Nurse practitioners can now prescribe narcotics
Nurse practitioners (NPs) in primary and acute care across VCH can prescribe controlled drugs and substances (CDS) for patients and clients as a result of a recent change to their scope of practice. CDS includes narcotics such as morphine and Tylenol #3 as well as benzodiazepines such as Ativan.
All NPs wishing to prescribe CDS must meet the requirements –complete a CDS course and module, and have access to PharmaNet – before applying to CRNBC for their duplicate prescription pad.
Prior to the scope change, NPs would provide patients and clients with care from assessment through prescribing treatment and medication to evaluation but would have to go with their clients to see physicians or refer them to a physician for CDS prescriptions. NPs ability to prescribe means care will be less fragmented so there’ll be less room for mistakes and greater patient safety. Other benefits include increasing patient’s access to care and alleviating pressure on physicians.
Leanne Mathias, nurse practitioner in Palliative Care on the North Shore, says she works with a supportive team of physician mentors and they had been waiting eagerly for VCH’s new Scope of Practice & Regulations Review Committee to approve the change so it could come into effect at VCH.
Behind the Scenes: Making Changes to Scope of Practice
1. NP’s governing body (College of Registered Nurses of British Columbia) set the standard and scope.
2. VCH’s Scope of Practice & Regulations Review Committee (SPRRC) then approved at an employer level that NPs can enact the scope change.
SPRRC serves as the mechanism for the employer level of control on practice in VCH and has been set up to centralize and streamline the process or those seeking changes – whether a governing body or a project team at VCH. The committee is the first of its kind in BC, and has been operating since last spring. The scope of the committee’s work includes all clinical practice settings for nurses and allied health (regulated or unregulated) and they consider requests for advancing and optimizing and/or expanding scope; and formal delegations.
Leane completed the required training almost immediately after CRNBC announced the change and got the rest of her requirements in order after VCH’s SPRRC approved the change. Since then she says she has used her prescription pad “quite a bit.”
“CDS prescribing is a key component of symptom management in end of life care,” says Leane “With this increased scope, I hope we will begin to see more nurse practitioners working in palliative care settings across the province.”
The change allows NPs to provide patients with more holistic care and saves valuable time for everyone.
Leane says her ability to prescribe CDS has simplified the process for everyone. “It allows me to provide patients with more holistic care and saves valuable time for everyone,” she says “My patients are often not able to travel to the hospital or GP office to have their CDS needs met.”
Eliza Henshaw, Family nurse practitioner at Raven Song Community Health Centre, is equally pleased with the change.
“In my work with complex, marginalized clients who are struggling with both medical and social challenges, this change is very useful,” says Eliza. “NP’s can now directly prescribe CDS to our patients with acute or chronic pain issues, when appropriate – in addition to providing alternative methods of pain control.”
Eliza continues: “More importantly, we are now able to also do continuation prescribing of Suboxone which allows us to provide low barrier care to our patients who are seeking treatment for addictions.”
Dr. Michael Norbury, Medical Director of Primary Care for Vancouver Community, concurs on the many benefits to the change saying “The change in scope is good news for everyone. It gives us flexibility, and there is more than enough work to go around.”
CRNBC is implementing a rigorous oversight program for the NP CDS prescribing and processes for prescription review are being developed. They are working closely with the College of Physicians and Surgeons of BC (CPSBC) and the Ministry of Health to establish policy and operational processes that build on the experience and evaluation of the CPSBC to date.
NPs in VCH now can do continuation prescribing of Suboxone
In response to the current overdose crisis, the College earlier this month expanded NP’s scope of practice in two phases: Effective immediately, NPs can prescribe continuation of Suboxone to treat addiction. Later this spring, there is hope that there will be further changes to the prescribing of Suboxone and methadone for addiction.
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