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6

(1)

(k)

in respect of a drug specified in Schedule I of the Drug Schedules Regulation,

 

 

 

(i)

prescribe the drug,

 

 

 

(ii)

compound the drug,

 

 

 

(iii)

dispense the drug, or

 

 

 

(iv)

administer the drug by any method;

 

 

 

for the purposes of

 

 

 

(v)

treating

 

 

 

 

(A)

anaphylaxis,

 

 

 

 

(B)

cardiac dysrhythmia,

 

 

 

 

(C)

opiate overdose,

 

 

 

 

(D)

respiratory distress in a known asthmatic,

 

 

 

 

(E)

hypoglycemia,

 

 

 

 

(F)

post-partum hemorrhage, or

 

 

 

 

(G)

conditions that are symptomatic of influenza-like illness, or

 

 

 

(vi)

preventing disease using immunoprophylactic agents and post-exposure chemoprophylactic agents

 

 

(l)

in respect of a drug specified in Schedule II of the Drug Schedules Regulation,

 

 

 

(i)

prescribe the drug,

 

 

 

(ii)

compound the drug,

 

 

 

(iii)

dispense the drug, or

 

 

 

(iv)

administer the drug by any method;

Under the Regulation, registered nurses are permitted to prescribe those medications that are within their autonomous scope of practice to compound, dispense or administer. This includes Schedule II medications, as well as the limited number of Schedule I medications that registered nurses are authorized to compound, dispense, or administer for specific purposes without an order1

BCCNM Limits and Con​​ditions

Registered nurses who prescribe medications, including Schedule I, II, III, or unscheduled medications must:

  • Prescribe only when they are recognized by their organization/employer as a prescriber.

  • Successfully complete additional education that supports safe, competent, and ethical practice of that activity.

  • Prescribe only when organizational/employer policies, processes and resources are in place that outline:

    • The accountability and responsibility of the prescribing nurse.

    • Processes for consulting with and/or referring to other health professionals (e.g. prescribers, pharmacists) about the prescribing decision as needed to meet the client’s needs.

    • Processes for ensuring continuity of care for the client, including:

      • responding to questions from the client (or their substitute decision-maker) or health care team members about the prescription or the need to make changes to the prescription,

      • consultation and referral pathways such as for diagnostic testing results, and

      • management and evaluation of client outcomes including monitoring, managing intended and unintended outcomes, and follow-up with respect to the prescribed medication.

  • Not prescribe dermal fillers.

For registered nurses who prescribe Schedule I medications, their additional education must include:

  • Basic prescribing competencies;

  • The condition(s)2 for which the medication is being prescribed; and

  • The medication to be prescribed.

Registered nurses who prescribe Schedule I medications must have access to PharmaNet.

In addition, registered nurses who prescribe any Schedule I or II medication must comply with all other applicable limits ‎and conditions that apply to the administration of that medication by a registered nurse ‎without an order.‎

Registered nurse scope of practice limits and conditions when prescribing for opioid use disorder

These limits and conditions for prescribing for opioid use disorder apply when registered nurses, within their autonomous scope of practice:

  • Prescribe a medication for a client for the treatment of opioid use disorder,
  • Compound a medication for a client for the treatment of opioid use disorder,
  • Dispense a medication to a client for the treatment of opioid use disorder,
  • Administer a medication to a client for the treatment of opioid use disorder.

Registered nurses who prescribe a controlled drug or substance are limited to prescribing only for the purpose of treating opioid use disorder.

Registered nurses who prescribe for the treatment of opioid use disorder must:

  • Prescribe only those medications identified by the British Columbia Centre on Substance Use (BCCSU) for the treatment of opioid use disorder and as allowed by their employer.
  • Meet the employment requirements set out in the Order of the Provincial Health Officer: Registered Nurse and Registered Psychiatric Nurse Public Health Pharmacotherapy.
  • Be recognized by their organization/employer as a prescriber for the treatment of opioid use disorder.
  • Successfully complete

    a.

    additional education that includes basic prescribing competencies and the medication to be prescribed; and

    b.

    the additional education and preceptorship requirements established by the British Columbia Centre on Substance Use (BCCSU) related to prescribing for the treatment of opioid use disorder. 

  • Follow the clinical guidelines and protocols established by BCCSU related to prescribing for the treatment of opioid use disorder. 
  • Prescribe for the treatment of opioid use disorder only when there are established policies and processes for

    a.

    the registered nurse to refer for diagnostic testing care, and

    b.

    the review and follow-up of diagnostic testing, and

    c.

    for the registered nurse to consult with, refer to and/or transfer care to physician, nurse practitioner, or addiction specialist. 

  • Prescribe controlled drugs and substances in accordance with the British Columbia Controlled Prescription Program, including:

    a.

    Storing all controlled prescription pads and personalized prescription pads in a secure and locked area,

    b.

    Reporting all loss, theft or misuse of personalized prescription pads or controlled prescription pads to BCCNM, PharmaNet Support Services, the police, and, if any client information is contained on the missing pad, the Information and Privacy Commissioner for British Columbia,

    c.

    Returning controlled prescription pads to BCCNM if no longer practising in British Columbia, if licensure status changes to non-practising or inactive, information printed on the pad is not current, or BCCNM staff instruct that pads must be returned, and

    d.

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

  • Have access to PharmaNet for documenting review of the client’s PharmaNet medication profile, medication reconciliation and prescription monitoring.
  • Prescribe only when the Order of the Provincial Health Officer: Registered Nurse and Registered Psychiatric Nurse Public Health is in effect.

In addition, registered nurses who prescribe for the treatment of opioid use disorder must comply with all other applicable BCCNM standards, limits and conditions that apply to the prescribing of medications.

While the Order of the Provincial Health Officer is in place, it creates a temporary exception to the usual restriction against registered nurses prescribing Schedule I or Schedule IA drugs, or compounding, dispensing, or administering Schedule I or Schedule IA drugs without an order from an authorized health professional.

Footnotes

1 Certified practice registered nurses are also authorized to prescribe Schedule I medications included ‎within their certified practice, as set out in decision support tools.
2 Or, in the case of a certified practice registered nurse, the disease, disorder or condition for which the medication is being prescribed.

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