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Limits and conditions on prescribing medications

Part 2: Scope of practice standards

Limits and Con​ditions on Prescribing Medications​​​

​​1.

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



​a.

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



​b.

​Successfully complete additional education to support safe, competent and ethical practice of that activity​​.


​c.

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




​i.

​​​​​​The accountability and responsibility of the prescribing nurse, ​​ ​ ​ ​



​ii.

​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​​,


​iii.

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




​1.

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



​2.

​​​consultation and referral path​ways such​ as for diagnostic testing results, and​ ​ ​



​3.

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



​d.

​​​​​Not prescribe dermal fillers.​​​ ​ ​ ​ ​

​2.

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



​a.

​​​​​Basic prescribing competencies;​​ ​ ​ ​ ​



​b.

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



​c.

​​​​​The medication to be prescribed.​​​ ​ ​ ​ ​

​3.

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

​​​Limits and Conditions on Prescribing for Opioid Use Disorder

These limits and conditions for prescribing for opioid use disorder apply when registered psychiatric nurses, within their aut​onomous 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​ ​ ​ ​ ​ ​ ​

​1.

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

​2.

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



​a.

​​​​​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. ​​​



​b.

​​​​​Meet the employment requirements set out in the Order of the Provincial Health Officer: Registered Nurse and Registered Psychiatric Nurse Public Health Pharmacotherapy.​​​ ​ ​ ​ ​


c.

​​​​​Be recognized by their organization/employer as a prescriber for the treatment of opioid use disorder.​



​d.

​​​​​Successfully complete​​




​i.

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



​ii.

​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 dis​​order.  


​e.

​​​​​​Follow the clinical guidelines and protocols established by BCCSU related to prescribing for the treatment of opioid use disorder.  ​ ​ ​ ​

​​

​f.

​​​​​Prescribe for the treatment of opioid use disorder only when there are established policies and processes for:



​i.​

​​​​the registered psychiatric nurse to refer for diagnostic testing, and


​ii.

​​the review and follow-up of diagnostic testing results, and


​iii.

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



​g.

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



​i.

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



​ii.​

​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,​​



​iii.

​Returning controlled prescription pads to BCCNM if licensure status changes to non-practicing or inactive, information printed on the pad is not current, or BCCNM staff instruct that pads be returned, and​


​iv.

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



​h.

​​​​​Have access to PharmaNet for documenting review of the client’s PharmaNet medication profile, medication reconciliation and prescription monitoring.  ​ ​ ​ ​


​i.

​Prescribe only when the Order of the Provincial Health Officer: Registered Nurse and Registered Psychiatric Nurse Public Health is in effect. ​

In addition, registered psychiatric 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 is in place, it creates a temporary exception to the usual restriction against registered psychiatric nurses prescribing any Schedule I or Schedule IA drugs, or compounding, dispensing or admin​istering Schedule I or Schedule IA drugs without an order from an authorized health professional.​

Limits and Conditions on Prescribing Specific Medications​​​​

​1.

RPNs who prescribe epinephrine to treat anaphylaxis must follow decision support tools in the Communicable Disease Immunization Program Section V - Management of Anaphylaxis in a Non-hospital Setting1 established by British Columbia Centre for Disease Control (BCCDC)2 or equivalent approved by their employer. ​

​2.

​RPNs who prescribe epinephrine must successfully complete additional education.​

​3.​

​RPNs must not prescribe a Schedule I drug to treat a suspected opiate overdose.

​4.

​​​RPNs are limited to prescribing salbutamol or ipratropium bromide to treat respiratory distress in known asthmatics. 

​5.

​​RPNs who prescribe salbutamol or ipratropium bromide to treat respiratory distress in a known asthmatic must follow a decision support tool approved by their employer.

​6.

​RPNs who prescribe salbutamol or ipratropium bromide must successfully complete additional education.​​

​7.

​RPNs are limited to prescribing D50W to treat hypoglycemia. ​​​

​8.

​RPNs who prescribe D50W to treat hypoglycemia must follow a decision support tool approved by their emplo​yer.

​9.

​RPNs who prescribe D50W must successfully complete additional ed​ucation.

​10.

​RPNs who prescribe antiviral medication to treat symptoms of influe​​nza-like illness must successfully complete additional education.

​11.

​RPNs who prescribe antiviral medication to treat symptoms of influenza-like illness must follow the RN and RPN Decision Support Tool (Clinical Practice Guidelines) for Identification and Early Tre​atment of Influenza-Like Illness (ILI) Symptoms during an Influenza Pandemic in the Absence of a Medical Practitioner or Nurse Practitioner​3 established by the provincial government, or equivalent approved by their employer.

​12.

​RPNs must not prescribe antiviral medicati​​on to treat symptoms of influenza-like illness for children under the age of 4.

​13.

​RPNs who prescribe immunoprophylactic or c​hemoprophylactic agents identified by the British Columbia Centre for Disease Control (BCCDC) must:

    • possess the competencies established by BCCDC4 and
  • must follow decision support tools established by BCCDC5.​
​14.

RPNs who prescribe post-exposure chemoprophylactic agents for sexual assault purposes must:

  • ​possess the BC Women's Sexual Assault Service Competencies for RN SANES6 (BCWSAS), and
  • follow Decision Support Tools for Sexual Assault Nurse Examiner7 (for Registered Nurses) established by BCWSAS​.
​15.

​RPNs must not prescribe immunoprophylactic or post-exposure chemoprophylactic agents for the purpose of preventing disease in travelers (also known as travel health).​​

​16.

​RPNs must not prescribe immunoprophylactic agents or post-exposure chemoprophylactic agents for children under the age of 4 years old.​​

​17.

​RPNs must not prescribe experimental vaccines for research purposes.​

​18.

​RPNs must not prescribe Schedule II medications to treat a disease or disorder.​​

​19​.

​RPNs may only prescribe Schedule II medications to treat a condition following an assessment and nursing diagnosis. Vaccines do not require the identification of a condition.​​

​20.

​RPNs who prescribe Schedule II drugs intravenously via a peripheral venous acce​ss device must follow an employer approved decision support tool.

​21.

​RPNs must not prescribe medication for administr​ation via central venous access devices.

​22.

​RPNs must not prescribe medication for administration via intrathecal, epidural, intraosseous or perineural routes.​

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Footnotes​

​1

​Drug Sc​hedules Regulation of the Pharmacy Operations and Drug Scheduling Act of British Columbia. http://www.bclaws.ca/civix/document/id/complete/statreg/9_98

​2

​​​Communicable Disease Immunization Program. Section V - Management of Anaphylaxis in a Non-Hospital Setting. http://www.bccdc.ca/resource-gallery/Documents/Guidelines%20and%20Forms/Guidelines%20and%20Manuals/Epid/CD%20Manual/Chapter%202%20-%20Imms/SectionV_Anaphylaxis.pdf

​3

RN and RPN Decision Support Tool (Clinical Pra​​ctice Guidelines) for Identification and Early Treatment of Influenza-Like Illness (ILI) Symptoms during an Influenza Pandemic in the Absence of a Medical Practitioner or Nurse Practitioner. https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/current-health-topics/pandemic-influenza

​4

​​​Immunization Competencies for BC Health Professionals. http://www.bccdc.ca/resource-gallery/Documents/Training%20and%20Events/Immunization/Vaccine%20Info/BCCDCImmunizationCompetencies_September2010.pdf

​5

​Communicable Disease Contr​ol Manual. http://www.bccdc.ca/health-professionals/clinical-resources/communicable-disease-control-manual

​6

​BC Women's Sexual Assault Service ​​Competencies for RN SANES Dispensing Prophylactic Medications to Protect against STI and HIV after Sexual Assault. http://www.bcwomens.ca/Professional-Resources-site/Documents/Sexual%20Assault/DST%20for%20SANES%20Dispensing%20HIV%20PEP%20August%201,%202018.pdf

​7

​Decision Support Tools for Sexual Assault Nurse​​ Examiners http://www.bcwomens.ca/health-professionals/professional-resources/sexual-assault-service-resources


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