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Restricted activities that require an order

Part 4: Restricted activities for licensed practical nurses

​LPNs require a client-specific order from an authorized health professional to carry out certain restricted activities. The health professional giving the order must be authorized to perform the restricted activity without an order (that is, within their autonomous scope of practice), and the restricted activity must be within the LPN scope of practice and permitted by employer policy. When acting with an order, LPNs follow BCCNM's St​andards for Acting with Client-Specific Orders​.​

​​R​​es​tricted Activ​ities with Orders
BCCNM LIMITS AND CONDITIONS
1.​​
​​Perform a procedure on tissue below the dermis or below the ​surface of a mucous membrane

​Perito​​neal​ Dialysis

LPNs ​carry out peritoneal dialysis:

  1. For clients with stable or ​predictable states of health

  2. After s​uccessfully completing additional education

​​Phlebotomy

LPNs perform phlebotomy:

  1. To collect blood samples from clients 14 years of age and older

  2. After successfully completing additional education

  3. By fol​​lowing decision support tools

  4. ​By using a peripheral evacuated system

Wound Care

LPNs apply compression therapy,

provide negative pressure wound therapy (vacuum assisted closure (VAC), or carry out maggot debridement therapy:

  1. ​​​​If a wound care treatment plan is in place

  2. ​​After successfully completing additional education

  3. ​By following decision support tools

​LPNs do not carry out any form of sharps debridement including conservative sharps wound debridement (CSWD).​

2.​

Cast a fracture of a bone

​L​PNs apply casts for a fracture of a bone:

  1. With a client-specific order from a medical practitioner or nurse practitioner registered in BC*

  2. A​​fter successfully completing additional education

    **Licen​sed practical nurses may only act on a client-specif​ic order to cast a fracture of a bone given by a medical practitioner or nurse practitioner who is registered in British Columbia as per the Nurses (Licensed Practical) Regulation section 7(3).

​3.
​​​Administer a substance by injection

​See lim​its and conditions for Medical Aesthetics.

​4.

​Administer a substance by inhalation

​​LPNs do not:

  1. Admini​ster nitrous oxide

  2. Monitor clients taking nitrous oxide

  3. Admini​ster inhaled substances for purposes of anaesthesia or procedural (conscious) sedation

LPNs work in a team nursing approach to  provide care and monito​r c​lients under:

  1. Gen​eral anesthesia

  2. P​​ro​cedural sedation

​5.

​​Administer a substance by mechanical ventilation

​LPNs care for ​​clients requiring mechanical ventilation:

  1. With stable or p​redictable states of health

  2. ​After successfully completing additional education

LPNs ​provide care to clients who use continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BPAP) after successfully completing additional education.

​6.

​Administer a substance by irrigation

​LPNs do not irrigate ​ostomies.

LPNs irrigate only those percutaneous tubes they are permitted to irrigate at entry-level.

​7.

​​Administer a substance by enteral or parenteral instillation

​LPNs:
  1. Change IV bags infusing via peripheral access (not central venous access)

  2. Monitor clients receiving blood or blood products in a team nursing approach

  3. ​​Provide care to clients receiving parenteral nutrition in a team nursing approach

LPNs do not:

  1. Start transfusions of blood or blood products

  2. Start or monitor parenteral nutrition

  3. Administer radiopaque dyes via parenteral instillation

  4. Ac​cess central venous access devices or central venous lines

Also see hemodialysis for exceptions​

​8.

​For the purpose of establishing intravenous access, maintaining patency or managing hypovolemia

    1. perform venipuncture, or
    2. administer a solution by parenteral instillation

​​​LPNs start IVs:

  1. After successfully completing additional education

  2. Using a short peripheral device

LPNs:

  1. ​Admi​nister parenteral solutions to clients with stable or ​predictable states of health

  2. ​​Change IV bags infusing via peripheral access (not central venous access)

Also s​ee hemodialysis for exceptions​

​9.

​​​​Put an instrument or a device, hand or finger into the external ear canal, up to the eardrum

​​LPNs do not insert a curette or other instrument into the external ear canal to remove:

  1. Foreign objects

  2. Earw​ax

​10.

​Put an instrument or a device, hand or finger beyond the point in the nasal passages where they normally narrow

​​​LPNs suction the nasal passages beyond the point where they normally narrow after successfully completing additional education.

LPNs do not:

  1. Insert nasogastric (NG) tubes

  2. Insert orogastric (OG) tubes

  3. Ca​rry out nasopharyngeal washes

​11.

​​Put an instrument or a device, hand or finger beyond the pharynx

​​LPNs do not insert laryngeal mask airways (LMAs).

Also see Restricted​​ Activities with O​rders #15

​12.

​​Put an instrument or a device, hand or finger beyond the opening of the urethra

L​PNs insert coude tip catheters after successfully completing additional education.
13.​

​​Put an instrument or a device, hand or finger beyond the labia majora​

​​​LPNs remove vaginal packing after successfully completing additional education.

LP​​Ns insert or remove pessaries after successfully completing additional education.

LPNs do not:

  1. Insert vaginal packing
  2. Carry out pelvic or vaginal examinations
  3. Perform cervical cancer screening
  4. ​Insert an instrument, substance or medication into or beyond the cervix.
​14.

​Put an instrument or a device, hand or finger beyond the anal verge

​​​LPNs insert tubes into the rectum:

  1. After successfully completing additio​​nal education

  2. By follow​ing decision support tools

LPNs do not insert or advance scopes for rectal/bowel examinations.

​15.

​​Put an instrument or a device, hand or fin​ger into an artificial opening into the body

​​​LPNs provide​ tracheostomy care to clients:

  1. With well-established tracheostomies

  2. After successfully completing additional education

​LPNs carry out digital examination of colostomies for clients:

  1. With well-established stomas

  2. After successfully completing additional education

LPNs insert suprapubic catheters and gastrostomy tubes for clients:

  1. With well-established stomas

  2. Af​ter successfully completing additional education

​16.

​​​Put into the ear canal, up to the eardrum, a substance that is under pressure

​​​LPNs syringe the ears of clients after successfully completing additional education that includes the competencies required to:

  1. assess the integrity of the eardrum

  2. use water that is under pressure equal to or less than the pressure created by an ear bulb syringe

Also s​ee Restricted Activities without Orders #9

​17.

​​Apply ultrasound for diagnostic or imaging purposes, except that ultrasound may be applied to a fetus only for the purpose of fetal heart monitoring

​​LPNs do not carry out:

  1. Ankle-bra​chial Index (ABI) testing

  2. Fetal heart monitoring using an intermittent Doppler, or any related activities including palpation and auscultation of the fetal heart

Also s​ee antenatal care

​18.

​In respect of a drug specified in Schedule I, IA or II of the Drug Schedules Regulation, compound, dispense or administer the drug

​​​The LPN Regulation (Section 7) permits LPNs to compound, dispense, and administer medications listed in Schedule I, IA or II of the provincial drug schedules with a client-specific order from an authorized (listed) health professional. 

LPNs change IV bags containing potassium chloride (KCL) infusing via peripheral access (not central venous access), when the IV bag has been compounded commercially or by a pharmacy.

LPNs administer IV medications after successfully completing additional education.​

LPNs do not administer:

  1. IV push medications

  2. IV medications through a central venous access device

  3. Intrathecal medications

  4. Intra-o​sseous medications

  5. Medica​tions into epidural spaces
  6. Medications into perineural spaces

  7. Inhaled​​ substances or medications for purposes of anaesthesia or procedural sedation

LPNs work in a team nursing approach to provide care and monitor clients under:

  1. General anesthesia
  2. Intrathecal anesthesia
  3. Epidural anesthesia
  4. Procedural sedation

Also see:​​

​19.

​​If nutrition is administered by enteral instillation, compound or dispense a therapeutic diet

None