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Standards

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

 

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 guidelines8 when prescribing.

6.

When prescribing, nurse practitioners:

 

a.

consider the client’s health history and other relevant factors (e.g. age, gender, lifestyle, the client’s perspective on their health)

 

b.

undertake and document an appropriate clinical evaluation (e.g. physical examination, review of relevant tests, imaging and specialist reports)

 

c.

obtain the best possible medication history for the client using PharmaNet (when access is available 9) and other sources

 

d.

review the medication history and take action to address any discrepancies

 

e.

ask about the client’s drug allergies and ensure drug allergy information is accurately and appropriately documented

 

f.

document the drugs prescribed to the client and the indication(s) for the drugs

 

g.

establish a plan for reassessment/follow-up

 

h

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

 

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.

name, strength and dose of the drug

 

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 10

 

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)

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 Regulations11

 

f.

retain any copy of the medical document for cannabis in the client health record

15.

Nurse practitioners:

 

a.

store all controlled prescription pads and personalized prescription pads in a secure and locked area

 

b.

report all loss, theft or misuse of personalized prescription pads or controlled prescription pads to BCCNP, PharmaNet Support Services, the police, and, if any client information is contained on the missing pad, the BC Privacy Commissioner12

 

c.

return controlled prescription pads to BCCNP if no longer practising in BC13

 

d.

store the duplicate copy of a controlled prescription with the client health record, not within the controlled prescription pad

16.

Before changing to non-practising or inactive registration with BCCNP (and therefore relinquishing prescribing authority), nurse practitioners take steps to ensure prescription refills and part-fills are managed for clients.

Footnotes

8.

Guidelines include those from BC Cancer, BC Centre for Excellence in HIV/AIDS, BC Centre on Substance Use, Perinatal Services BC, and BC Centre for Disease Control.

9.

Nurse practitioners register for Pharmanet access appropriate to the practice sites where they will be prescribing (e.g. Community Health Practice Access to PharmaNet).

10.

Prescriptions for drugs that are part of the Controlled Prescription Program cannot be faxed. Prescriptions for long term care and extended care licenced facility patients do not require the use of controlled prescription program forms and may be faxed to the authorized community pharmacy.

NOTE: Effective March 19, 2020, and for the duration of the COVID-19 pandemic, it is 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. More information>>.

11.

Requirements for completing a medical document or written order for cannabis are set out in sections 273 and 274 of the Cannabis Regulations.

12.

See the BCCNM Controlled Prescription Pads webpage for more information about lost or stolen pads.

13.

See the BCCNP Controlled Prescription Pads webpage for more information about returning pads to BCCNP.

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