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Joint Statement on Long-Term Care – Authorized Prescriptions

There have been several questions and requests for clarification in follow up to the Long-Term Care – Authorized Prescriptions joint statement that was sent out by CPSS, CRNS, CLPNS and SCPP. Legislation requirements were included in the original joint statement. This second joint statement has been issued to provide further clarity regarding the use of verbal/telephone orders to dispense a prescription in a Long-Term Care (LTC) setting.

Pharmacists

  • Must receive orders to dispense a prescription directly from a physician, NP, RN (AAP), dentist and other authorized prescribers.
  • May accept a verbal/phone or faxed original prescription written and signed by an authorized prescriber.
  • May receive a faxed transcribed order from a nurse as a means of communication so the pharmacist can expect an order from the authorized prescriber and alerts the pharmacist to follow up with the prescriber if the prescription is not received.

Physicians

  • May provide nurses with a telephone/verbal order to facilitate timely patient care.
  • Must provide pharmacists with an order directly to authorize the pharmacist to dispense a prescription.

Nurses

  • May take telephone/verbal orders from an authorized prescriber and may fax the transcribed order to the pharmacist for communication purposes.
  • Cannot act as a third party in the direct communication required between the authorized prescriber and the pharmacist when there is an order to dispense a prescription.

CRNS Nursing Advisors are available to answer your questions. They can be contacted by phone at 1.800.667.9945 or 306.359.4227 or by email at practiceadvice@crns.ca.

Medical Assistance in Dying Guideline (2024)                 

The CRNS is pleased to announce the release of the updated Medical Assistance in Dying Guideline (2024). The Medical Assistance in Dying Guideline was approved by CRNS Council on February 23, 2024.

The guideline was updated to reflect best practices and standards as outlined in the nationally developed Model Practice Standard for Medical Assistance in Dying (MAID) and the Saskatchewan Health Authority (SHA) MAID program; Nurse Practitioner (NP) Entry-Level Competencies (ELC) were updated to the 2023 version; and the date in which people whose sole underlying medical condition is mental illness and wish to seek MAID was updated to reflect federal legislation and is March 17, 2027.

Reviewing this document will assist you in knowing the expectations of RN and NP practice in providing care to people seeking MAID. CRNS Practice Advisors are available to answer your questions. They can be contacted by phone at 1.800.667.9945 or 306.259.4227 or by email at practiceadvice@crns.ca.

Joint Statement: Long Term Care – Authorized Prescriptions                 

The SCPP, the CRNS, the CLPNS, and the CPSS have issued a joint statement regarding verbal orders generated from Long Term Care (LTC) Facilities. A pharmacist may only accept a verbal or faxed original order written and signed by an authorized prescriber e.g. physician, NP, dentist. A pharmacist may not accept a verbal or faxed written order (transcribed) from an RN. The full statement can be accessed here.

CRNS Nursing Advisors are available to answer your questions. They can be contacted by phone at 1.800.667.9945 or 306.359.4227 or by email at practiceadvice@crns.ca. 

Cervical Cancer Screening Updates

Cervical cancer screening in Saskatchewan recently changed when the revised cervical cancer screening clinical practice guidelines were updated in November 2023. Key changes to the new guidelines include:

  • Screening will start at age 25 or three years after becoming sexually active, whichever is later;
  • Routine screening will now be every three years until the age of 69; and,
  • The addition of Human Papillomavirus (HPV) reflex testing. 

These new evidence-based changes ensure people continue to benefit from screening while avoiding unnecessary tests and follow-up treatment. 

Click here to find information about the guidelines, including the new guidelines document. (link to: http://saskcancer.ca/health-professionals-article/cancer-screening-guidelines-and-resources/cervical-cancer-screening)

The SCA has collaborated with the Department of Obstetrics and Gynecology and the Division of Continuing Medical Education to create a free accredited course on the guidelines. The course will be available until July 2024. It can be found here. (link to: https://cmelearning.usask.ca/learn-here/cme-online-courses/cervical_cancer_guidelines_online-course.php)

If any questions arise about the guidelines, please feel free to reach out to the Screening Program for Cervical Cancer at ED.Coordinator@saskcancer.ca.

IV Hydration Therapy

The evolution of independent for-profit (stand-alone) clinics providing intravenous (IV) hydration therapy has prompted many calls to the CRNS. After completing environmental scanning and a review of best practices, the CRNS has determined that it is within the scope of practice of Registered Nurses (RN) to administer IV hydration therapy and medications, vitamins, and/or electrolytes (additives) while working in stand-alone clinics so long as the nursing process is implemented and appropriate policies and supports are in place to support safe, competent, and ethical care of this client population.  

RNs and Nurse Practitioners (NP) are accountable to practice within their legislated scope of practice and personal competence and to adhere to their Practice Standards and Code of Ethics as they would in any other practice setting.  Registrants must complete the Recognition of Practice process to use the title RN and/or NP and to count the practice hours they have worked in an IV hydration clinic towards licensure.

With the growing popularity of IV hydration therapy and individuals “self-selecting” treatments – for example, to relieve the effects of a hangover, there is an increasing trend of complaints related to unsafe practices and untoward events reported in Canada and the United States.  It is essential for RNs and NPs engaged in this practice to understand that IV hydration is a medical treatment and, therefore, there must be a medical condition for the client to obtain the treatment. As with all treatments and interventions, the risks of accepting treatments should be disclosed to the client and informed consent obtained.   

To provide safe, competent nursing care and to meet the requirements for Recognition of Practice, the following must be in place when performing IV hydration therapy treatments:

  1. Appropriate policies, procedures, and resources.
  2. A health history and physical examination must be performed and documented by the prescribing NP or physician to ascertain if underlying co-morbidities, such as congestive heart failure or kidney disease, might be a contraindication to the client receiving treatment.
  3. Provision for diagnostic testing, as indicated for co-morbidities, should be completed as part of the client assessment. Diagnostic testing should be considered to establish a baseline for ongoing treatment.
  4. The infusion must be prescribed to treat a diagnosed medical condition; clients must not “self-select” treatments. 
  5. There must be an order from an NP or physician for the RN to initiate the IV and/or administer the IV solution and additives.
  6. There must be appropriate documentation, including the client assessment, client consent, treatment ordered and administered, and client response to that treatment.
  7. The supplies, including IV lines, solution, and additives, must be procured from a reputable source and stored and handled in alignment with current infection prevention and control (IPAC) best practices and principles. 
  8. There must be an ability to manage untoward events, including having the necessary emergency equipment on site.

For more information or to inquire about recognition of practice, please contact a nursing practice advisor practiceadvice@crns.ca.

Alternative and Complementary Therapies

The number of RNs and NPs engaging in alternative or complementary therapies, such as aesthetics, through non-traditional employers or self-employed practice, has increased in recent times.  These practices require assessment by the College of Registered Nurses of Saskatchewan (CRNS) to determine if the activity is recognized as registered nursing practice. Being engaged in self-employed practice brings certain opportunities as well as inherent risks, therefore it is important for RNs and NPs interested in and/or practicing in these areas to:

  • Consult with a Nursing Practice Advisor to discuss your practice situation and receive guidance on next steps;
  • Consult with a Regulatory Services Nursing Advisor to discuss the Recognition of Practice process;
  • Refrain from using the RN or NP title until the activity has been recognized as nursing practice by the CRNS;
  • Ensure that the necessary resources, including but not limited to, supplies to manage untoward events, policy/procedure manual, are in place for safe patient care;
  • Ensure that you have the appropriate authority to conduct the activities; and,
  • Refrain from including hours worked in these areas in self-reported RN or NP practice hours until the activity has been recognized as nursing practice by the CRNS.

As the landscape of alternative and complementary therapies grows and changes, the CRNS applies principles of right touch regulation when working with members to reasonably assure accountable professional practice. The CRNS lives this by applying consistent and transparent processes, providing decisions that are proportionate to the risk posed and by showing agility to adapt to change while keeping the focus on public safety.

CRNS Nursing Advisors are available by emailing:

Regulatory Services at regulation@crns.ca or

Practice at practiceadvice@crns.ca.

Joint Statement on the Section 56 Exemption for CDSA Drugs

The current Health Canada section 56 exemption for all drugs under the Controlled Drugs and Substances Act (CDSA) that was set to expire on September 30, 2021, has been extended to September 30, 2026. The purpose of the exemption was to reduce regulatory barriers to support the continuity of care for patients, and as the pandemic continues and Health Canada works toward modernizing federal regulations, the extension to September 30, 2026, meets these continued needs. The Saskatchewan Prescription Review Program partners – Ministry of Health, Saskatchewan College of Pharmacy Professionals, College of Registered Nurses of Saskatchewan, College of Physicians and Surgeons, and the College of Dental Surgeons of Saskatchewan – have considered the long-term implications of the exemption, with a focus on patient safety and access.

This exemption provides prescribers, including Nurse Practitioners, the authority to issue a verbal prescription for controlled substances drugs to extend or refill a prescription. The Saskatchewan Prescription Review Program partners have agreed to accept the new exemption with the following two provisions for Saskatchewan:

  • CDSA drugs may only be transferred once within Saskatchewan. While there remains risk of diversion of medications, the Patient ID Policy alleviates some risk and permitting one transfer may benefit the patient.
  • Verbal prescription orders should only be accepted after every effort has been made to receive a written or e-prescription from a provider. The rationale for accepting a verbal order must be documented by the pharmacist.

As previous, Health Canada can terminate this exemption depending on the current conditions if the Minister deems that such suspension is necessary to protect public health, safety or security. If necessary, the Minister may change the terms and conditions of this exemption. Should this be the case, you will be informed. Read the Full Statement

Ethical Considerations for Industry Sponsorship

Industry sponsorship consists of any interest: personal; business; commercial; political; academic; or financial offered by a private, for-profit, or commercial enterprise as part of its marketing and public relations efforts. When encountering industry sponsorship, Registered Nurses (RN) and Nurse Practitioners (NP) must be aware of conflicts of interest. A conflict of interest can be an actual, perceived or potential conflict between the professional duty of an RN or NP and their private interests. A conflict of interest can occur when the RN or NP is in a position to make a decision based upon what is beneficial to their individual interests (i.e., deriving personal benefit [Traversy et al., 2021]) and not in the best interest of the client.

RNs and NPs can engage in ethical considerations for industry sponsorship to ensure safe, competent and ethical care for clients in Saskatchewan by:

  • Reflecting on and practicing according to current CRNS practice documents, including:
    • The Registered Nurses Act, 1988; CRNS bylaws; CNA Code of Ethics for Registered Nurses; Registered Nurse Practice Standards; Registered Nurse Entry-Level Competencies; Registered Nurse (Nurse Practitioner) Practice Standards; Registered Nurse (Nurse Practitioner) Entry-Level Competencies; and other CRNS documents as appropriate.
  • Understanding the employer’s conflict of interest policy. If a conflict of interest policy does not exist, advocate for policy that addresses conflict of interest.
  • Identifying and seeking to avoid conflict of interest to ensure the maintenance of public trust.
    • Any conflict of interest must be resolved in favour of the interest of the client receiving care.
  • Being fully transparent and fully disclosing any actual, perceived or potential conflict of interest when engaging in industry sponsorship.

This nursing practice update replaces the former CRNS Ethics Guidelines for Industry Sponsorship, 2015.

Questions or comments are welcome and can be directed to practiceadvice@crns.ca or by phone: 306.359.4200 or 1.800.667.9945 (toll-free within Canada).

Resources:
• RN Practice Standards
• RN Entry-Level Competencies
• CNA Code of Ethics (2017)
• Registered Nurse (Nurse Practitioner) Entry-level Competencies (ELC)s CRNS
• Registered Nurse (Nurse Practitioner) Practice Standards CRNS
• Self-Employed Practice Guideline

Reference:
Traversy, G., Barnieh, L., Akl, E. A., Allan, G. M., Brouwers, M., Ganache, I., … & Tonelli, M. (2021). Managing conflicts of interest in the development of health guidelines. CMAJ, 193(2), E49-E54.

Triaging in Emergency Departments

Registered nurses (RN) are responsible and accountable to provide evidence-based, safe, competent and ethical nursing care in all practice settings. In the emergency department, “the process of triage is essential for safe and appropriate care of the emergency department patient” (National Emergency Nurses Association [NENA], 2019).

In 2019, NENA revised their position statement, Role of the Triage Nurse and includes the following key points:

  • Triage is a sorting process that requires rapid assessment, critical thinking and application of a standard set of guidelines with patients that can experience instability and changes to their condition.
  • The process of triage is best carried out by RNs and Nurse Practitioners (NP) with emergency nursing expertise who have completed a triage-specific educational program.

RNs and NPs work in the emergency department as part of a multidisciplinary team, where safe and appropriate care is best achieved through collaboration and respect.

This nursing practice update replaces the former Triaging in Emergency Departments CRNS and SALPN Joint Statement, 2013.

If you have questions, please contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4200 or by email practiceadvice@crns.ca

Reference:

National Emergency Nurses Association. 2019. Role of the Triage Nurse. Retrieved from https://nena.ca/w/wp-content/uploads/2014/11/Role-of-the-Triage-Nurse-2.pdf

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