A Sample Dermatology Protocol
Many nurse practitioners have asked me about dermatology protocols. They are no different from other protocols and should be an outline of your practice agreement with your supervising or collaborating physician.
These protocols should remain broad and general, but list important and specific aspects of your practice like prescribing higher risk medications such as isotretinoin, methotrexate, biologics, etc. or performing basic dermatologic procedures such as excision and closures. Be specific when stating simple, intermediate and complex closures. Protocols should be based on training and proficiency. Also, don't forget to include the statement "The following protocols include, but not limited to ..."
Here is an example of a basic dermatology protocol you can use as a guide. It may be altered based on your experience, training and agreement of practice guidelines set forth by you and your supervising or collaborating physician. Remember, always be prepared to support your specialty practice with formal educational experience and supervised hours. PLEASE READ YOUR STATE NURSE PRACTICE ACT!
ARNP Protocol Agreement Between Collaborating Physician and ARNP
I. Requiring Authority
a. Nurse Practice Act, Florida Statutes, Chapter 464
b. Florida Administrative Code, Rules Chapter 6469-4 Administrative Policies pertaining to
Advanced Registered Nurse Practitioners.
II. Parties To Protocol:
- a. _______________________________________
Name and Address of Collaborating Physician, ME #, DEA #
- b. __________________________________
Name and Address of ARNP, license # and DEA #(if applicable)
III. Nature of Practice:
This collaborative agreement is to establish and maintain a practice model in which the nurse practitioner will provide health care services under the general supervision of ___________________________________ (supervising physician)
This practice shall encompass dermatology specialty. The focus will be on health screening and supervision, wellness and health education and counseling, and the treatment of common health problems.
IV. Descriptions of the duties and management areas for which the ARNP is responsible:
a. Duties of the ARNP:
The ARNP may interview clients, obtain and record health histories, perform physical and development assessments, order appropriate diagnostic tests, diagnose health problems, manage the health care of those clients for which he/she has been educated, provide health teaching and counseling, initiate referrals, and maintain health records.
- b. The conditions for which the ARNP may initiate treatment include, but are not limited to:
Skin Cancer Psoriasis
Cellulitis Sexually Transmitted Diseases
Acne/Rosacea Verruca Vulgaris
Conjunctivitis General Skin Infections
Alopecia Viral Infections
Dermatitis Fungal/Yeast infections
Seborrheic Keratoses Non-Melanoma Skin Cancers
Actinic Keratoses Melanoma
- c. Treatments that may be initiated by the ARNP, depending on the patient condition and judgement of the ARNP, include, but are not limited to the following:
Hyfercation of skin lesions
Skin Biopsies-all techniques (shave or punch)
Incision and drainage of abscesses
Skin tag removal
Electrodessication and curettage
Excision of melanoma and non-melanoma skin cancers including simple, intermediate, or complex closures.
Drug therapies that the ARNP may prescribe, initiate, monitor, alter, or order: Any prescription medication which is not listed as a controlled substance and which is within the scope of training and knowledge base of the nurse practitioner.
V. Duties of the Physician:
The physician shall provide general supervision for routine health care and management of common health problems, and provide consultation and / or accept referrals for complex health problems. The physician shall be available by telephone or by other communication device when not physically available on the premises.
VI. Specific Conditions and Requirements for Direct Evaluation
With respect to specific conditions and procedures that require direct evaluation, collaboration, and/or consultation by the physician, the following will serve as a reference guide: Clinical Guidelines in family practice, 3rd. Edition, by Constance R. Uphold, ARNP, PhD. and Mary Virginia Graham, ARNP, PhD.