1.
| Nurse practitioners prescribe drugs within nurse practitioners’ scope of practice, relevant legislation and their individual competence.
|
2.
| Nurse practitioners are accountable for their prescribing decisions. |
3.
| Before prescribing, nurse practitioners ensure their competence to: |
| a.
| Establish or confirm a diagnosis for the client, |
| b.
| Manage the treatment and care of the client, and |
| c.
| Monitor and manage the client’s response to the drug. |
4.
| Nurse practitioners use current evidence to support decision-making when prescribing. |
5.
| Nurse practitioners apply relevant guidelines[1] when prescribing. |
6.
| When prescribing, nurse practitioners: |
| a.
| Consider the client’s health history and other relevant factors (e.g. age, sex, gender, past medical and mental health history, lifestyle, risks factors and the client’s perspective on their health), |
| b.
| Undertake and document an appropriate clinical evaluation (e.g. physical examination, mental health examination, review of relevant tests, imaging and specialist reports), |
| c.
| Obtain and review the best possible medication history for the client using PharmaNet and/or other sources (including any traditional medicines, natural health products, non-prescription medications, and substance use, in addition to prescribed medications), and take action to address any discrepancies, |
| d.
| Ask about the client’s drug allergies and ensure drug allergy information is accurately and appropriately documented, |
| e.
| Document the drugs prescribed to the client and the indication(s) for the drugs, |
| f.
| Establish a plan for reassessment/follow-up, and |
| g.
| Monitor and document the client’s response to the drugs prescribed (as appropriate). |
7.
| Nurse practitioners undertake medication reconciliation to ensure accurate and comprehensive medication information is communicated consistently across health care transitions. |
8.
| When prescribing, nurse practitioners provide information to clients about: |
| a.
| The expected action of the drug, |
| b.
| The duration of the drug therapy, |
| c.
| Specific precautions or instructions for the drug, |
| d.
| Potential side-effects and adverse effects (e.g. allergic reactions) and action to take if they occur, |
| e.
| Potential interactions between the drug and certain foods, other drugs, or substances, and |
| f.
| Recommended follow-up. |
9.
| Nurse practitioners complete prescriptions accurately and completely, including: |
| a.
| The date the prescription was written, |
| b.
| Client name, address (if available) and date of birth, |
| c.
| Client weight (if required), |
| d.
| The name of the drug or ingredients, strength if applicable, and dose, |
| e.
| The quantity prescribed and quantity to be dispensed, |
| f.
| Dosage instructions (e.g. the frequency or interval, maximum daily dose, route of administration, duration of drug therapy), |
| g.
| Refill authorization if applicable, including number of refills and interval between refills, |
| h.
| Prescriber’s name, address, telephone number, written (not stamped) signature, and prescriber number, |
| i.
| Date of transmission, the name and fax number of the pharmacy intended to receive the transmission, and the practitioner’s fax number if the prescription is being faxed,[2] and |
| j.
| Directions to the pharmacist not to renew or alter if a pharmacist-initiated adaption would be clinically inappropriate. |
10.
| When notified of a pharmacist-initiated prescription adaption, nurse practitioners document the adaption in the client record. |
11.
| Nurse practitioners report adverse drug reactions to the Canada Vigilance Program. |
12.
| Nurse practitioners prescribe controlled drugs and substances in accordance with the Controlled Prescription Program. |
13.
| When prescribing controlled drugs and substances, nurse practitioners meet the Prescribing Drugs standards and also: |
| a.
| Assess the client in person, or by telehealth with visual assessment if clinically appropriate, except in cases where the client is: |
|
| i. Known to the nurse practitioner, and/or |
|
| ii. Being assessed in person by another health care provider. |
| b.
| Document their review of the client’s PharmaNet medication profile, |
| c.
| Document the indication and duration for which the drug is being prescribed, the goals of treatment, and the rationale for the drug’s use over alternatives (if applicable), |
| d.
| Prescribe the lowest possible dose and the minimum quantity to be dispensed, |
| e.
| Know the risks of co-prescribing opioid and sedative-hypnotic drugs (e.g. benzodiazepines) and limit co-prescribing whenever possible; document the rationale and the follow-up plan if co-prescribing is necessary, |
| f.
| Advise clients about the side effects and risks of controlled drugs and substances as applicable (e.g. physical tolerance, psychological dependence, addiction, diversion), |
| g.
| Implement evidence-informed strategies for minimizing risk (e.g. treatment agreements, pill counts, urine drug screens, client education about safe storage and disposal), and |
| h.
| Follow the requirements of the British Columbia Controlled Prescription Program including requirements related to securing and disposing of prescription pads; reporting any loss, theft or misuse of the prescription pads; and record retention. |
14.
| When authorizing medical cannabis, nurse practitioners meet the Prescribing Drugs standards and also: |
| a.
| Review the client’s medication profile and history through PharmaNet and other sources, |
| b.
| Document their review of the client’s PharmaNet medication profile, |
| c.
| Document the indication and duration for which medical cannabis is being authorized, the goals of treatment, and the rationale for its use over alternatives, |
| d.
| Advise clients about the side effects and risks of medical cannabis, |
| e.
| Complete medical documents or written orders for cannabis in accordance with the requirements set out in the Cannabis Regulations,[3] and |
| f.
| Retain any copy of the medical document for cannabis in the client health record. |
15.
| Before changing to non-practising or inactive registration with BCCNM (and therefore relinquishing prescribing authority), nurse practitioners take steps to ensure prescription refills and part-fills are managed for clients.
|