29.5.5§1207. Improper influence; 29.5.6§1211. Official misconduct; 29.5.7§1212. Profiteering. Perjury and related offenses 29.5.8§1221. Perjury in the third degree; 29.5.9§1222. Perjury in the second degree; 29.5.10§1223. Perjury in the first degree; 29.5.11§1233. Making a false written statement; 29.5.12§1239. Wearing a disguise during the commission of a felony; 29.5.13§1240. Terroristic threatening of public officials or public servants; 29.5.14§1241. Refusing to aid a police officer; 29.5.15§1243. Obstructing fire-fighting operations; 29.5.16§1244. Hindering prosecution; 29.5.17§1245. Falsely reporting an incident; 29.5.18§1246. Compounding a crime; 29.5.19§1248. Obstructing the control and suppression of rabies; 29.5.20§1249. Abetting the violation of driver’s license restrictions; 29.5.21§1250. Offenses against law-enforcement animals; 29.5.22§1251. Escape in the third degree; 29.5.23§1252. Escape in the second degree; 29.5.24§1253. Escape after conviction; 29.5.25§1254. Assault in a detention facility; 29.5.26§1257A. Use of an animal to avoid capture; 29.5.27§1259. Sexual relations in detention facility; 29.5.28§1260. Misuse of prisoner mail. Offenses Relating to Judicial and Similar Proceedings 29.5.29§1261. Bribing a witness; 29.5.30§1262. Bribe receiving by a witness; 29.5.31§1263. Tampering with a witness; 29.5.32§1263A.Interfering with child witness. 29.5.33§1264. Bribing a juror; 29.5.34§1265. Bribe receiving by a juror; 29.5.35§1266. Tampering with a juror; 29.5.36§1267. Misconduct by a juror; 29.5.37§1269. Tampering with physical evidence; 29.5.38§1271. Criminal contempt; 29.5.39§1271A.Criminal contempt of a domestic violence protective order; 29.5.40§1273. Unlawful grand jury disclosure. 29.6Any crime which involves offenses against a public health order and decency which may tend to bring discredit upon the profession, specifically including the below listed crimes from Title 11 of the Delaware Code Annotated which evidence a lack of appropriate concern for the safety and well being of another person or persons in general or sufficiently flawed judgment to call into question the individuals ability to make health care decisions or advise upon health care related matters for other individuals. Disorderly Conduct and Related Offenses 29.6.1§1301. Disorderly conduct; 29.6.2§1302. Riot; 29.6.3§1304. Hate crimes; 29.6.4§1311. Harassment; 29.6.5§1312. Aggravated harassment; 29.6.6§1312A.Stalking; 29.6.7§1313. Malicious interference with emergency communications; 29.6.8§1315. Public intoxication; 29.6.9§1316. Registration of out-of-state liquor agents; 29.6.10§1320. Loitering on property of a state- supported school, college or university; 29.6.11§1321. Loitering 29.6.12§1322. Criminal nuisance; 29.6.13§1323. Obstructing public passages; 29.6.14§1324. Obstructing ingress to or egress from public buildings; 29.6.15§1331. Desecration; 29.6.16§1332. Abusing a corpse; 29.6.17§1333. Trading in human remains and associated funerary objects. 29.6.18§1335. Violation of privacy; 29.6.19§1338. Bombs, incendiary devices, Molotov cocktails and explosive devices; 29.6.20§1339. Adulteration; 29.6.21§1340. Desecration of burial place. Offenses Involving Public Indecency 29.6.22§1341. Lewdness; 29.6.23§1342. Prostitution; 29.6.24§1343. Patronizing a prostitute prohibited. 29.6.25§1351. Promoting prostitution in the third degree; 29.6.26§1352. Promoting prostitution in the second degree; 29.6.27§1353. Promoting prostitution in the first degree; 29.6.28§1355. Permitting prostitution; Obscenity 29.6.29§1361. Obscenity; acts constituting; 29.6.30§1365. Obscene literature harmful to minors; 29.6.31§1366. Outdoor motion picture theatres; Offenses Involving Gambling 29.6.32§1403. Advancing gambling in the first degree; 29.6.33§1404. Providing premises for gambling; 29.65.34§1405. Possessing a gambling device; class A misdemeanor. 29.6.35§1406. Being concerned in interest in keeping any gambling device; 29.6.36§1407. Engaging in a crap game; 29.6.37§1411. Unlawfully disseminating gambling information. 29.7Any crime which involves the illegal possession or the misuse or abuse of narcotics, or other addictive substances and those non-addictive substances with a substantial capacity to impair reason or judgment and shall include by way of example and not of limitation the following crimes listed in Chapter 47 of Title 16 of the Delaware Code Annotated: 29.7.1§4751. Prohibited acts A; 29.7.2§4752. Prohibited acts B; 29.7.3§4752A.Unlawful delivery of noncontrolled substance. 29.7.4§4753. Prohibited acts C. 29.7.5§4753A.Trafficking in marijuana, cocaine, illegal drugs, methamphetamines, L.S.D., or designer drugs. 29.7.6§4754. Prohibited acts D; 29.6.7§4754A.Possession and delivery of noncontrolled prescription drug. 29.7.8§4755. Prohibited acts E; 29.7.9§4756. Prohibited acts; 29.7.10§4757. Hypodermic syringe or needle; delivering or possessing; disposal; exceptions; 29.7.11§4758. Keeping drugs in original containers. 29.7.12§4761. Distribution to persons under 21 years of age; 29.7.13§4761A.Purchase of drugs from minors; 29.7.14§4767. Distribution, delivery, or possession of controlled substance within 1,000 feet of school property; 29.7.15§4768. Distribution, delivery or possession of controlled substance in or within 300 feet of park, recreation area, church, synagogue or other place of worship. 29.8Any crime which involves the misuse or illegal possession or sale of a deadly weapon or dangerous instrument and shall include by way of example and not of limitation the following crimes listed in Title 11 of the Delaware Code Annotated: Offenses Involving Deadly Weapons and Dangerous Instruments 29.8.1§1442. Carrying a concealed deadly weapon; 29.8.2§1443. Carrying a concealed dangerous instrument; 29.7.3§1444. Possessing a destructive weapon; 29.8.4§1445. Unlawfully dealing with a dangerous weapon; 29.8.5§1446. Unlawfully dealing with a switchblade knife; 29.8.6§1447. Possession of a deadly weapon during commission of a felony; 29.8.7§1447A.Possession of a firearm during commission of a felony; 29.8.8§1448. Possession and purchase of deadly weapons by persons prohibited; 29.8.9§1448A.Criminal history record checks for sales or firearms; 29.8.10§1449. Wearing body armor during commission of felony; 29.8.11§1450. Receiving a stolen firearm; 29.8.12§1451. Theft of a firearm; 29.8.13§1452. Unlawfully dealing with knuckles- combination knife; 29.8.14§1453. Unlawfully dealing with martial arts throwing star; 29.8.15§1454. Giving a firearm to person prohibited; 29.8.16§1455. Engaging in a firearms transaction on behalf of another; 29.8.17§1456. Unlawfully permitting a minor access to a firearm; 29.8.18§1457. Possession of a weapon in a Safe School and Recreation Zone; 29.8.19§1458. Removing a firearm from the possession of a law enforcement officer; 29.8.20§1459. Possession of a weapon with a removed, obliterated or altered serial number; 29.8.21§1471. Prohibited acts. Offenses Involving Drug Paraphernalia 29.8.22§4774. Penalties. Offenses Involving Organized Crime and Racketeering 29.8.23§1504. Criminal Penalties for Organized Crime & Racketeering Offenses Involving Intimidation of Victims or Witnesses 29.8.24§3532. Acts of Intimidation: Class E felony 29.8.25§3533. Aggravated act of intimidation, Class D felony Other Crimes 29.8.26Title 3 §1041. Willfully or maliciously starting fires; Carelessly Starting Fires; 29.8.27§1043. Setting fire to woodland; Unseasonable Marsh Burning. 29.8.28Title 4 §901. Offenses carrying penalty of imprisonment for 3 to 6 months; 29.8.29§902. Offenses carrying penalty of fine of $500 to $1,000 or imprisonment of 3 to 6 months on failure to pay fine; 29.8.30§903. Offenses carrying penalty of fine of not more than $100 imprisonment for 1 month on failure to pay fine; 29.8.31§904. Offenses concerning certain persons; 29.8.32§905. Unlicensed manufacture of alcoholic liquor; Possession of still, apparatus, mash, etc., by unlicensed person; 29.8.33 §906. Transportation or shipment; 29.8.34 §907. Interference with officer or inspector; 29.8.35§908. Failure of licensee to file report; 29.8.36§909. Violation of rules respecting liquor taxes. 29.8.37Title 7 §1717. Unauthorized acts against a service guide or seeing eye dog. 29.8.38Title 11 §2403. Manufacture, possession or sale of intercepting device; 29.8.39§2410. Breaking and entering, etc. to place or remove equipment; 29.8.40§2412. Obstruction, impediment or prevention of interception; 29.8.41§2422. Divulging contents of communications; 29.8.42§3532. Act of intimidation; 29.8.43§3533. Aggravated act of intimidation; 29.8.44§3534. Attempt to intimidate; 29.8.45§8523. Penalties [for violation of reporting provision re: SBI]; 29.8.46§8562. Penalties [for failure of child-care provider to obtain information required under §8561 or for those providing false information] 29.8.47§8572. Penalties [for providing false information when seeking employment in a public school] 29.8.48 §9016. Filing false claim [under Victims’ Compensation Fund]. 29.8.49Title 12 §210. Alteration, theft or destruction of Will. 29.8.50Title 16 §1136.Abuse or neglect of a patient or resident of a nursing facility. 29.8.51Title 21 §2118A.Unlawful possession or manufacture of proof of insurance; 29.8.52§2133. Penalties; jurisdiction of justices of the peace. 29.8.53§2315. False statements; 29.8.54§2316. Altering or forging certificate of title, manufacturer’s certificate of origin, registration sticker or vehicle I identification plate; 29.8.55§2620. False statements; incorrect or incomplete information; 29.8.56§2703. License to operate a motorcycle, motorbike, etc.; 29.8.57§2710. Issuance of a Level 1 Learner’s Permit and Class D operator’s license to persons under 18 years of age; 29.8.58§2722. Restricted licenses based on driver’s physical limitations; 29.8.59§2751. Unlawful application for or use of license or identification card; 29.8.60§2752. False statements; 29.8.61§2756. Driving vehicle while license is suspended or revoked; penalty; 29.8.62§2760. Duplication, reproduction, altering, or counterfeiting of driver’s licenses or identification cards. 29.8.63Title 23 §2302. Operation of a vessel or boat while under the influence of intoxicating liquor and/or drugs; 29.8.64§2305. Penalties; jurisdiction. 29.8.65Title 24 §903. Sale to persons under 21 or intoxicated persons. 29.8.66Title 29 §3107. Motor vehicle safety- responsibility; False statements; 29.8.67§4175A.Reckless driving; 29.8.68§4177. Driving a vehicle while under the influence or with a prohibited alcohol content; evidence; arrests; and penalties. 29.8.69§4177M.Operating a commercial motor vehicle with a prohibited blood alcohol concentration or while impaired by drugs; 29.8.70§4183 Parking areas for vehicles being used by persons with disabilities; 29.8.71§4198J. Bicycling on highways under influence of drugs or alcohol; 29.8.72§4198O. Operation of electric personal assistive mobility devices (EPAMD); 29.8.73§4201. Duty of driver involved in accident resulting in property damage or injury; 29.8.74§4202. Duty of driver involved in accident resulting in injury or death to any person; 29.8.75§4203. Duty to report accidents; evidence; 29.8.76§4204. Report of damaged vehicles; cars involved in fatal accidents; 29.8.77§4604. Possession of motor vehicle master keys, manipulative keys, key-cutting devices, lock picks or lock picking devices and hot wires; 29.8.78§6420. Odometers penalties; 29.8.79§6702. Driving vehicle without consent of owner; 29.8.80§6704. Receiving or transferring stolen vehicle; 29.8.81§6705. Removed, falsified or unauthorized identification number on vehicle, bicycle or engine; removed or affixed license/registration plate with intent to misrepresent identity; 29.8.82§6707. Penalty; 29.8.83§6709. Removal of warranty or certification stickers; vehicle identification plates; confidential vehicle identification numbers; 29.8.84§6710. Unlawful possession of assigned titles, assigned registration cards, vehicle identification plates and warranty stickers. 29.8.85Title 30 §571. Attempt to evade or defeat tax; 29.8.86§572. Failure to collect or pay over tax; 29.8.87§573. Failure to file return, supply information or pay tax; 29.8.88§574. Fraud and false statements; 29.8.89§576. Misdemeanors. 29.8.90Title 31 §1007. Fraudulent acts penalties; 29.8.91§3913. Welfare violations [knowing or reckless abuse of an infirm adult] 29.9Any crime which is a violation of Title 24, Chapter 17 (Delaware Medical Practices Act) as it may be amended from time to time or of any other statute which requires the reporting of a medical situation or condition to state, federal or local authorities or a crime which constitutes a violation of the Medical Practice Act of the state in which the conviction occurred or in which the physician is licensed. 29.10The Board reserves the jurisdiction and authority to modify this regulation as and if it becomes necessary to either add or delete crimes including such additions as may be required on an emergency basis under 29 Del.C. §10119 to address imminent peril to the public health, safety or welfare.   The Board also specifically reserves the jurisdiction to review any crime committed by an applicant for licensure as a physician and to determine whether to waive the disqualification under 24 Del.C. §1720(d). *Please Note: As the rest of the sections were not amended they are not being published. A complete set of the rules and regulations for the Board of Medical Practice is available at: http://www.state.de.us/research/ AdminCode/title24/1700 Board of Medical Practice.shtml DEPARTMENT OF ADMINISTRATIVE SERVICES DIVISION OF PROFESSIONAL REGULATION BOARD OF NURSING 24 DE Admin. Code 1900 Statutory Authority: 24 Delaware Code, Section 1906(1) (24 Del.C. §1906(1)) ORDER Pursuant to due notice of the time and place of hearing published in the News Journal and in the Delaware State News and in compliance with the requirements of 29 Del.C. §10115, the Delaware Board of Nursing ("Board") under its authority to enact rules and regulations specified in 24 Del.C. §1906(1), conducted a public hearing concerning proposed modifications to the Rules and Regulations of the Board. The proposed modifications and additions were published in the Delaware Register of Regulations Volume 8, Issue 3, Wednesday, September 1, 2004 beginning at Page 377. Notice of the hearing was also published in two newspapers of general circulation and on page 499 of Volume 8, Issue 3 of the Delaware Register of Regulations(Hearing Exhibit No. 1). The public hearing was held on October 13, 2004 as scheduled in Conference Room A, Cannon Building, 861 Silver Lake Boulevard, Dover, Kent County, Delaware. A quorum of the Board was present for the hearing. Summary Of The Evidence Pursuant to 29 Del.C. §10118, the following is a summary of the evidence and information provided at the hearing. David Klopfenstein, CRNA, MSN, President, Delaware Association of Nurse Anesthetists presented oral and written comments (Hearing Exhibit No. 2) expressing the opposition of the Delaware Association of Nurse Anesthetists to the proposed Regulation provision which would provide that Advanced Practice Nurses (APN’s), properly trained, could insert and remove epidural catheters. Mr. Klopfenstein noted that objections were based upon a threat to patient safety and that the change did not address an access to care issue and did not advance the profession of nursing. Delphose E. Price, Jr., CRNA, MSN, stated to the Board that he was knowledgeable concerning the insertion and removal of epidural catheters and that there were patient safety issues with both the insertion and removal of such catheters and that only nurses who were Certified Registered Nurse Anesthetists were properly trained to insert and remove these catheters. Iva J. Boardman, R.N., M.S.N., Executive Director of the Board of Nursing, was sworn and testified concerning the development of the proposed modification to the Rules and Regulations of the Board. Ms. Boardman noted that the proposed Regulation began in 1989 as a Board position paper and had experienced seven revisions in the intervening years. In February of 2004 in reviewing the use of anesthetic agents by registered nurses prior to intravascular therapy, the Board, upon the advice of legal counsel determined to move the position paper statements into the form of Rules and Regulations of the Board. Written comments were received by the Board of Nursing. David Klopfenstein, CRNA, MSN, on behalf of the Delaware Association of Nurse Anesthetists wrote to express concern regarding the proposed change relating to the insertion and removal of epidural catheters by APN’s after special training. The letter noted, among other things, that there are already many health care providers in Delaware that are trained and permitted to insert epidurals and that adequate access was available through physicians and nurse anesthetists (Hearing Exhibit No. 2). Lenhart Fagraeus, MD, PH. D., provided written comments expressing concern with the same propose provision because of safety and education issues and noted that there are enough Anesthesia personnel in the State of Delaware to meet the needs for pain management. Dr. Fagraeus opined that CRNA’s should be the only nurses working with epidural catheters (Hearing Exhibit No. 3). Sandra P. Como-Fluehr, MSN, RN, APN, BC of the Pain Management Service, Alfred I. DuPont Hospital for Children also provided written comments. She noted that there are many states which allow removal of epidural catheters by properly trained registered nurses. Ms. Como- Fluehr also noted that the insertion of epidural catheters and their removal were separate issues. She supported their removal by trained APNs (Hearing Exhibit No. 4). Peter B. Panzer, MD, provided written comments proposing further modification to the Rules and Regulations of the Board of Nursing to provide that intradermal or topical anesthetics may be used by the RN or LPN in various situations or settings provided there is an authorized prescribers’ order. Dr. Panzer’s comments recognized that his proposal was not addressed by the section relating to intravascular therapy which was the subject of the present proceeding but sought to have the Board give consideration to his proposal as either a stand-alone section or as part of another section of the Nursing Regulations (Hearing Exhibit No. 5). Leslie Verucci, RN,MSN, CNS,APRN-BC, CNRP, Chair of the Advanced Practice Council of Delaware Nurses Association provided written comments observing that there are no nurse practitioners who have come forward with a request to insert epidural catheters. Ms. Verucci noted that her Association supported the use of CRNA’s to perform the task of inserting epidural catheters but believed that RN’s with specialized training may remove epidurals safely (Hearing Exhibit No. 6). Findings Of Fact And Conclusions The Board finds that the procedures required for the modification of Rules and Regulations have been accomplished as required and that the proposed change furthers the public purposes of the Board of Nursing. The only area where the proposed Rules and Regulations relating to the provision of intravascular therapy met with any controversy surrounded the proposed provisions relating to the insertion and removal of epidural catheters. The currently proposed provision 7.8.4.3.1.6 sets forth the existing practice in this state and provides that the Registered Nurse may not insert or remove epidural catheters. The Board finds that it is not appropriate at this time to change this limitation. The proposed section 8.7.16 proposed that it was to be considered to be within the scope of practice of APNs with specialized training to insert and remove epidural catheters. The Board finds that it is not appropriate at this time to adopt this provision because of the information provided by and on behalf of CRNAs raises questions which need to be addressed further concerning patient safety relating to the removal as well as the insertion of epidural catheters. The Board’s Regulations are now silent on who can insert and remove such catheters. CRNAs have historically been engaging in both the removal and insertion of epidural catheters and so the status quo relating to the insertion and removal of epidural catheters will be maintained by the Board’s determination to enact section 7.8.4.3.1.6 and to abstain from enacting section 8.7.16. The Nursing Practice Committee of the Board will review the question of authorization to insert and remove epidural catheters and will make a recommendation to the Board concerning these matters after further study. DECISION AND ORDER Based upon the findings and conclusions set forth above, the undersigned, constituting a quorum of the Delaware Board of Nursing, adopt the proposed modification to the Rules and Regulations published in the Register of Regulations in Volume 8, Issue 3, Wednesday, September 1, 2004, beginning at page 377 as a modification to the Rules and Regulations of the Board, effective December 13, 2004 with the exception of Proposed Section 8.7.16 regarding the insertion and removal of epidural catheters which is not adopted. (See Attached EXHIBIT A). The written comments of Dr. Peter B. Panzer (Hearing Exhibit No. 5) are referred to the Nursing Practice Committee for consideration and action as appropriate. The Rules and Regulation Committee of the Board of Nursing shall review the circumstances and situations surrounding the insertion and removal of epidural catheters and make recommendations to the Board as to appropriate additions to the Board’s Rules and Regulations concerning the insertion and removal of such catheters. SO ORDERED this 20th Day of October, 2004. BY ORDER OF THE BOARD OF NURSING 7.0Standards of Nursing Practice 7.1Authority “Standards of nursing practice” means those standards of practice adopted by the Board that interpret the legal definitions of nursing, as well as provide criteria against which violations of the law can be determined. Such standards of nursing practice shall not be used to directly or indirectly affect the employment practices and deployment of personnel by duly licensed or accredited hospitals and other duly licensed or accredited health care facilities and organizations. In addition, such standards shall not be assumed the only evidence in civil malpractice litigation, nor shall they be given a different weight than any other evidence. 7.2Purpose The purpose of standards is to establish minimal acceptable levels of safe practice for the Registered and Licensed Practical Nurse, and to serve as a guide for the Board to evaluate safe and effective nursing care. 7.3Standards of Practice for the Registered and Licensed Practical Nurse 7.3.1Standards related to the Registered Nurse. 7.3.1.1The Registered Nurse shall conduct and document nursing assessments of the health status of individuals and groups by: 7.3.1.1.1Collecting objective and subjective data from observations, examinations, interviews and written records in an accurate and timely manner. The data include but are not limited to: 7.3.1.1.1.1Biophysical and emotional status and observed changes; 7.3.1.1.1.2Growth and development; 7.3.1.1.1.3Ethno-cultural, spiritual, socio-economic and ecological background; 7.3.1.1.1.4Family health history; 7.3.1.1.1.5Information collected by other health team members; 7.3.1.1.1.6Ability to perform activities of daily living; 7.3.1.1.1.7Consideration of client’s health goals; 7.3.1.1.1.8Client knowledge and perception about health status and potential, or maintaining health status; 7.3.1.1.1.9Available and accessible human and material resources; 7.3.1.1.1.10Patterns of coping and interaction. 7.3.1.1.2Sorting, selecting, reporting, and recording the data. 7.3.1.1.3Analyzing data. 7.3.1.1.4Validating, refining and modifying the data by using available resources including interactions with the client, family, significant others, and health team members. 7.3.1.1.5Evaluating data. 7.3.1.2Registered Nurses shall establish and document nursing diagnoses that serve as the basis for the strategy of care. 7.3.1.3Registered Nurses shall develop strategies of care based on assessment and nursing diagnoses. This includes, but is not limited to: 7.3.1.3.1Prescribing nursing intervention(s) based on the nursing diagnosis. 7.3.1.3.2Initiating nursing interventions through 7.3.1.3.2.1Giving care. 7.3.1.3.2.2Assisting with care. 7.3.1.3.2.3Delegating care. 7.3.1.3.3Identifying to the identification of priorities in the strategies of care. 7.3.1.3.4Setting realistic and measurable goals for implementation. 7.3.1.3.5Identifying measures to maintain comfort, to support human functions and responses, to maintain an environment conducive to well being, and to provide health teaching and counseling. 7.3.1.3.6Supervising the caregiver to whom care is delegated. 7.3.1.4Registered Nurses shall participate in the implementation of the strategy of care by: 7.3.1.4.1Providing care for clients whose conditions are stabilized or predictable. 7.3.1.4.2Providing care for clients whose conditions are critical and/or fluctuating, under the direction and supervision of a recognized authority. 7.3.1.4.3Providing an environment conducive to safety and health. 7.3.1.4.4Documenting nursing interventions and client outcomes. 7.3.1.4.5Communicating nursing interventions and client outcomes to health team members. 7.3.1.5Registered Nurses shall evaluate outcomes, which shall include the client, family, significant others and health team members. 7.3.1.5.1Evaluation data shall be appropriately documented; and 7.3.1.5.1.1Be communicated to the client, family, significant others and appropriate members of the health care team; and 7.3.1.5.1.2Used as a basis for modifying outcomes by reassessing client health status, modifying nursing diagnoses, revising strategies of care or prescribing changes in nursing interventions. 7.4Standards of Practice for the Licensed Practical Nurse 7.4.1Standards related to the Licensed Practical Nurse’s contributions to the nursing process. 7.4.1.1The Licensed Practical Nurse shall contribute to and document nursing assessments of the health status of individuals and groups by: 7.4.1.1.1Sorting, selecting, reporting, and recording the data. 7.4.1.1.2Collecting objective and subjective data from observations, examinations, interview and written records in an accurate and timely manner. The data include but are not limited to: 7.4.1.1.2.1Biophysical and emotional status and observed changes; 7.4.1.1.2.2Growth and development; 7.4.1.1.2.3Ethno-cultural, spiritual, socio-economic, and ecological background; 7.4.1.1.2.4Family health history; 7.4.1.1.2.5Information collected by other health team members; 7.4.1.1.2.6Ability to perform activities of daily living; 7.4.1.1.2.7Consideration of client’s health goals; 7.4.1.2Licensed Practical Nurses shall participate in establishing and documenting nursing diagnoses that serve as the basis for the strategy of care. 7.4.1.3Licensed Practical Nurses shall participate in developing strategies of care based on assessment and nursing diagnoses. 7.4.1.3.1Contributing to setting realistic and measurable goals for implementation. 7.4.1.3.2Participating in identifying measures to maintain comfort, to support human functions and responses to maintain an environment conducive to well-being, and to provide health teaching and counseling. 7.4.1.3.3Contributing to setting client priorities. 7.4.1.4Licensed Practical Nurses shall participate in the implementation of the strategy of care by: 7.4.1.4.1Providing care for clients whose conditions are stabilized or predictable. 7.4.1.4.2Providing care for clients whose conditions are critical and/or fluctuating, under the directions and supervision of a recognized licensed authority. 7.4.1.4.3Providing an environment conducive to safety and health. 7.4.1.4.4Documenting nursing interventions and client outcomes. 7.4.1.4.5Communicating nursing interventions and client outcomes to health team members. 7.4.1.5Licensed Practical Nurses shall contribute to evaluating outcomes by appropriately documenting and communicating to the client, family, significant others and the health care team members. 7.5Standards Related to the Registered and Licensed Practical Nurse’s Competencies and Responsibilities. 7.5.1Registered and Licensed Practical Nurses shall: 7.5.1.1Have knowledge of the statutes and regulations governing nursing and function within the legal boundaries of professional and practical nursing practice. 7.5.1.2Accept responsibility for competent nursing practice. 7.5.1.3Function as a member of the health team: 7.5.1.3.1By collaborating with other members of the health team to provide optimum care, or 7.5.1.3.2As an LPN under the direction and supervision of a recognized licensed authority. 7.5.1.4Consult with nurses, other health team members and community agencies for continuity of care and seek guidance as necessary. 7.5.1.5Obtain instruction and supervision as necessary when implementing nursing techniques. 7.5.1.6Contribute to the formulation, interpreting, implementing and evaluating of the objectives and policies related to professional and practical nursing practice within the employment setting. 7.5.1.7Participate in evaluating nurses through peer review. 7.5.1.8Report unsafe nursing practice to the Board and unsafe practice conditions to recognized legal authorities. 7.5.1.9Practice without discrimination as to age, race, religion, sex, sexual orientation, national origin, or disability. 7.5.1.10Respect the dignity and rights of clients regardless of social or economic status, personal attributes or nature of health problems. 7.5.1.11Respect the client’s right to privacy by protecting confidentiality unless obligated by law to disclose the information. 7.5.1.12Respect the property of clients, their families and significant others. In addition to the proceeding, the Registered Nurse shall: 7.5.1.13Delegate to others only those nursing interventions that those persons are prepared or qualified to perform. 7.5.1.14Supervise others to whom nursing interventions are delegated. 7.5.1.15Retain professional accountability for care when delegating. 7.5.1.16Teach safe practice to other health care workers as appropriate. 7.6Dispensing 7.6.1Definitions 7.6.1.1“Dispensing” means providing medication according to an order of a practitioner duly licensed to prescribe medication. The term shall include both the repackaging and labeling of medication from bulk to individual doses. 7.6.1.2“Prescription label” - a label affixed to every prescription or drug order which contains the following information at a minimum. 7.6.1.2.1A unique number for that specific drug order. 7.6.1.2.2The date the drug was dispensed. 7.6.1.2.3The patient’s full name. 7.6.1.2.4The brand or established name and manufacturer and the strength of the drug to the extent it can be measured. 7.6.1.2.5The practitioner’s directions as found on the prescription order. 7.6.1.2.6The practitioner’s name. 7.6.1.2.7The initials of the dispensing nurse. 7.6.1.2.8The name and address of the facility or practitioner from which the drug is dispensed. 7.6.1.2.9Expiration date. 7.6.1.3“Standing order” - An order written by the practitioner which authorizes a designated registered nurse or nurses to dispense prescription drugs to his/her patients(s) according to the standards listed below. 7.6.2Authority to Dispense 7.6.2.1Registered Nurses may assume the responsibility of dispensing as defined in the Nurse Practice Act. 7.6.2.2Licensed Practice Nurses may assume the responsibility of dispensing as authorized by the Nurse Practice Act and defined in these Regulations, Section 7.6.2.2.1., 7.6.2.2.2, and 7.6.2.2.3 7.6.2.2.1Licensed Practical Nurses may provide to a patient pre-packaged medications in accordance with the order of a practitioner duly licensed to prescribe medication where such medications have been pre- packaged by a person with lawful authority to dispense drugs. 7.6.2.2.2Licensed Practical Nurses, per written order of a physician, dentist, podiatrist, advanced practice nurse, or other practitioner duly licensed to prescribe medication, may add the name of the client to a preprinted label on a pre-packaged medication. 7.6.2.2.3Licensed Practical Nurses in a licensed methadone clinic may apply a preprinted label to a pre-packaged medication. 7.6.3Standards for Dispensing 7.6.3.1All licensed nurses engaged in dispensing shall adhere to these standards. 7.6.3.1.1The medication must be prepackaged by a pharmaceutical company or prepared by a registered pharmacist. 7.6.3.1.2The nurse shall be responsible for proper drug storage of the medication prior to dispensing. 7.6.3.1.3The practitioner who originated the prescription or drug order must be on the premises or he/she or their designated coverage shall be available by telephone during the act of dispensing. 7.6.3.1.4Once a drug has been dispensed it shall not be returned for reuse by another or the same patient in an institutional setting. 7.6.3.1.5The nurse may not delegate any part of the dispensing function to any other individual who is not licensed to dispense. 7.6.3.1.6The dispensing nurse must assure compliance to the state generic substitution laws when selecting the product to be dispensed. 7.6.3.1.7The nurse-dispensed prescription may not be refillable; it requires the authority of the prescriber with each dispensing. 7.6.3.1.8A usage review process must be established for the medicines dispensed to assure proper patient usage. 7.6.3.1.9All dispensed drugs must be labeled as defined above and dispensed in proper safety closure containers that meet the standards established by the United States Pharmacopoeia for stability. 7.6.3.1.10Record keeping must include the maintenance of the original written prescription of drug order for at least three years, allow retrospective review of accountability, and provide an audit trail. All dispensing records must be maintained on site, and available for inspection by authorized agents of the Board of Health, Pharmacy, and Nursing. 7.6.3.1.11The dispensing nurse shall assume the responsibility of patient counseling of drug effects, side-effects, desired outcome, precautions, proper storage, unique dosing criteria, drug interactions, and other pertinent data, and record evidence of patient education. 7.6.3.1.12Conformance to paragraphs 6 through 11 are not necessary if the original prescription was dispensed by a pharmacist for that specific patient. 7.7Delegation 7.7.1Definitions 7.7.1.1“Accountability” - The state of being accountable, answerable, or legally liable for actions and decisions, including supervision. 7.7.1.2“Delegation” - Entrusting the performance of selected nursing duties to individuals qualified, competent and legally able to perform such duties while retaining the accountability for such act. 7.7.1.3“Supervision” - The guidance by a registered nurse (RN) for the accomplishment of a function or activity. The guidance consists of the activities included in monitoring as well as establishing the initial direction, delegating, setting expectations, directing activities and courses of action, critical watching, overseeing, evaluating, and changing a course of action. 7.7.1.4“Unlicensed Assistive Personnel” - Individuals not licensed to perform nursing tasks that are employed to assist in the delivery of client care. The term “unlicensed assistive personnel” does not include members of the client’s immediate family, guardians, or friends; these individuals may perform incidental care of the sick in private homes without specific authority from a licensed nurse (as established in 24 Del.C. §1921(a)(4) of the Nurse Practice Act). 7.7.2Conditions 7.7.2.1The following conditions are relevant to delegation: 7.7.2.1.1Only RNs may delegate. 7.7.2.1.2The RN must be knowledgeable regarding the unlicensed assistive personnel’s education and training and have opportunity to periodically verify the individual’s ability to perform the specific tasks. 7.7.2.1.3The RN maintains accountability for determining the appropriateness of all delegated nursing duties and responsibility for the delivery of safe and competent care. Unlicensed assistive personnel may not reassign a delegated act. 7.7.3Criteria 7.7.3.1The RN may delegate only tasks that are within the scope of sound professional nursing judgment to delegate. 7.7.3.2Determination of appropriate factors include, but are not limited to: 7.7.3.2.1stability of the client’s condition 7.7.3.2.2educational background, skill level, or preparation of the individual 7.7.3.2.3nature of the nursing act that meets the following: 7.7.3.2.3.1task is performed frequently in the daily care of a client 7.7.3.2.3.2task is performed according to an established sequence of steps 7.7.3.2.3.3task may be performed with a predictable outcome 7.7.3.2.3.4task does not involve ongoing assessment, interpretation or decision making that cannot be logically separated from the task itself. 7.7.3.3The RN must be readily available in person or by telecommunication. 7.7.4Exclusions 7.7.4.1The following activities require nursing knowledge, judgment, and skill and may not be delegated by the RN to an unlicensed assistive person. These exclusions do not apply to Advanced Practice Nurses. 7.7.4.2Physical, psychological, and social assessment which requires professional nursing judgment, intervention, referral, or follow-up; 7.7.4.3Development of nursing diagnosis and care goals; 7.7.4.4Formulation of the plan of nursing care and evaluation of the effectiveness of the nursing care provided; 7.7.4.5Specific tasks involved in the implementation of the plan of care which require nursing judgment, skill, or intervention, that include, but are not limited to: performance of sterile invasive procedures involving a wound or anatomical site; nasogastric, newly established gastrostomy and jejunostomy tube feeding; nasogastric, jejunostomy and gastrostomy tube insertion or removal; suprapubic catheter insertion and removal; (phlebotomy is not considered a sterile, invasive procedure); 7.7.4.6Administration of medications, including prescription topical medications; and 7.7.4.7Receiving or transmitting verbal orders. 1 DE Reg. 1888 (6/1/98) 6 DE Reg. 1195 (3/1/03) 7.8Intravascular Therapy By Licensed Nurses Intravascular therapy encompasses several components, some of which require primarily skill proficiency with a minimum of critical judgement. Other aspects of intravascular therapy require skill proficiency and more importantly a high degree of knowledge, critical judgement and decision making to perform the function safely. 7.8.1Definition Of Terms 7.8.1.1Vascular system - is composed of all peripheral and central veins and arteries. 7.8.1.2Intravascular therapy (IV) - is the broad term including the administration of fluids and medications, blood and blood derivatives into an individual's vascular system. 7.8.1.3Intravenous fluids - include solutions, vitamins, nutrient preparations, and commercial blood fractions designed to be administered into an individual's vascular system. Whole blood and blood components, which are administered in the same manner, are considered intravenous fluids in this definition. 7.8.1.4Intravenous and intra-arterial medications - are drugs administered into an individual's vascular system by any one of the following methods: 7.8.1.4.1By way of infusion diluted in solution or suspended in fluid and administered over a specified time at a specified rate. 7.8.1.4.2Through an established intra- vascular needle or catheter (referred to as "IV push"). 7.8.1.4.3By venipuncture carried out for the sole purpose of administering the medication. This method is referred to as direct medication injection (direct IV push). 7.8.1.5Vascular access - Utilization of an established device or the introduction of a needle or catheter into an individual’s vascular system. 7.8.1.6Venipuncture - Introduction of a needle or catheter into an individual's peripheral vein for the purpose(s) of withdrawing blood or establishing an infusion or administering medications. 7.8.1.7Intravascular therapy maintenance - Monitoring of the therapy for changes in patient's condition, appropriate flow rate, equipment function, the hanging of additional fluid containers and the implementation of site care. 7.8.1.8Termination of intravascular therapy - Cessation of the therapy either by withdrawing a needle or catheter from an individual’s vascular system or by discontinuing the infusion and maintaining the device as a reservoir. 7.8.1.9Supervision - a registered nurse, licensed physician or dentist is physically present in the unit where the patient is being provided care, or within immediate electronic/telephone contact. 7.8.2Conditions Of Performing Intravascular Therapy Procedures By Licensed Nurses 7.8.2.1Intravascular therapy must be authorized by a written order from a state licensed and authorized prescriber. 7.8.2.2The performance of any procedures of intravascular therapy by a licensed practical nurse will be done under the supervision of a registered nurse, APN, or person licensed to practice medicine, surgery, or podiatry. 7.8.2.3Admixed intravascular solutions documented and instituted by one licensed nurse and subsequently interrupted may be re-instituted by another licensed nurse after confirmation with the state licensed and authorized prescriber's order. 7.8.2.4Admixed intravascular solutions documented and prepared by one licensed nurse may be initiated or continued by another licensed nurse after confirmation with the state licensed and authorized prescriber's order. 7.8.2.5Intradermal or topical anesthetics may be used by the RN or LPN when initiating vascular access therapy in various situations or settings, provided there is an authorized prescriber’s order and organizational policy/ procedure to support use of these medications. All RNs and LPNs must have documented educational preparation according to the employing agency’s policies and procedures. Documented evidence must include both theoretical instruction including anatomy and physiology, pharmacology, nursing management and education of patients and demonstration of clinical proficiency in performance of the task. 7.8.3Functional Scope Of Responsibility For Intravascular Therapy Procedures 7.8.3.1Registered Nurses bear the responsibility and accountability for their nursing practice under the license granted by the Board of Nursing and are permitted to perform the following: 7.8.3.1.1Assessment of the patient and the prescribed intravascular therapy before, during and after the therapy is carried out. 7.8.3.1.2Acceptance and confirmation of intravascular therapy order(s). 7.8.3.1.3Calculation of medication dosage and infusion rate for intravascular therapy administration. 7.8.3.1.4Confirmation of medication dosage and infusion rate for intravascular therapy administration. 7.8.3.1.5Addition of prescribed medications in intravascular solution, labeling and documenting appropriately. 7.8.3.1.6Start initial solution or add replacement fluids to an existing infusion as prescribed. 7.8.3.1.7Vascular access for establishing an infusion or administering medications. 7.8.3.1.8Administration of medications by "IV push". 7.8.3.1.9Intravascular therapy maintenance. 7.8.3.1.10Termination of intravascular therapy, including the removal of subclavian and PICC lines. 7.8.3.1.11Access the vascular system for the purpose of the withdrawal of blood and to monitor the patient's condition before, during, and after the withdrawal of blood. 7.8.3.2Licensed Practical Nurses bear the responsibility and accountability for their nursing practice under the license granted by the Board of Nursing and are permitted to perform the following for peripheral lines: 7.8.3.2.1Acceptance of intravascular therapy order(s). 7.8.3.2.2Calculation of medication dosage and infusion rate of intravascular medications prescribed. This does not include titration. 7.8.3.2.3Confirmation of medication dosage and infusion rate for intravascular therapy administration. 7.8.3.2.4Addition of mediations in intravascular solutions, label and document appropriately. 7.8.3.2.5Venipuncture with needle device to establish access to the peripheral vascular system. 7.8.3.2.6Start initial solution or add replacement fluids to an existing infusion as prescribed. 7.8.3.2.7Intravascular therapy maintenance including the flushing of peripheral lines with Heparin and/or saline solution. 7.8.3.2.8Termination of peripheral intravascular therapy. 7.8.3.2.9Performance of venipuncture for the purpose of the withdrawal of blood and to monitor the patient's condition before, during and after the withdrawal of blood. 7.8.3.3The Licensed Practical Nurse is permitted to perform the following procedures for central lines: 7.8.3.3.1Acceptance of intravascular therapy order(s). 7.8.3.3.2Calculation of medication dosage and infusion rate of intravascular medications prescribed. This does not include titration. 7.8.3.3.3Confirmation of medication dosage and infusion rate for intravascular therapy administration. 7.8.3.3.4Addition of medications in intravascular solutions, label and document appropriately. 7.8.3.3.5Intravascular therapy maintenance, including the flushing of central lines with Heparin and/or saline solution. 7.8.3.3.6Dressing and tubing changes, including PICC lines. 7.8.3.3.7Addition of replacement fluids to an existing infusion as prescribed. 7.8.4.Special Intravascular Procedures By Registered Nurses 7.8.4.1Chemotherapy - Only intravascular routes are addressed in these rules. Review of the Oncology Nursing Society’s current guidelines is recommended before the administration of anti-neoplastic agents. 7.8.4.1.1Definition of Terms 7.8.4.1.1.1Cancer Chemotherapy - is the broad term including the administration of anti- neoplastic agents into an individual's vascular system. 7.8.4.1.1.2Anti-neoplastic agents - are those drugs which are administered with the intent to control neoplastic cell growth. 7.8.4.1.2The Registered Nurse who administers cancer chemotherapy by the intravascular route must have documented educational preparation according to the employing agency's policies and procedures. 7.8.4.1.3The Registered Nurse must have documented evidence of knowledge and skill in the following: •Pharmacology of anti- neoplastic agents •Principles of drug handling and preparation •Principles of administration •Vascular access •Side effects of chemotherapy on the nurse, patient, and family 7.8.4.2Central Venous Access Via Peripheral Veins 7.8.4.2.1Definition of Terms 7.8.4.2.1.1Central venous access - is that entry into an individual's vascular system via the insertion of a catheter into a peripheral vein threaded through to the superior vena cava with placement confirmed by x- ray. 7.8.4.2.2The Registered Nurse who performs central venous access via peripheral veins must have documented educational preparation according to the employing agency's policies and procedures. 7.8.4.2.3Documented evidence must include, but is not limited to, evidence of both theoretical instruction and clinical proficiency in performance of the task. 7.8.4.2.3.1Theoretical instruction must include, but is not limited to, anatomy and physiology, pharmacology, nursing management, and education of patients as they relate to central venous access via peripheral veins. 7.8.4.2.3.2A preceptor must supervise the learning experience and must document the Registered Nurse's competency in the performance of the procedure. 7.8.4.3Pain Management Via Epidural Catheter 7.8.4.3.1It is within the scope of practice of a Registered Nurse to instill analgesics (opiates)/ low dose anesthetics at analgesic levels into an existing catheter under the following conditions/exceptions: 7.8.4.3.1.1The epidural catheter is in place. 7.8.4.3.1.2The position of the epidural catheter was verified as correct by a physician at the time of insertion. 7.8.4.3.1.3Bolus doses and/or continuous infusions, as pre-mixed by anesthesiologists, C.R.N.A.s, or pharmacists, of epidural analgesics/low does anesthetics at analgesic levels can be administered by the Registered Nurse only after the initial dose has been administered. Changes in medication and/or dosage of the same medication are not defined as the initial dose. 7.8.4.3.1.4Only analgesics (opiates)/low dose anesthetics at analgesic levels will be administered via this route for acute and chronic pain management. 7.8.4.3.1.5The Registered Nurse must complete a course that includes, but is not limited to, a) anatomy, physiology, pharmacology, nursing management, assessment, and education of patients as they relate to epidural administration of opiates/low dose anesthetics at analgesic levels; b) a credentialed preceptor must supervise the learning experience and must document the Registered Nurse's clinical competency in the performance of the procedure. 7.8.4.3.1.6The Registered Nurse may not insert or remove epidural catheters 8.0Rules and Regulations Governing the Practice of Nursing as an Advanced Practice Nurse in the State of Delaware 8.1Authority These rules and regulations are adopted by the Delaware Board of Nursing under the authority of the Delaware Nurse Practice Act, 24 Del.C. §§1902(d), 1906(1), 1906(7). 8.2Purpose 8.2.1The general purpose of these rules and regulations is to assist in protecting and safeguarding the public by regulating the practice of the Advanced Practice Nurse. 8.3Scope 8.3.1These rules and regulations govern the educational and experience requirements and standards of practice for the Advanced Practice Nurse. Prescribing medications and treatments independently is pursuant to the Rules and Regulations promulgated by the Joint Practice Committee as defined in 24 Del.C. §1906(20). The Advanced Practice Nurse is responsible and accountable for her or his practice. Nothing herein is deemed to limit the scope of practice or prohibit a Registered Nurse from engaging in those activities that constitute the practice of professional nursing and/or professional nursing in a specialty area. 8.4Definitions “Advanced Practice Nurse” as defined in 24Del.C. §1902(d)(1). Such a nurse will be given the title Advanced Practice Nurse by state licensure, and may use the title Advanced Practice Nurse within his/her specific specialty area. “Audit” The verification of existence of a collaborative agreement for a minimum of 10% of the total number of licenses issued during a specified time period. “Board” The Delaware Board of Nursing “Certified Nurse Midwife (C.N.M.)” A Registered Nurse who is a provider for normal maternity, newborn and well-woman gynecological care. The CNM designation is received after completing an accredited post- basic nursing program in midwifery at schools of medicine, nursing or public health, and passing a certification examination administered by the ACNM Certification Council, Inc. or other nationally recognized, Board of Nursing approved certifying organization. “Certified Registered Nurse Anesthetist (C.R.N.A.)” A Registered Nurse who has graduated from a nurse anesthesia educational program accredited by the American Association of Nurse Anesthetists’ Council on Accreditation of Nurse Anesthesia Educational programs, and who is certified by the American Association of Nurse Anesthetists’ Council on Certification of Nurse Anesthetists or other nationally recognized, Board of Nursing approved certifying organization. “Clinical Nurse Specialist (C.N.S.)” A Registered Nurse with advanced nursing educational preparation who functions in primary, secondary, and tertiary settings with individuals, families, groups, or communities. The CNS designation is received after graduation from a Master’s degree program in a clinical nurse specialty or post Master’s certificate, such as gerontology, maternal-child, pediatrics, psych/mental health, etc. The CNS must have national certification in the area of specialization at the advanced level if such a certification exists or as specified in 8.9.4.1 of these Rules and Regulations. The certifying agency must meet the established criteria approved by the Delaware Board of Nursing. “Clinical Nursing Specialty” a delimited focus of advanced nursing practice. Specialty areas can be identified in terms of population, setting, disease/pathology, type of care or type of problem. Nursing administration does not qualify as a clinical nursing specialty. 3 DE Reg. 1373 (4/1/00) “Collaborative Agreement” Written verification of health care facility approved clinical privileges; or health care facility approved job description; or a written document that outlines the process for consultation and referral between an Advanced Practice Nurse and a licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system. “Guidelines/ Protocols” Suggested pathways to be followed by an Advanced Practice Nurse for managing a particular medical problem. These guidelines/protocols may be developed collaboratively by an Advanced Practice Nurse and a licensed physician, dentist or a podiatrist, or licensed Delaware health care delivery system. “National Certification” That credential earned by a nurse who has met requirements of a Board approved certifying agency. The agencies so approved include but are not limited to: •American Academy of Nurse Practitioners •American Nurses Credentialing Center •American Association of Nurse Anesthetists Council on Certification of Nurse Anesthetists •American Association of Nurse Anesthetists Council on Recertification of Nurse Anesthetists •National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties •National Certification Board of Pediatric Nurse Practitioners and Nurses. •ACNM Certification Council, Inc. “Nurse Practitioner (N.P.)” A Registered Nurse with advanced nursing educational preparation who is a provider of primary health care in a variety of settings with a focus on a specific area of practice. The NP designation is received after graduation from a Master’s program or from an accredited post-basic NP certificate program of at least one academic year in length in a nurse practitioner specialty such as acute care, adult, family, geriatric, pediatric, or women’s health, etc. The NP must have national certification in the area of specialization at the advanced level by a certifying agency which meets the established criteria approved by the Delaware Board of Nursing. “Post Basic Program” A combined didactic and clinical/preceptored program of at least one academic year of full time study in the area of advanced nursing practice with a minimum of 400 clinical/preceptored hours. The program must be one offered and administered by an approved health agency and/or institution of higher learning, Post basic means a program taken after licensure is achieved. “Scope of Specialized Practice” That area of practice in which an Advanced Practice Nurse has a Master’s degree or a post-basic program certificate in a clinical nursing specialty with national certification. “Supervision” Direction given by a licensed physician or Advanced Practice Nurse to an Advanced Practice Nurse practicing pursuant to a temporary permit. The supervising physician or Advanced Practice Nurse must be periodically available at the site where care is provided, or available for immediate guidance. 8.5Grandfathering Period 8.5.1Any person holding a certificate of state licensure as an Advanced Practice Nurse that is valid on July 8, 1994 shall be eligible for renewal of such licensure under the conditions and standards prescribed herein for renewal of licensure. 8.6Standards for the Advanced Practice Nurse 8.6.1Advanced Practice Nurses view clients and their health concerns from an integrated multi-system perspective. 8.6.2Standards provide the practitioner with a framework within which to operate and with the means to evaluate his/her practice. In meeting the standards of practice of nursing in the advanced role, each practitioner, including but not limited to those listed in 8.6.2 of these Rules and Regulations: 8.6.2.1Performs comprehensive assessments using appropriate physical and psychosocial parameters; 8.6.2.2Develops comprehensive nursing care plans based on current theories and advanced clinical knowledge and expertise; 8.6.2.3Initiates and applies clinical treatments based on expert knowledge and technical competency to client populations with problems ranging from health promotion to complex illness and for whom the Advanced Practice Nurse assumes primary care responsibilities. These treatments include, but are not limited to psychotherapy, administration of anesthesia, and vaginal deliveries; 8.6.2.4Functions under established guidelines/protocols and/or accepted standards of care; 8.6.2.5Uses the results of scientifically sound empirical research as a basis for nursing practice decisions; 8.6.2.6Uses appropriate teaching/learning strategies to diagnose learning impediments; 8.6.2.7Evaluates the quality of individual client care in accordance with quality assurance and other standards; 8.6.2.8Reviews and revises guidelines/ protocols, as necessary; 8.6.2.9Maintains an accurate written account of the progress of clients for whom primary care responsibilities are assumed; 8.6.2.10Collaborates with members of a multi-disciplinary team toward the accomplishment of mutually established goals; 8.6.2.11Pursues strategies to enhance access to and use of adequate health care services; 8.6.2.12Maintains optimal advanced practice based on a continual process of review and evaluation of scientific theory, research findings and current practice; 8.6.2.13Performs consultative services for clients referred by other members of the multi-disciplinary team; and 8.6.2.14Establishes a collaborative agreement with a licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system to facilitate consultation and/or referral as appropriate in the delivery of health care to clients. 8.6.3In addition to these standards, each nurse certified in an area of specialization and recognized by the Board to practice as an Advanced Practice Nurse is responsible for practice at the level and scope defined for that specialty certification by the agency which certified the nurse. 8.7Generic Functions of the Advanced Practice Nurse Within the Specialized Scope of Practice include but are not limited to: 8.7.1Eliciting detailed health history(s) 8.7.2Defining nursing problem(s) 8.7.3Performing physical examination(s) 8.7.4Collecting and performing laboratory tests 8.7.5Interpreting laboratory data 8.7.6Initiating requests for essential laboratory procedures 8.7.7Initiating requests for essential x-rays 8.7.8Screening patients to identify abnormal problems 8.7.9Initiating referrals to appropriate resources and services as necessary 8.7.10Initiating or modifying treatment and medications within established guidelines 8.7.11Assessing and reporting changes in the health of individuals, families and communities 8.7.12Providing health education through teaching and counseling 8.7.13Planning and/or instituting health care programs in the community with other health care professionals and the public 8.7.14Delegating tasks appropriately 8.7.15Prescribing medications and treatments independently pursuant to Rules and Regulations promulgated by the Joint Practice Committee as defined in 24 Del.C. §1906(20). [8.7.16Inserting and removing epidural catheters after specialized training.] 8.8Criteria for Approval of Certification Agencies 8.8.1A national certifying body which meets the following criteria shall be recognized by the Board to satisfy 24 Del.C. §1902(d)(1). 8.8.2The national certifying body: 8.8.2.1Is national in the scope of its credentialing. 8.8.2.2Has no requirement for an applicant to be a member of any organization. 8.8.2.3Has educational requirements which are consistent with the requirements of these rules. 8.8.2.4Has an application process and credential review which includes documentation that the applicant’s education is in the advanced nursing practice category being certified, and that the applicant’s clinical practice is in the certification category. 8.8.2.5Uses an examination as a basis for certification in the advanced nursing practice category which meets the following criteria: 8.8.2.5.1The examination is based upon job analysis studies conducted using standard methodologies acceptable to the testing community; 8.8.2.5.2The examination represents the knowledge, skills and abilities essential for the delivery of safe and effective advanced nursing care to the clients; 8.8.2.5.3The examination content and its distribution are specified in a test plan (blueprint), based on the job analysis study, that is available to examinees; 8.8.2.5.4Examination items are reviewed for content validity, cultural sensitivity and correct scoring using an established mechanism, both before use and periodically; 8.8.2.5.5Examinations are evaluated for psychometric performance; 8.8.2.5.6The passing standard is established using acceptable psychometric methods, and is reevaluated periodically; and 8.8.2.5.7Examination security is maintained through established procedures 8.8.2.6Issues certification based upon passing the examination and meeting all other certification requirements. 8.8.2.7Provides for periodic recertification which includes review of qualifications and continued competency. 8.8.2.8Has mechanisms in place for communication to Boards of Nursing for timely verification of an individual’s certification status, changes in certification status, and changes in the certification program, including qualifications, test plan and scope of practice. 8.8.2.9Has an evaluation process to provide quality assurance in its certification program. 8.9Application for Licensure to Practice as an Advanced Practice Nurse 8.9.1Application for licensure as a Registered Nurse shall be made on forms supplied by the Board. 8.9.2In addition, an application for licensure to practice as an Advanced Practice Nurse shall be made on forms supplied by the Board. 8.9.2.1The APN applicant shall be required to furnish the name(s) of the licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system with whom a current collaborative agreement exists. 8.9.2.2Notification of changes in the name of the licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system shall be forwarded to the Board office. 8.9.3Each application shall be returned to the Board office together with appropriate documentation and non-refundable fees. 8.9.4A Registered Nurse meeting the practice requirement as listed in 8.11 and all other requirements set forth in these Rules and Regulations may be issued a license as an Advanced Practice Nurse in the specific area of specialization in which the nurse has been nationally certified at the advanced level and/or has earned a Master’s degree in a clinical nursing specialty. 8.9.4.1Clinical nurse specialists, whose subspecialty area can be categorized under a broad scope of nursing practice for which a Board-approved national certification examination exists, are required to pass this certification examination to qualify for permanent licensure as an Advanced Practice Nurse. This would include, but not be limited to medical-surgical and psychiatric-mental health nursing. If a more specific post-graduate level certification examination that has Board of Nursing approval is available within the clinical nursing specialist’s subspecialty area at the time of licensure application, the applicant may substitute this examination for the broad-based clinical nursing specialist certification examination. 8.9.4.2Faculty members teaching in nursing education programs are not required to be licensed as Advanced Practice Nurses. Those faculty members teaching in graduate level clinical courses may apply for licensure as Advanced Practice Nurses and utilize graduate level clinical teaching hours to fulfill the practice requirement as stated in 8.11.2.1. 8.9.5Renewal of licensure shall be on a date consistent with the current Registered Nurse renewal period. A renewal fee shall be paid. 8.9.6The Board may refuse to issue, revoke, suspend or refuse to renew the license as an Advanced Practice Nurse or otherwise discipline an applicant or a practitioner who fails to meet the requirements for licensure as an Advanced Practice Nurse or as a registered nurse, or who commits any disciplinary offense under the Nurse Practice Act, 24 Del.C. Ch. 19, or the Rules and Regulations promulgated pursuant thereto. All decisions regarding independent practice and/or independent prescriptive authority are made by the Joint Practice Committee as provided in 24 Del.C. §1906(20) - (22). 8.10Temporary Permit for Advanced Practice Nurse Licensure 8.10.1A temporary permit to practice, pending Board approval for permanent licensure, may be issued provided that: 8.10.1.1The individual applying has also applied for licensure to practice as a Registered Nurse in Delaware, or 8.10.1.2The individual applying holds a current license in Delaware, and 8.10.1.3The individual submits proof of graduation from a nationally accredited or Board approved Master’s or certificate advanced practice nursing program, and has passed the certification examination, or 8.10.1.4The individual is a graduate of a Master’s program in a clinical nursing specialty for which there is no certifying examination, and can show evidence of at least 1000 hours of clinical nursing practice within the past 24 months. 8.10.1.5Application(s) and fee(s) are on file in the Board office. 8.10.2A temporary permit to practice, under supervision only, may be issued at the discretion of the Executive Director provided that: 8.10.2.1The individual meets the requirements in 8.10.1.1 or 8.10.1.2, and 8.10.1.5 and; 8.10.2.2The individual submits proof of graduation from a nationally accredited or Board approved Master’s or certificate advanced practice nurse program, and; 8.10.2.3The individual submits proof of admission into the approved certifying agency’s examination or is seeking a temporary permit to practice under supervision to accrue the practice hours required to sit for the certifying examination or has accrued the required practice hours and is scheduled to take the first advanced certifying examination upon eligibility or is accruing the practice hours referred to in 8.10.2.4; or, 8.10.2.4The individual meets 8.10.2.1 and 8.10.2.2 hereinabove and is awaiting review by the certifying agency for eligibility to sit for the certifying examination. 8.10.3If the certifying examination has been passed, the appropriate form must accompany the application. 8.10.4A temporary permit may be issued: 8.10.4.1For up to two years in three month periods. 8.10.4.2At the discretion of the Executive Director. 8.10.5A temporary permit will be withdrawn: 8.10.5.1Upon failure to pass the first certifying examination 8.10.5.1.1The applicant may petition the Board of Nursing to extend a temporary permit under supervision until results of the next available certification exam are available by furnishing the following information: 8.10.5.1.1.1current employer reference, 8.10.5.1.1.2supervision available, 8.10.5.1.1.3job description, 8.10.5.1.1.4letter outlining any extenuating circumstances, 8.10.5.1.1.5any other information the Board of Nursing deems necessary. 8.10.5.2For other reasons stipulated under temporary permits elsewhere in these Rules and Regulations. 3 DE Reg. 1373 (4/1/00) 8.10.6A lapsed temporary permit for designation is equivalent to a lapsed license and the same rules apply. 8.10.7Failure of the certifying examination does not impact on the retention of the basic professional Registered Nurse licensure. 8.10.8Any person practicing or holding oneself out as an Advanced Practice Nurse in any category without a Board authorized license in such category shall be considered an illegal practitioner and shall be subject to the penalties provided for violations of the Law regulating the Practice of Nursing in Delaware, (24 Del.C. Ch. 19). 8.10.9Endorsement of Advanced Practice Nurse designation from another state is processed the same as for licensure by endorsement, provided that the applicant meets the criteria for an Advanced Practice Nurse license in Delaware. 8.11Maintenance of Licensure Status: Reinstatement 8.11.1To maintain licensure, the Advanced Practice Nurse must meet the requirements for recertification as established by the certifying agency. 8.11.2The Advanced Practice Nurse must have practiced a minimum of 1500 hours in the past five years or no less than 600 hours in the past two years in the area of specialization in which licensure has been granted. 8.11.2.1Faculty members teaching in graduate level clinical courses may count a maximum of 500 didactic course contact hours in the past five years or 200 in the past two years and all hours of direct on-site clinical supervision of students to meet the practice requirement. 8.11.2.2An Advanced Practice Nurse who does not meet the practice requirement may be issued a temporary permit to practice under the supervision of a person licensed to practice medicine, surgery, dentistry, or advanced practice nursing, as determined on an individual basis by the Board. 8.11.3The Advanced Practice Nurse will be required to furnish the name(s) of the licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system with whom a current collaborative agreement exists. 8.11.4Advanced Practice Nurses who fail to renew their licenses by February 28, May 31, or September 30 of the renewal period shall be considered to have lapsed licenses. After February 28, May 31, or September 30 of the current licensing period, any requests for reinstatement of a lapsed license shall be presented to the Board for action. 8.11.5To reinstate licensure status as an Advanced Practice Nurse, the requirements for recertification and 1500 hours of practice in the past five years or no less than 600 hours in the past two years in the specialty area must be met or the process described in 8.11.4 followed. 8.11.6An application for reinstatement of licensure must be filed and the appropriate fee paid. 8.12Audit of Licensees 8.12.1The Board may select licensees for audit two months prior to renewal in any biennium. The Board shall notify the licensees that they are to be audited for compliance of having a collaborative agreement. 8.12.1.1Upon receipt of such notice, the licensee must submit a copy of a current collaborative agreement(s) within three weeks of receipt of the notice. 8.12.1.2The Board shall notify the licensee of the results of the audit immediately following the Board meeting at which the audits are reviewed. 8.12.1.3An unsatisfactory audit shall result in Board action. 8.12.1.4Failure to notify the Board of a change in mailing address will not absolve the licensee from audit requirements. 8.12.2The Board may select licensees for audit throughout the biennium. 8.13Exceptions to the Requirements to Practice 8.13.1The requirements set forth in 8.9 shall not apply to a Registered Nurse who is duly enrolled as a bona fide student in an approved educational program for Advanced Practice Nurses as long as the practice is confined to the educational requirements of the program and is under the direct supervision of a qualified instructor. 8.14Definitions 8.14.1Collaborative Agreement - Includes 8.14.1.1A true collegial agreement between two parties where mutual goal setting, access, authority, and responsibility for actions belong to individual parties and there is a conviction to the belief that this collaborative agreement will continue to enhance patient outcomes and 8.14.1.2a written document that outlines the process for consultation and referral between an Advanced Practice Nurse and a duly licensed Delaware physician, dentist, podiatrist or licensed Delaware health care delivery system. This document can include, but not be limited to, written verification of health care facility approved clinical privileges or a health care facility approved job description of the A.P.N. If the agreement is with a licensed Delaware health care delivery system, the individual will have to show that the system will supply appropriate medical back-up for purposes of consultation and referral. 8.14.2National Certification - That credential earned by an Advanced Practice Nurse who has met requirements of a Board of Nursing approved certifying agency. 8.14.3Pharmacology/Pharmacotherapeutics - refers to any course, program, or offering that would include, but not be limited to, the identification of individual and classes of drugs, their indications and contraindications, their likelihood of success, their dosages, their side-effects and their interactions. It also encompasses clinical judgement skills and decision making. These skills may be based on thorough interviewing, history taking, physical assessment, test selection and interpretation, patho-physiology, epidemiology, diagnostic reasoning, differentiation of conditions, treatment decisions, case evaluation and non- pharmacologic interventions. 8.14.4Prescription Order - includes the prescription date, the name of the patient, the name, address, area of specialization and business telephone number of the advanced practice nurse prescriber, the name, strength, quantity, directions for use, and number of refills of the drug product or device prescribed, and must bear the name and prescriber ID number of the advanced practice nurse prescriber, and when applicable, prescriber’s D.E.A. number and signature. There must be lines provided to show whether the prescription must be dispensed as written or substitution is permitted. 8.15Requirements for Initial Independent Practice/ prescriptive Authority An APN who has not had independent prescriptive authority within the past two years in Delaware or any other jurisdiction who is applying for independent practice and/or independent prescriptive authority shall: 8.15.1Be an Advanced Practice Nurse (APN) holding a current permanent license issued by the Board of Nursing (BON). If the individual does not hold national certification, eligibility will be determined on a case by case basis. 8.15.2Have completed a post basic advanced practice nursing program that meets the criteria as established in Section 4.7 of Article 7 of the Rules and Regulations of the Delaware Board of Nursing with documentation of academic courses in advanced health assessment, diagnosis and management of problems within the clinical specialty, advanced patho-physiology and advanced pharmacology/pharmacotherapeutics. In the absence of transcript verification of the aforementioned courses, applicants shall show evidence of content integration through course descriptions, course syllabi, or correspondence from school officials. If the applicant cannot produce the required documentation, such applicant may petition the Joint Practice Committee for consideration of documented equivalent independent prescriptive authority experience. 8.15.3Submit a copy of the current collaborative agreement to the Joint Practice Committee (JPC). The collaborative agreement(s) shall include arrangements for consultation, referral and/or hospitalization complementary to the area of the nurse's independent practice. 8.15.4Show evidence of the equivalent of at least thirty hours of advanced pharmacology and pharmacotherapeutics related continuing education within the two years prior to application for independent practice and/or independent prescriptive authority. This may be continuing education programs or a three credit, semester long graduate level course. The thirty hours may also occur during the generic APN program as integrated content as long as this can be documented to the JPC. All offerings will be reviewed and approved by the JPC. 8.15.5Demonstrate how submitted continuing education offerings relate to pharmacology and therapeutics within their area of specialty. This can be done by submitting the program titles to show content and dates attended. If the JPC questions the relevance of the offerings, the applicant must have available program descriptions, and/ or learner objectives, and/or program outlines for submission to the JPC for their review and approval. 8.16Requirements for Independent Practice/ prescriptive Authority by Endorsement An APN who has had prescriptive authority in another jurisdiction who is applying for independent practice and/or independent prescriptive authority shall: 8.16.1Show evidence of meeting 8.15.1 and 8.15.3. 8.16.2Show evidence of having current prescriptive authority in another jurisdiction. 8.16.3Have no encumbered APN designation(s) in any jurisdiction. 8.16.4Show evidence of completion of a minimum of ten hours of JPC approved pharmacology/ pharmacotherapeutics related continuing education within the area of specialization and licensure within the past two years. 8.17Application 8.17.1Names and credentials of qualified applicants will be forwarded to the Joint Practice Committee for approval and then forwarded to the Board of Medical Practice for review and final approval. 8.18Prescriptive Authority 8.18.1APNs may prescribe, administer, and dispense legend medications including Schedule II - V controlled substances, (as defined in the Controlled Substance Act and labeled in compliance with 24 Del.C. §2536(C), parenteral medications, medical therapeutics, devices and diagnostics. 8.18.2APNs will be assigned a provider identifier number as outlined by the Division of Professional Regulation. 8.18.3Controlled Substances registration will be as follows: 8.18.3.1APNs must register with the Drug Enforcement Agency and use such DEA number for controlled substance prescriptions. 8.18.3.2APNs must register biennially with the Office of Narcotics and Dangerous Drugs in accordance with 16 Del.C. §4732(a). 8.18.4APNs may request and issue professional samples of legend, including schedule II-V controlled substances, and over-the-counter medications that must be labeled in compliance with 24 Del.C. §2536(C). 8.18.5APNs may give verbal prescription orders. 8.19Prescriptive Writing 8.19.1All prescription orders will be written as defined by the Delaware Board of Pharmacy as defined in 8.14.4. 8.20Renewal 8.20.1Maintain current APN licensure. 8.20.2Maintain competency through a minimum of ten hours of JPC approved pharmacology/ pharmacotherapeutics related continuing education within the area of specialization and licensure per biennium. The pharmacology/ pharmacotherapeutics content may be a separate course or integrated within other offerings. 8.21Disciplinary Proceedings 8.21.1Pursuant to 24 Del.C. §1906(19)(c), the Joint Practice Committee is statutorily empowered, with the approval of the Board of Medical Practice, to grant independent practice and/or prescriptive authority to nurses who qualify for such authority. The Joint Practice Committee is also empowered to restrict, suspend or revoke such authority also with the approval of the Board of Medical Practice. 8.21.2Independent practice or prescriptive authority may be restricted, suspended or revoked where the nurse has been found to have committed unprofessional conduct in his or her independent practice or prescriptive authority or if his or her mental or physical faculties have changed or deteriorated in such a manner as to create an inability to practice or prescribe with reasonable skill or safety to patients. 8.21.3Unprofessional conduct, for purposes of restriction, suspension or revocation of independent practice or prescriptive authority shall include but not be limited to: 8.21.3.1The use or attempted use of any false, fraudulent or forged statement or document or use of any fraudulent, deceitful, dishonest or immoral practice in connection with any acquisition or use of independent practice or prescriptive authority; 8.21.3.2Conviction of a felony; 8.21.3.3Any dishonorable or unethical conduct likely to deceive, defraud or harm the public; 8.21.3.4Use, distribution or prescription of any drugs or medical devices other than for therapeutic or diagnostic purposes; 8.21.3.5Misconduct, incompetence, or gross negligence in connection with independent or prescriptive practice; 8.21.3.6Unjustified failure upon request to divulge information relevant to authorization or competence to independently practice or exercise prescriptive authority to the Executive Director of the Board of Nursing or to anyone designated by him or her to request such information. 8.21.3.7The violation of the Nurse Practice Act or of an Order or Regulation of the Board of Nursing or the Board of Medical Practice related to independent practice or prescriptive authority. 8.21.3.8Restriction, suspension, or revocation of independent practice or prescriptive authority granted by another licensing authority in any state, territory or federal agency. 8.21.4Complaints concerning the use or misuse of independent practice or prescriptive authority received by the Division of Professional Regulation or the Board of Nursing shall be investigated in accordance wit