Amendment: Pharmacists Prescribing for Acetaminophen to Support Accessing Compounded Supplies During the Pediatric Analgesic Shortage

This is an update to the October 12, 2022, Nursing Practice Update. The provincial Collaborative Practice Agreement to support accessing compounded supplies during the pediatric analgesic shortage has been updated to include ibuprofen.

There is a demand surge for pediatric analgesic and antipyretic dosage forms which is creating an ongoing supply issue for patients. Pharmacists have been supporting patients by assisting with advice on alternate products, different dosage forms, repackaging bulk supplies when able, and compounding. 

To support patient access during the pediatric analgesic shortage, the College of Physicians and Surgeons of Saskatchewan, the College of Registered Nurses of Saskatchewan, and the Saskatchewan College of Pharmacy Professionals have created a short-term solution in the form of a provincial CPA which would then enable pharmacists to prescribe for pediatric acetaminophen and ibuprofen. 

Read the full statement here.

Update to Pharyngitis: Adult and Pediatric Clinical Decision Tool (CDT)

There is an updated dose of Azithromycin as a third-line oral antibiotic agent within the Pharyngitis: Adult and Pediatric CDT. This change takes effect immediately and is posted on the CRNS website along with all of the CDTs for RN(AAP) practice. 

The change in Adult and Pediatric dosing and duration of Azithromycin is consistent with the RxFiles: Drug comparison charts (13th ed.), and is as follows: 

If you have any questions, CRNS Practice Advisors are available by emailing practiceadvice@crns.ca.

Reference

RxFiles Academic Detailing Program. (2021). RxFiles: Drug comparison charts (13th ed.). Saskatoon Health Region.

CRNS Bylaws Update

The 2022 Bylaws package was presented to registrants for their approval at the annual meeting on May 5, 2022. All proposed bylaw amendments were approved which allowed CRNS to follow the established government processes for finalizing the bylaws. Administrative bylaws were filed with the Information Services Corporation (ISC) following the annual meeting and we received written approval from them on May 31, 2022. Regulatory bylaws were submitted to the Ministry of Health for Ministerial approval in June. These bylaws were approved and published in the September 9, 2022, Saskatchewan Gazette which brings them into force and effect. 

What this means for registrants is that the 2022 Bylaws are being updated and are now posted on the CRNS website for review. On November 1, 2022, all registrants will be required to comply with these bylaws. Some of the key regulatory bylaw amendments are listed below:

  • Continuing Competence Program (CCP) requirements for the revised program will be implemented for the upcoming 2023 registration year which begins on December 1, 2022. The new requirements have been outlined in Bylaw V.1 Continuing Competence. 
  • To fulfill the CRNS mandate of protection of the public, all practicing members in every category must report to the Registrar by email or phone, as soon as is reasonably practical, a charge under the Criminal Code (Canada), the Controlled Drugs and Substances Act (Canada) or any similar legislation in any province, territory, state, or country, or any charge concerning the practice of nursing or another profession in any jurisdiction. This amendment can be found in Bylaw VI Membership.
  • Bylaw VI Categories of Practice, Section 3 Nurse Practitioner Category contains a change for NP practice. It enables NPs to order or request medical imaging involving the application or detection of forms of energy for diagnostic and screening purposes and to receive and interpret reports, or to perform ultrasound imaging for the sole purpose of point of care diagnostic assistance when it is in the best interest of the client, in accordance with their practice standards and code of ethics, when they have the competence and judgment to safely do so, when it is in alignment with best practice evidence and when agency policy permits. This is an important amendment that facilitates increased access to timely care for the residents of Saskatchewan. 
  • Another bylaw that impacts NPs directly is Bylaw VI Categories of Practice, Section 4 Prescription Review Program as the language has been updated to reflect current best practices on providing prescriptions directly to a pharmacy. 
  • A new section was added to Bylaw VI Categories of Practice, Section 5 Resignation on Medical or Other Grounds. This bylaw essentially allows a CRNS registrant who identifies that their fitness to practice is significantly impacted by the effects of a physical or mental disability and choose to resign from practice to protect the safety of patients. The bylaw outlines the conditions of this process. 
  • Bylaw XV adopts the recently published RN with Additional Authorized [RN(AAP)] Practice Standards as the standards required of registered nurses practicing with Additional Authorized Practice, so this will be of special interest to RN(AAP)s and managers or interdisciplinary colleagues of RN(AAPs). The 2022 RN(AAP) Practice Standards will be posted online in the upcoming weeks.

Some of the key administrative bylaw amendments are listed below:

  • The Canadian Nurses Association (CNA) officially changed their membership structure at their 2021 annual meeting and this was implemented on January 1, 2022. Jurisdictional Membership will not exist going forward. Instead of organizations representing nurses as members, individual nurses will obtain their own memberships. Therefore, Bylaw I, Section 6 and Bylaw VII Fees, Sections 3 and 4 have all been updated to reflect this. This is important for registrants to be aware of because CRNS will no longer be collecting CNA fees during license renewal. Should registrants wish to be CNA members, they can do so independently by following this link.
  • Bylaw VII Fees also contains wording regarding fees for practicing registrants currently licensed in a jurisdiction whose nursing regulatory body has signed a multijurisdictional agreement with the council to provide virtual care in Saskatchewan. 

Should you have questions regarding the 2022 Bylaws, contact a Nursing Practice Advisor by email at practiceadvice@crns.ca or by phone at 1.800.667.9945.

National NP Regulation Project Update, as of March 2, 2022

The Canadian Council for Registered Nurse Regulators (CCRNR) Nurse Practitioner Regulation Framework Implementation Plan Project (NPR-FIPP) continues to move forward. All project updates can be found on the CCRNR website. 

If you’d like to stay up-to-date on this project, you can subscribe to the CCRNR NPR-FIPP newsletter when you visit CCRNR website. The CRNS will be setting up meetings to inform partners of the project and involve key stakeholders in consultation. 

If you are interested in learning more about this project, email Donna Cooke, Nursing Advisor, at dcooke@crns.ca.

Amendments to the Criminal Code to Protect Health Care Workers and People Seeking Access to Health Services

Nursing Practice Update: Amendments to the Criminal Code to protect health care workers and people seeking access to health services

Changes to the Criminal Code came into effect on January 16, 2022, and serve to enhance protection for health care workers and people seeking access to health services. Violence and threats of violence towards Registered Nurses and other health care workers is a long-standing issue that has worsened during the COVID-19 pandemic and has extended to the public who are seeking health services. A backgrounder from the Government of Canada is available here.

The Canadian Nurses Protective Society (CNPS) has written an article further describing the changes to the Criminal Code and how they may intersect with Registered Nurses as health care professionals.

CRNS members are encouraged to read the linked articles in this update to become familiar with the legislation changes.

Questions? Contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227, or by email at practiceadvice@crns.ca.

External Consultation – Assignment of Tasks to Unregulated Care Providers

The CRNS is updating direction to its members who assign tasks to unregulated care providers. The CRNS is seeking feedback on this resource from members and external stakeholders, including the public, as part of the external consultation process. This process is in place to ensure relevant information is clearly presented. Feedback can be provided by accessing this survey and will be accepted until Monday, January 31, 2022 at 4:30pm.

Final approval of the resource is through the CRNS Executive Director. Questions or comments are welcome and can be directed to tbelcourt@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.

Medical Assistance in Dying Guideline

The CRNS is pleased to announce the release of an updated nursing practice guideline, Medical Assistance in Dying Guideline, 2021. The guideline has been updated to reflect current, evidence-informed best practices, legislative changes and applies to all categories of nursing practice.

Please review this document and consider how it may relate to your practice. If you have any questions, please contact a CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@crns.org.

NPs Prescribing Cosmetics

Nurse Practitioners (NP) in Saskatchewan can prescribe bioactive agents and medical fillers for cosmetic purposes when:

  • the patient condition for which they are prescribing the agents fall within the individual NP common medical disorders;and,
  • the NP has the knowledge, skills and competence to safely assess, treat, prescribe and/or administer the product in accordance with bylaws, standards and competencies and federal legislation.

NPs work within a collaborative team of physicians, Registered Nurses (RN) and other health care providers to implement the nursing process including assessment, care planning, implementation and evaluation. Recognition of practice is required for NPs who practice in the most responsible practitioner role. Contact regulation@crns.ca for further information.

Providing cosmetic services and procedures has evolved over the past several years and includes unique liability risks that NPs should understand prior to engaging in this area of practice. It is strongly recommended that NPs contact the Canadian Nurses Protective Society (CNPS) to discuss liability risks associated with cosmetic nursing.

This nursing practice update replaces the former CRNS October 13, 2020, nursing practice update.

Questions? Contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227, or by email 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

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