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Oversight

CRNBC has a robust prescription oversight program

Introduction

Nurse practitioners (NPs) in B.C. have a broad scope of practice, which includes drug prescribing. In 2016, NPs in B.C. were granted new authority to prescribe many controlled drugs and substances (CDS) under federal legislation. In 2017, the CRNBC Board approved practice standards for NPs to undertake continuation prescribing of buprenorphine-naloxone (suboxone) for treatment of opioid addiction.

Establishing and implementing rigorous Quality Assurance Program processes for monitoring, assessing, and acting on sub-optimal prescribing practices is integral to meeting CRNBC’s public interest mandate.

CRNBC’s Quality Assurance Program

CRNBC’s Quality Assurance Program supports our mandate to regulate in the public interest. The program is administered and maintained by the Quality Assurance Committee in accordance with governing legislation (such as the Health Professions Act and the CRNBC bylaws) and QA Program policy.

The QA Program incorporates CRNBC’s regulatory philosophy, and is proactive, and supports nurses to meet high practice standards to ensure safe competent ethical care, through methods such as self-assessment and feedback from assessors, peers and non-peers, the QA Committee; and ongoing professional development.

Since 2005, QA Program policy has required an onsite peer review for NPs within two years of their initial registration. The chart review guide which is based on CRNBC Standards of Practice and Competencies for NPs, has specific prescribing criteria including CDS criteria reviewed by an assessor appointed by the QA Committee. (See section IV, pp. 8-9 of the Onsite Chart Review Guide).

The Quality Assurance Committee

The Quality Assurance Committee is responsible for overseeing  the QA Program including Prescription Review. This authority is derived from the Health Professions Act, CRNBC Bylaws and QA policy. The committee responsibilities include:

  • Policy development and implementation
  • Review of individual registrant QA data to determine whether high practice standards are being achieved, and if further information is required from the registrant

When assessing QA data to determine a registrant’s QA standing, the QA Committee apply

In the majority of cases, standards are being met or exceeded. When it appears that higher standards could be achieved by the registrant, the committee may make specific recommendations and/or require follow-up to support the registrant to raise the standard of their practice. In very rare cases, after working with and receiving information from a registrant and their assessor regarding opportunities to make practice improvements and registrant efforts in that regard, the QA Committee may determine that a serious risk to the public exists and may make a referral to the Inquiry Committee for its assessment.

Prescription Review Program

The QA Committee will monitor and review the prescribing of selected drugs or drug classes to identify concerns, trends or issues related to selected drugs and/or drug class prescribing practices, and provide information to

  • The nurse practitioner standards committee for consideration in the development of NP standards of practice and standards of professional ethics;  
  • The registrar for the purpose of commencing or conducting continuing competence audits; or
  • Selected groups of registrants or the profession as a whole for the purpose of promoting safe client care and high practice standards in relation to the prescribing of drugs.

CRNBC continues to work closely with our partners, the College of Physicians and Surgeons of BC (CPSBC), College of Pharmacists of BC, the BC Centre on Substance Use, the Ministry of Health, as well as NPs and employers, to establish and implement prescription review policy and operational processes that reflect provincial research, experience and evaluation.     

CRNBC’s Prescription Review Program will review NP prescribing practices to: 

  • Promote high practice standards for NP drug prescribing
  • Increase NP registrant awareness and understanding regarding CRNBC’s NP Scope of Practice Standards, Limits and Conditions, thereby
    • Reducing risks associated with sub-optimal  drug prescribing
    • Reducing diversion of prescription drugs
  • Identify possibly sub-optimal prescribing: e.g. patients with multiple opioids, high morphine dose equivalents, moderate to large dispenses, co-prescribing opioids and benzodiazepines 
  • Intervene with individual registrants when it appears higher standards of prescribing  could be achieved, by
    • Making recommendation(s) such as for education or remediation or follow-up interviews or chart reviews
    • Establishing voluntary prescription monitoring agreements

In very rare cases, after working with and receiving information from a registrant and their assessor regarding opportunities to make practice improvements and registrant efforts in that regard, the QA Committee may determine that a serious risk to the public exists and may make a referral to the Inquiry Committee for its assessment.

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