Nurses (Registered Psychiatric) Regulation gives registered psychiatric nurses the authority to prescribe:
A registered psychiatric nurse “prescribes" within the meaning of the
Nurses (Registered Psychiatric) Regulation when they issue an authorization to dispense a specified medication for use by a designated individual.
These standards for Prescribing Medications apply when 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.
“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).
Under the registered psychiatric nurse limits and condition on prescribing medications, registered psychiatric nurses only prescribe medications to be dispensed by a pharmacist when they meet the requirements to prescribe for the treatment of opioid use disorder, in accordance with the registered psychiatric nurse limits and conditions for the diagnosis and treatment of opioid use disorder.
In addition to these standards for Prescribing Medications, and the prescribing limits and conditions governing RPN prescribing, 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.
Organizations/employers provide the organizational supports and systems necessary for registered psychiatric nurse prescribers to meet their standards of practice.
Registered psychiatric nurses are accountable and responsible for their prescribing decisions.
Registered psychiatric nurses prescribe only those medications as allowed by:
Nurses (Registered Psychiatric) Regulation1,
Other relevant provincial or federal regulations,
BCCNM standards, limits, and conditions,
Organizational/employer policies and processes, and
the nurse’s individual competence.
Before prescribing, 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 nursing diagnosis 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,
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.
Registered psychiatric nurses use current evidence to support decision-making when prescribing medications.
When prescribing, 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, 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.
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,
Undertake and document an appropriate clinical evaluation such as a physical examination or a review of relevant diagnostic tests and specialist reports,
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),
Review the medication history and follow organizational policies and processes for any identified discrepancies to be addressed,
Ask about the client’s medication allergies and ensure medication allergy information is accurately and appropriately 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 registered psychiatric nurse themselves or by another prescriber, and
Monitor and document the client’s response to the medication being prescribed (as applicable).
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),
Name, strength, and dose of the medication,
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.
Registered psychiatric nurses using order sets (pre-printed or electronic) to prescribe a medication:
Make the order specific for that individual client,
Include any necessary changes based on an assessment of the client, and
Date and sign with their written/electronic signature.
Registered psychiatric 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.
Registered psychiatric nurses collaborate, communicate, and/or consult with the client and with other health care professionals when prescribing medications, including:
Consideration of the broader plan of care for the client developed by the health care team including other prescribers,
The plan for reassessment/follow-up with respect to the prescribed medication,
When the prescribing decision would benefit from the expertise of other health care professionals,
When the needs of the client exceed the nurse’s scope of practice or individual competence, and
Documenting the plan of care and communication with the health care team to meet the client’s care needs.
Registered psychiatric nurses do not provide any person with a blank, signed prescription.
Registered psychiatric nurses do not prescribe medications for themselves, or anyone else who is not their client.
Registered psychiatric nurses participate in required and relevant provincial and/or national reporting programs.
1. Despite the Nurses (Registered Psychiatric) Regulation, registered practical nurses are only authorized to prescribe any medications (to be dispensed by a pharmacist) for the purpose of treating opioid use disorder, in accordance with the limits and conditions in Limits and conditions on prescribing medications.
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