Articulated Plan Sample Template
Instructions
The Nurse-Physician Advisory Taskforce for Colorado Healthcare (NPATCH) has created a template to
help Advance Practice Nurses create an articulated plan for safe prescribing.
C.R.S. §12-38-111.6(4.5)(b)(II)(A-D) states “(a)n Articulated plan…shall include at least the
following:

A mechanism for consultation and referral for issues regarding prescriptive

A quality assurance plan;

Decision support tools; and,

Documentation of ongoing continuing education in pharmacology and safe prescribing.”
The four parts of the Plan should be customized by the APN to fit the setting, population focus,
certification, and other unique attributes of his or her practice.
The Board of Nursing has created rules for Articulated Plans.
This template, along with the examples of possible customized language, was created to give you
ideas to create the best plan for yourself.
The examples provided are neither required nor inclusive. Each APN may choose to include some, all,
or none of the examples provided. Examples will not be relevant to each APN’s practice.
Use what is useful, ignore what is not.
The Children’s Hospital Template
The Children’s Hospital has created the attached template specifically for use by APN’s at TCH. The
four required sections each have two components: The first includes generic examples of tools and
opportunities available at TCH to support safe prescribing and second, an area to allow each APN or
department to customize to their areas.
Next Steps:





Complete your customized articulated plan and have it signed by a MD partner/mentor. Plans
may be customized to an individual or by department.
Complete your “Attestation of Development of an Articulated Plan form” with appropriate
signatures and return to the State Board of Nursing.
Submit a copy of your signed articulated plan to the TCH Nursing Credential Review Board.
Review and update your personal Articulated Plan annually. The state will conduct random
audits which could result is loss of prescriptive authority if the Articulated Plan is not current.
Deadline for APN’s with current Prescriptive Authority to complete the above is 7/1/11. It is
recommended that you complete this process as soon as your Articulated Plan is complete.
Articulated Plan
The Children’s Hospital
Advanced Practice Nurse ______________________________________________
TCH Department ____________________________________________________
License Number RXN Number __________________________________________
DEA Number (if applicable) ____________________________________________
Certification ________________________________________________________
ARTICULATED PLAN
Consultation and Referral Plan
As we practice in an academic medical center this setting affords us many resources for consultation
and collaboration with physicians, APN’s and other health care providers in all Pediatric subspecialties, as well as other resources for information/guidance regarding safe prescribing.
These resources include but are not limited to:
A. Practice within an academic medical center that is devoted to ongoing education and training
of health care providers in a context of life-long learning.
B. On-site pharmacists (adult and pediatric) 24 hours per day. Prescribing providers also have
access to health care professionals working in pharmacy clinical trials and Pharm. D. health
professionals.
C. Pediatrics sub-specialists who are able to provide guidance/protocols for prescribing and
patient care.
D. Lexi-Comp – an internet-based platform delivering time sensitive drug information on an easyto-use interface. This program works well for multi-user groups in a networked system and is
linked to our electronic medication record (EPIC). The system provides information regarding
method of action, dosing, adverse effects, contraindications, interactions, compatibility,
toxicology and patient education.
E. Hospital Formulary which is linked to our electronic medical record. The hospital formulary is a
compilation of pharmaceuticals and other information that reflects the current clinical
judgment of a hospital's medical staff. The hospital formulary is governed by the Pharmacy
and Therapeutics Committee.
F. Medical Libraries. There is a medical library on-site and in close proximity to the outpatient
clinic. Prescribing providers also have access to the University of Colorado on-campus medical
libraries.
G. Reference Materials. Most all clinical areas stock reference books which include
pharmacological text books/references. University of Colorado Medical Bookstore on campus.
Personal annual budget for purchase of updated pharmacy handbooks/references.
H. Certifying Organizations. Certain nurse practitioner certifying organizations require a certain
amount of documented pharmacology continuing education. Self study modules have led to
informal nurse practitioner study groups.
I. Professional Journals offering pharmacy self study modules.
J. Divisional medication protocols that offer specific guidelines to prescribing. For example,
“Guide to Anticonvulsant Drug Usage” within the Division of Neurology.
Department Specific Additions may be added here:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_______________________________________________________________________________
Articulated Plan
Quality Assurance Plan
Quality Assurance Plan:
1. Use of standardized practice guidelines specifically for your area of practice, examples as
follows, please customize as appropriate for your area of practice:
a. Asthma Care Guideline
b. Bronchiolitis Care Guideline
c. Home Oxygen Care Guideline
d. Diastat guideline
e. Hypoglycemia guideline
f. ______________________________
2. Participation in educational offerings with specific pediatric pharmacology content, examples
as follows, please customize as appropriate:
a. PNCB pediatric pharmacology SAE
b. Conference attendance for specific pediatric and/or disease pharmacology content
c. TCH sponsored pharmacology continuing education conference/ meeting, etc
3. Use of order sets approved by the Pharmacy and Therapeutics Committee with standard
dosing options
4. Pediatric/Adult Pharmacist available 24 hours a day for phone consultation and rounding with
sub-specialties
5. Sub-specialist consultation available as needed with documentation of same
6. Use of computer generated CORE sheets specific to child’s weight
7. Department based Quality Initiatives may include:
a. Department Specific Quality Initiatives related to medication safety
b. Peer review/ chart audit
i. Audited by NP peer or MD
ii. Evaluating:
1. Current weight on chart
2. Allergies documented
3. Appropriate medication choice
4. Medications prescribed right dose, right strength, right interval, etc.
5. Documentation of discussion of side effects with family
Articulated Plan
Decision Support Tools
The following decision support tools for pharmaceutical information are available to all APNs affiliated
with The Children’s Hospital either in print or on the TCH intranet website:
ON-LINE and/or PRINT resources:
EPIC computerized system for order entry
Formulary and Drug Dosing Handbook (Lexi-Comp) –
Pediatric, adult, and Natural Therapeutics
Stat!Ref
MICROMEDEX "
Other Services/Resources
Patient/Family Education: Medication Handouts
Drugs.com
RxList
PDR online
ePocrates
Drug Information Sites
Evidence-Based Practice
Resources
Family Health Library
Government / Statistical Sites
Health Dictionaries
Health Images
Health Sciences Library (UCHSC)
Nursing Research Sites
Style Manuals, Writing Guides
DailyMed
Center for Disease Control immunization guidelines
Pediatric Red Book
Up to Date on-line
MD Consult on- line
Library search tools available on-line.
TCH and UCH library: professional journals, textbooks, and resource materials. Many are available
on-line.
Harriett Lane Handbook
In-Person resources:
In-house pharmacists available 24 hours a day
Specialty services available for formal and informal consultation (i.e. Infectious Disease, Renal, Acute
Pain Service)
Physician consultation
In addition, specific resources for my division and subspecialty include:
Articulated Plan
Documentation of Continuing Education in Pharmacology and safe Prescribing
Documentation of the RXN’s ongoing continuing education in pharmacology and safe prescribing is
required.
“Such documentation shall include a personal record of the RXN’s participation in programs
with content relevant to the RXN’s prescribing practice. This may include academic courses,
programs by entities offering continuing education credit under nationally recognized
educational program standards (e.g. ANCC), and educational content on safe prescribingpharmacology offered by professional healthcare organizations and associations, and programs
with relevant content. Certificates of attendance, information on program content, and
objectives or copies of presentations may serve as verification documents."
Additionally, documentation shall include publications and lectures that the RXN has prepared
or offered that involves pharmacology.
___________________________________________________________________________
Key:
Type of education with content relevant to RXN’s prescribing practice:
a.
b.
c.
d.
e.
Professional Association CE Content
Academic Courses
Certification Maintenance Pharmacology offerings
Pharmacology Related education: TCH conferences, (departmental or housewide)
and/or external programs
Publications or lectures provided by RXN
Verification Documentation:
a. Certificate of attendance
b. Information on course content
c. Copy of presentation
d. List of objectives
_________________________________________________________________________________
Type of Education
Date
Organization/Publisher
Verification
_________________________________________________________________________________
Articulated Plan
Signature Page
RXN Signature: _____________________________________________________
Date: _____________________________________________________________
Physician Mentor Name: _____________________________________________
Date: ___________________ Signature: __________________________________
RXN Mentor Name (if applicable):
Date: ___________________ Signature: __________________________________
RXN Plan
Review on
Review on
Review on
Review on
Review on
Review (at least annually)
(date) ____________________________________________________
(date) ____________________________________________________
(date) ____________________________________________________
(date) ____________________________________________________
(date) ____________________________________________________