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Medication Management Guideline

The CRNS is pleased to announce the release of an updated nursing practice guideline, Medication Management Guideline. The guideline has been updated to reflect current, evidence-informed best practices 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 an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@crns.ca.

Joint Message about Ivermectin in the Prevention and Treatment of COVID-19

Ivermectin for prophylaxis or treatment of COVID-19 has been promoted on social media and is not supported by scientific evidence. In humans, ivermectin is only approved for treatment of parasitic infections and rosacea.

Based on the current scientific evidence and best-practice guidelines, the College of Physicians and Surgeons (CPSS), the College of Registered Nurses of Saskatchewan, the Saskatchewan College of Pharmacy Professionals, the Saskatchewan Medical Association, and the Pharmacy Association of Saskatchewan disapprove of the use of ivermectin for either treatment or prophylaxis for COVID. This opinion is further supported by the evidence from Health Canada, the World Health Organization (WHO), Alberta Health Services Covid-19 Scientific Advisory group, and the British Columbia COVID-19 Therapeutics Committee guidance document.

The joint statement is available here.

If you have any questions, please contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@crns.ca.

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

Physician to RN Delegation

The College of Physicians and Surgeons of Saskatchewan (CPSS), through The Medical Professions Act, 1981 and their bylaws provide the opportunity for physicians to delegate certain activities to Registered Nurses (RN). The current CPSS Bylaw 23.3 permits delegation from a physician to an RN.

RNs who are considering accepting a delegation from a physician must understand the conditions for this to occur. RNs accepting a delegation from a physician should ensure that they:

  • are certain that the practice is in the best interest of the client in their surrounding environment, including assessment of the risks and all possible outcomes;
  • are willing to only accept a delegation from a physician if the activity is specified in the current CPSS Bylaw 23.3 and for which they are competent;
  • confirm appropriate education, supervision, support and communication avenues are in place with the delegating physician before performing a delegated medical activity;
  • possess the competencies required to manage any outcomes of that activity, including intended and unintended consequences;
  • do not delegate any activity delegated by a physician, to another RN or any other health care provider;
  • are practicing within the legislated scope of registered nursing practice and are upholding the current standards, competencies and code of ethics;
  • have a written agreement with the physician who is delegating to the RN;
  • verify that employer policies and processes are in place to enable acceptance of a delegation from a physician; and,
  • adhere to the employer policy and procedure for a delegated medical activity. That said, no employer policy can relieve RNs of their professional accountability and responsibility. The RN must ensure that:
    • roles, responsibilities and authority, specific for the physician and RN, are clearly outlined in the policies and procedures, including clear lines of reporting and communication;
    • a collaborative process with representation from appropriate professionals, guides the development of these policies and procedures, to ensure professional roles are accurate, professional accountabilities and standards can be met, and that the documents are based upon evidence-informed best practice; and that
    • there is ongoing monitoring and evaluation of the physician to RN delegation process.

The information contained within this nursing practice update replaces the former CRNS document, Guidelines for Physician to RN Delegation.

If you have questions, please contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@crns.ca.

External Consultation MAiD Guideline

Following feedback from Canadians, experts, practitioners, stakeholders, Indigenous groups, provinces and territories, changes were made to Medical Assistance in Dying legislation which took effect on March 17, 2021.

In response, the CRNS has revised and updated the Guidelines for RN Involvement in Medical Assistance in Dying and the Guidelines for NP Involvement in Medical Assistance in Dying.

The new document Medical Assistance in Dying identifies the changes to the legislation as well as combines the two previous documents into one document. The CRNS is seeking feedback from members, stakeholders and the public related to the new document. Please access the document here. Please access the survey questions here. The CRNS would appreciate any feedback by July 13, 2021, at 4:30 pm.

Final approval of the document is through the CRNS Executive Director and CRNS Council. The document will take effect on the day of CRNS Council approval.

Questions or comments are welcome and can be directed to creece@crns.ca.

Drug Recall and Pharmacist Approved Substitutes

As per the safety alert from Health Canada, there is a significant recall of Angiotensin II Receptor Blockers (ARBs) including irbesartan, losartan and valsartan due to an azido impurity. To ensure the continuity of care for patients using ARBs, the Registrar for the Saskatchewan College of Pharmacy Professionals (SCPP) has passed emergency exemptions that allow pharmacists to prescribe therapeutic substitutions, in collaboration with the College of Physicians and Surgeons of Saskatchewan, the College of Registered Nurses of Saskatchewan and the Ministry of Health. See the joint recall notification. 

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.

CRNS Social Media Resource

The CRNS is pleased to announce the release of a new Social Media resource. This resource has been created using current information and feedback from CRNS members and the public. The resource provides guidance and recommendations to CRNS members who utilize social media both inside and outside the workplace. The resource offers strategies to balance advocacy and engagement while also adhering to the practice standards and the code of ethics.

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

Medication Management Guideline

The CRNS is currently reviewing the Medication Management Guideline and is seeking feedback on the content. Medication management is one of the most important responsibilities Registered Nurses (RN) have. This document is applicable to all designations and outlines the responsibilities of both the RN and the employer, as well as the importance of providing safe and competent client care.

The CRNS is seeking feedback on this document from members and 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 the document here and the survey here. Feedback will be accepted until Tuesday, May 18, 2021 at 4:30 pm.

Final approval of the document is through the CRNS Executive Director and CRNS Council. The document will take effect on the day of CRNS Council approval.

Questions or comments are welcome and can be directed to creece@crns.ca.

Canada’s New Medical Assistance in Dying (MAiD) Law

On March 17, 2021 new MAID legislation came into effect. Some of the key changes include:

Eligibility Criteria:

  • Persons requesting MAiD have a grievous and irremediable medical condition remains in the legislation.
  • “Reasonable foreseeability of natural death” criterion has been repealed.
  • Eligibility for persons suffering solely from mental illness is temporarily excluded until March 17, 2023.

Safeguards & Consent:

  • Safeguards have been separated into two tracks based on whether the person’s natural death is reasonably foreseeable.
  • Safeguards have been eased for eligible persons whose death is reasonably foreseeable. This includes the possible waiver of final consent for eligible persons under certain circumstances.
  • Safeguards have been added and/or strengthened for eligible persons whose death is not reasonably foreseeable. Final consent for this group must be provided by the person immediately before administration of MAiD.

Data Collection and Monitoring:

  • All assessments (not only referrals) for MAiD are required to be reported to better capture who is requesting MAiD across the country.

The Government of Canada website includes the updated information and other resources related to the changes to the MAiD law. CRNS MAiD resources are being updated to reflect the changes and will be shared once complete.

If you have questions, please contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@crns.ca.

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