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Prescribing

Part 2: Scope of practice standards

Introduction

The Nurses (Registered) and Nurse Practitioners Regulation  gives registered nurses1 the authority to prescribe:

  • A limited number of Schedule I medications (for specified purposes listed in the Regulation)
  • Schedule II medications

A registered nurse “prescribes” within the meaning of the Nurses (Registered) and Nurse Practitioners Regulation when they issue an authorization to dispense a specified medication for use by a designated individual.   

These Standards for Prescribing apply when registered nurses prescribe a medication to be dispensed to or for an individual client or give a client-specific order for a medication to be administered to, or dispensed to or for, an individual client.

 “Medication” used within this standard refers to Schedule I, IA, II, III, and unscheduled drugs as defined in the provincial Drug Schedules Regulation under the Pharmacy Operations and Drug Scheduling Act (PODSA). 

In addition to the Standards for Prescribing, and prescribing limits and conditions governing RN prescribing, RNs who prescribe medication must comply with the Medication practice standard and the Acting within Autonomous Scope of Practice standard, as well as any other BCCNM standards, limits or conditions on nursing practice that may apply depending on the context.
Organizations/employers provide the organizational supports and systems necessary for registered nurse prescribers to meet their standards of practice.

Principles

1.

Registered nurses are accountable and responsible for their prescribing decisions.

2.

Registered nurses prescribe only those medications as allowed by:

 

a.

The Nurses (Registered) and Nurse Practitioners Regulation,

 

b.

Other relevant provincial or federal regulations,

 

c.

BCCNM standards, limits, and conditions, 

 

d.

Organizational/employer policies and processes, and

 

e.

the nurse’s individual competence.

3.

Before prescribing, registered nurses ensure they have the competence to:

 

a.

Assess the client health status, including conducting an accurate health history and clinical evaluation,

 

b.

Make or confirm a nursing diagnosis2 of a condition that can be improved or resolved within the context of the client’s overall health status and care needs by prescribing a medication within the registered nurse’s scope of practice,

 

c.

Prescribe the medication safely, including knowing the medication’s therapeutic use, indications, dosages, precautions, contraindications, side effects, adverse effects, potential interactions between the medication and foods/medications/substances, medication forms and routes for administration, and     

 

d.

Manage, monitor, and evaluate the client’s response to the prescribed medication.

4.

Registered nurses use current evidence to support decision-making when prescribing medications.

5.

When prescribing, registered nurses: 

 

a.

Assess the client in person, or, if clinically appropriate, through a virtual health care encounter with a visual assessment. If a visual assessment is not possible, registered nurses prescribe without a visual assessment only after determining that it is clinically appropriate and only:

 

 

 i.  if the client is known to the nurse, and/or

 

 

ii.  the client is being assessed in person by another health care provider.

 

b.

Consider the client’s health history related to the condition or health concern such as age, sex, past medical history, family history, social history and the client’s understanding, beliefs, and values, 

 

c.

Undertake and document an appropriate clinical evaluation such as a physical examination or a review of relevant diagnostic tests and specialist reports,

 

d.

Obtain the best possible medication history for the client, including the client’s use of non-prescription medications and natural health products, as outlined in organizational/employer requirements (using PharmaNet when access is available and other sources),  

 

e.

Review the medication history and follow organizational policies and processes for any identified discrepancies to be addressed,

 

f.

Assess the client’s known allergies and ensure allergy information is documented, 

 

g.

Assess for difficulties in the client’s ability to pay for and/or access medications, and the potential need to refer the client to available provincial medication access programs,

 

h.

Document the medication prescribed to the client and the indication(s) for the medication,

 

i.

Establish a plan for reassessment/follow-up with respect to the prescribed medication, either by the registered nurse themself or by another prescriber, and 

 

j.

Monitor and document the client’s response to the medication being prescribed (as applicable).

6.

Registered nurses complete prescriptions for medications, legibly, 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 medication, 

 

e.

The quantity prescribed and quantity to be dispensed,

 

f.

Dosage instructions (e.g. the frequency, maximum daily dose, route of administration, duration of medication therapy), and 

 

g.

Prescriber’s name, work address, work telephone number, written/electronic signature, and prescriber number.

7.

Registered nurses using order sets (pre-printed or electronic) to prescribe a medication:

 

a.

Make the order specific for that individual client,

 

b.

Include any necessary changes based on an assessment of the client,

 

c.

Date and sign with their written/electronic signature.

8.

Registered nurses follow organizational/employer policies and processes, (including security, privacy, and confidentiality measures), when transmitting a prescription to a pharmacy by phone, facsimile, or other electronic means. 

9.

Registered nurses collaborate, communicate, and/or consult with the client and with other health care professionals when prescribing medications, including:

 

a.

Consideration of the broader plan of care for the client developed by the health care team including other prescribers,

 

b.

The plan for reassessment/follow-up with respect to the prescribed medication,

 

c.

When the prescribing decision would benefit from the expertise of other health care professionals, 

 

d.

When the needs of the client exceed the nurse’s scope of practice or individual competence, and

 

e.

Documenting the plan of care and communication with the health care team to meet the client’s care needs.

10.

Registered nurses do not provide any person with a blank, signed prescription.

11.

Registered nurses do not prescribe medications for themselves, or anyone else who is not their client.

12.

Registered nurses participate in required and relevant provincial and/or national reporting programs.

Footnotes

1 References in this standard to registered nurses include licensed graduate nurses.
2 Certified practice registered nurses may also make a diagnosis of a disease, disorder or condition that is within the autonomous scope of the nurse’s certified practice designation and the nurse’s individual competence.

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