Registered Psychiatric Nurses (Certified) may prescribe medications associated with their certified practice area within their autonomous scope of practice. These standards for Prescribing Medications apply when certified practice registered psychiatric nurses prescribe a medication to be dispensed by a pharmacist for use by a designated individual. The standards for Giving Client-specific Orders apply when a registered psychiatric nurse gives a client-specific order for compounding, dispensing or administering a medication to be acted on by another nurse (RPN, LPN or RN) or other health professional, other than a pharmacist.
In addition to these standards for Prescribing Medications, and the prescribing limits and conditions governing certified practice RPN prescribing, certified practice RPNs 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 psychiatric nursing practice that may apply depending on the context.
“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).
Certified practice registered psychiatric nurses are accountable and responsible for their prescribing decisions.
Certified practice registered psychiatric nurses prescribe only those medications as allowed by:
Nurses (Registered) and Nurse Practitioners Regulation,19
Other relevant provincial or federal legislation or regulations,
BCCNM standards, limits, and conditions,
Organizational/employer policies and processes, and
the nurse’s individual competence.
Before prescribing, certified practice registered psychiatric nurses ensure they have the competence to:
Assess the client health status, including conducting an accurate health history and clinical evaluation,
Make or confirm a diagnosis of a disease, disorder, or condition that is within the autonomous scope of practice of the nurse’s certified practice designation and the nurse’s individual competence, and that can be improved or resolved within the context of the client’s overall health status and care needs,
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
Manage, monitor, and evaluate the client’s response to the prescribed medication.
Certified practice registered psychiatric nurses use current evidence to support decision-making when prescribing medications.
When prescribing, certified practice registered psychiatric nurses:
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, certified practice registered psychiatric 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.
Consider the client’s health history related to the condition or health concern such as age, sex, past medical and mental health history, family history, social history, risk factors, and the client’s understanding, beliefs, and values,
Undertake and document an appropriate clinical evaluation such as a physical and mental examination and/or a review of relevant diagnostic or monitoring tests and/or specialist reports,
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,
Assess the client’s known allergies and ensure allergy information is documented,
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,
Document the medication prescribed to the client and the indication(s) for the medication,
Establish a plan for reassessment/follow-up with respect to the prescribed medication, either by the certified practice registered psychiatric nurse themself or by another prescriber, and
Monitor and document the client’s response to the medication being prescribed (as applicable).
Certified practice registered psychiatric nurses complete prescriptions for medications, legibly, accurately, and completely, including:
The date the prescription was written,
Client name, address (if available) and date of birth,
Client weight (if required),
The name of the drug or ingredients, strength if applicable, and dose,
The quantity prescribed and quantity to be dispensed,
Dosage instructions (e.g. the frequency, maximum daily dose, route of administration, duration of medication therapy), and
Prescriber’s name, work address, work telephone number, written/electronic signature, and prescriber number.
Certified practice registered psychiatric nurses follow organizational/employer policies and processes (including security, privacy, and confidentiality measures) when transmitting a prescription to a pharmacy.
Certified practice registered psychiatric nurses collaborate, communicate, and/or consult with the client and with other health care professionals when prescribing medications, including:
The broader plan of care for the client developed by the health care team including other prescribers,
When the prescribing decision would benefit from the expertise of other health care professionals, and
When the needs of the client exceed the nurse’s scope of practice or individual competence.
Documenting the prescribing decision, plan of care and communication with the health care team.
Certified practice registered psychiatric nurses do not provide any person with a blank, signed prescription.
Certified practice registered psychiatric nurses do not prescribe medications for themselves, or anyone else who is not their client.
Certified practice registered psychiatric nurses participate in required and relevant provincial and/or national reporting programs.
Certified practice registered psychiatric nurses who prescribe controlled drugs and substances follow the requirements of the
Controlled Prescription Program20 including requirements related to securing and disposing of prescription pads; reporting any loss, theft or misuse of the prescription pads; and record retention