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Prescribing during the pandemic


BCCNM recognizes your efforts and challenges in working in a pandemic. If you need more information or wish to speak with someone about a practice concern, please contact one of our Regulatory Practice Consultants.

  • Email practice@bccnm.ca​
  • 604.742.6200 x8803 (Metro Vancouver)
  • Toll-free 1.866.880.7101 x8803 (within Canada only)

For Controlled Drugs and Substances (CDS) prescribers

Prescribing under the Controlled Prescription Program

Health Canada has introduced regulatory exemptions to improve pharmacological and therapeutic options for allowing patients to access controlled medications during the COVID-19 pandemic.

Precautions in place due to the COVID-19 pandemic such as physical distancing, self isolation, and quarantine are impacting clients requiring prescriptions for drugs under the Controlled Prescription Program (CPP). Patients at particular risk are those on opioid medications for chronic pain or those receiving opioid agonist therapy (OAT).

The Ministry of Health, the College of Pharmacists of BC, BCCNP and others are working toward a solution. In these exceptional times, prescribers are asked to ensure their patients have an unbroken supply of these medications. If it is not possible to meet with a patient face-to-face, prescribers should consider alternative means to getting duplicate prescriptions to pharmacies.

Health Canada exemptions

Health Canada has provided temporary exemptions to parts of the Controlled Drugs and Substances Act (CDSA) and its Regulations to permit pharmacists to extend prescriptions, transfer prescriptions, and for pharmacists and pharmacy employees to deliver controlled medications, and to permit prescribers to issue verbal orders for controlled medications.

Temporary changes to practice

The College of Pharmacists of BC has amended its bylaws relating to the Pharmacy Operations and Drugs Scheduling Act (PODSA) and the Health Professions Act (HPA). During the pandemic, it is now acceptable for prescribers to fax prescriptions, or give verbal prescriptions for controlled drugs to pharmacists, and then deliver (by mail courier or other means) a hard copy of the original duplicate form. It is essential the pharmacists receive the original duplicate form as soon as reasonably possible.

Clinicians are expected to weigh carefully the risks and benefits to both patients and the public when prescribing by these means. The need for physical distancing and self isolation and the risks of travel to medical appointments for clinicians and patients must be balanced with the overarching need to ensure continuous supply of these essential medications. NP prescribers are reminded that they must continue to meet BCCNP standards, limits and conditions for prescribing CDS and OAT, and follow their employer policies and guidelines.

To further enable access to these controlled prescriptions, pharmacists can now provide emergency supplies of controlled drugs (including OAT). Pharmacists are also able to deliver these medications when it is safe and in the best interest of the patient to do so, which includes practising physical distancing and screening for potential COVID-19 exposure.

BC Centre on Substance Use

The BC Centre on Substance Use has developed updated clinical guidance for prescribers and pharmacists to improve access to OAT in the context of COVID-19. Visit their website to access these resources.

For Opioid Agonist Treatment (OAT) prescribers

The BC Centre on Substance Use (BCCSU) has put together guidance for OAT prescribers during the COVID-19 pandemic.

For MAiD providers

The BCCNM Board has made modifications to the standards, limits and conditions for practice respecting medical assistance in dying (MAiD) for nurse practitioners.

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​Effective March 27, 2020, and for the duration of the COVID-19 public health emergency in British Columbia, the BCCNM Board has made the following modifications to the standards, limits and conditions for practice respecting medical assistance in dying (MAiD) for nurse practitioners:

  1. The standard allowing only one assessor to conduct a telemedicine assessment for a client requesting MAiD is temporarily rescinded. Both assessors may conduct the assessment by telemedicine. Telemedicine assessments must meet the requirements set out in federal legislation as well as the standards and expectations that apply to in-person assessments.
  2. The requirement for a regulated health professional to be in physical attendance with the client to act as a witness to a telemedicine assessment is temporarily subject to the following exception: No witness is required for a telemedicine assessment if a regulated health professional is not reasonably available for that purpose.
  3. The requirement that nurse practitioners must not delegate or assign the return of MAiD substances to any other person is temporarily subject to the following exception: A nurse practitioner may ask another physician, nurse practitioner, licensed practical nurse, registered nurse, registered psychiatric nurse or pharmacist to return the substances to the pharmacy. The nurse practitioner must document the name of the person assigned to return the substances in the client record.

The Scope of Practice for Nurse Practitioners: Standards, Limits and Conditions has been updated to reflect this change (pp. 27-29).

For LPNs, RNs and RPNs

To support changes listed above, BCCNM has also made the following modification to the standards, limits, and conditions for licensed practical nurses, registered nurses, and registered psychiatric nurses, effective immediately and for the duration of the COVID-19 public health emergency in British Columbia:

  1. The limits preventing licensed practical nurses, registered nurses and registered psychiatric nurses from returning MAiD substances to the pharmacy are temporarily rescinded to the extent necessary to allow them to do so when requested by the assessor-prescriber. When carrying out such a request, licensed practical nurses, registered nurses and registered psychiatric nurses ensure the drugs are stored securely until transported and are returned to the pharmacy within 72 hours of the MAiD procedure, and they sign any forms normally signed by the assessor-prescriber to note the return of the substances.

The Scope of Practice for Licensed Practical Nurses: Standards, Limits and Conditions has been updated to reflect this change (p. 36).

The Scope of Practice for Registered Nurses: Standards, Limits and Conditions has been updated to reflect this change (p. 52).

The Scope of Practice for Registered Psychiatric Nurses: Standards, Limits and Conditions has been updated to reflect this change (p. 68).

Guidance for certifying COVID-19 deaths

With the World Health Organization declaring COVID-19 a pandemic and subsequent increasing mortality from the virus worldwide, there is increased importance on certifying these deaths correctly.

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The following information was provided by the BC Vital Statistics Agency to ensure deaths due to COVID-19 are properly certified.

With the World Health Organization declaring COVID-19 a pandemic and subsequent increasing mortality from the virus worldwide, there is increased importance on certifying these deaths correctly.

1. Recording COVID-19 on the medical certificate as cause of death

COVID-19 should be recorded on the medical certificate of cause of death for ALL decedents where the disease caused, or is assumed to have caused, or contributed to death.

2. Terminology

The use of official terminology, as recommended by the World Health Organization, i.e. COVID-19, should be used for all certification of this cause of death.

As there are many types of coronaviruses it is recommended not to use "coronavirus" in place of COVID-19. This will help to reduce uncertainty for coding and monitoring these deaths which may lead to underreporting.

3. Chain of events

Due to the public health importance of COVID-19, when it is thought to have caused or contributed to death it should be recorded in Part I of the medical certificate of cause of death.

Specification of the causal sequence leading to death in Part I of the certificate is also important.  For example, in cases when COVID-19 causes pneumonia and fatal respiratory distress, both pneumonia and respiratory distress should be included along with COVID-19 in Part I.  Certifiers should include as much detail as possible based on their knowledge of the case, medical records, laboratory testing, etc. 

Example

Immediate cause: Acute respiratory distress syndrome
Conditions leading to the cause: Pneumonia, COVID-19

4. Co-morbidities

There is increasing evidence that people with existing chronic conditions or compromised immune systems due to disability are at greater risk of death due to COVID-19. Chronic conditions may be non-communicable diseases such as coronary artery disease, COPD, and diabetes or disabilities. If the decedent had existing chronic conditions, such as those listed above, these should be listed in Part II of the medical certificate of cause of death.

Example:

Other significant conditions contributing to death but not related to the disease or conditions causing it:

A. Coronary artery disease
B. Type 2 diabetes
C. COPD​

 External resources