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Medications

Section 6: Restricted activities that do not require an order

Medications

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;

Note: CRNBC is developing standards, limits and conditions related to prescribing.

The Regulation states that registered nurses may prescribe, compound, dispense or administer a limited number of Schedule I medications for specific purposes without an order. Schedule I drugs are those that normally require a prescription or an order. The Regulation allows registered nurses to use Schedule I medications to treat the following emergencies:

  • Anaphylaxis
  • Cardiac dysrhythmia
  • Opiate overdose
  • Respiratory distress in known asthmatics
  • Post-partum hemorrhage
  • Hypoglycemia

CRNBC Limits and Conditions

Registered nurses may compound or administer

  • Salbutamol or ipratropium bromide to treat respiratory distress in known asthmatics
  • Oral corticosteroids to treat respiratory distress in known asthmatics in emergency care settings
  • Oxytocin to treat post-partum hemorrhage
  • D50W to treat hypoglycemia
  • Epinephrine to treat anaphylaxis
  • Epinephrine, atropine, amiodarone or lidocaine to treat cardiac dysrhythmia

Registered nurses who administer salbutamol, ipratropium bromide, or oral corticosteroids must successfully complete additional education and follow an established decision support tool.

Registered nurses who administer oxytocin must possess the competencies established by Perinatal Services BC (PSBC) and follow decision support tools established by PSBC.

Registered nurses who administer D50W must follow an established decision support tool.

Registered nurses who administer epinephrine to treat anaphylaxis must follow an established decision support tool.

Registered nurses who administer epinephrine, atropine, amiodarone or lidocaine to treat cardiac dysrhythmia must possess the competencies established by Providence Health Care and follow decision support tools established by Providence Health Care.


CRNBC Limits and Conditions

Registered nurses who compound, dispense or administer antivirals to treat symptoms of influenza-like illness must successfully complete additional education and follow the decision support tool established by the Provincial Government – RN and RPN Decision Support Tool (Clinical Practice 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.

Under the Regulation, registered nurses are permitted within autonomous scope of practice to prescribe, compound, dispense or administer medications listed in Schedule II of the provincial drug schedules. Further direction related to medications, including dispensing, is included in two CRNBC Practice Standards – Medication Administration and Dispensing Medications.

Schedule II medications include drugs such as:

  • Glucagon
  • Activated charcoal
  • Sublingual nitroglycerine
  • Gentian violet
  • Some pediculicides
  • Some debri
  • ts
  • Some analgesics and decongestants
  • Some vitamins

Schedule II medications also include the following vaccines:

  • Influenza vaccines
  • Vaccines that are part of a routine immunization program
  • Vaccines that require special enhanced public access due to disease outbreaks
  • Oral, inactivated cholera vaccine when used for prophylaxis against traveler’s diarrhea

The Regulation permits registered nurses within autonomous scope of practice to prescribe, compound, dispense or administer immunoprophylactic and post-exposure chemoprophylactic agents to prevent disease. These agents may be in either Schedule I or Sch

edule II.

CRNBC Limits and Conditions

Registered nurses only compound, dispense or administer Schedule II medications within autonomous scope of practice to treat a condition following an assessment and nursing diagnosis. Registered nurses require a client-specific order from a listed health professional before compounding, dispensing or administering Schedule II medications to treat a disease or disorder.

For example, registered nurses would not administer insulin without knowing that a physician or nurse practitioner had diagnosed diabetes and ordered insulin therapy. Similarly, registered nurses would not inject sclerosing agents to treat varicose veins without knowing that a physician had diagnosed the underlying medical problem and ordered the treatment.

CRNBC Limits and Conditions

Registered nurses who carry out insulin dose adjustment must possess the competencies and follow the decision support tools set out by Fraser Health Authority.

Registered nurses require a client-specific order before compounding or injecting dermal fillers.

The BC Centre for Disease Control (BCCDC) sets direction for clinical practice related to routine immunizations, such as childhood immunizations, and for chemoprophylaxis in contacts of clients with communicable disease.

CRNBC Limits and Conditions

Registered nurses compound, dispense or administer immunoprophylactic or chemoprophylactic agents only under the following circumstances:

  • Registered nurses who compound, dispense or administer immunoprophylactic or chemoprophylactic agents identified by the BC Centre for Disease Control (BCCDC) must possess the competencies established by BCCDC and follow decision support tools established by BCCDC.
  • Registered nurses who compound, dispense or administer immunoprophylactic agents for the purpose of preventing disease in travelers must successfully complete BCCDC’s basic immunization course and additional education in the area of travel health. These registered nurses must follow the Canadian Immunization Guide in conjunction with the Canada Communicable Disease Reports. They must be employed, on contract to an employer or have a written collaborative agreement with an authorized prescriber.
  • Registered nurses may compound and administer experimental vaccines as part of a formal research program involving a physician. These registered nurses must successfully complete BCCDC’s basic immunization course as well as additional education related to the specific experimental vaccine. They must follow established decision support tools.
  • Registered nurses who compound, dispense or administer immunoprophylactic or chemoprophylactic agents to prevent infection following sexual assault must either:
    • possess the competencies established by the B.C. Women’s Sexual Assault Service (BCW SAS) and follow decision support tools established by BCW SAS (Note: This will apply to sexual assault nurse examiners), or
    • possess the competencies established by the B.C. Centre for Disease Control (BCCDC) and follow decision support tools established by BCCDC (Note: This will apply to registered nurses who hold CRNBC certification in STI management).
  • Registered nurses who compound, dispense or administer immunoprophylactic agents for the purpose of preventing respiratory syncytial virus infection must possess the competencies established by the Provincial Health Services Authority and follow decision support tools established by the Provincial Health Services Authority.

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