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Changes to RN and NP scope in response to opioid crisis

Posted Dec. 7, 2016

Opioid overdose crisis in B.C.

In April 2016, B.C.’s provincial health officer declared a public health emergency in response to the opioid overdose crisis. The CRNBC Board on Dec. 2, 2016 approved changes to both RN and NP scopes of practice to allow nurses and nurse practitioners to better respond to this crisis.

RN scope change: naloxone

The CRNBC Board has approved changes to the Scope of Practice for Registered Nurses: Standards Limits Conditions and to the Dispensing Medications practice standard in response to federal and provincial schedule changes to naloxone. These changes come into effect Jan. 6, 2017.

Changes to standards, limits, conditions for naloxone:

  • The limits and conditions for the compounding, administering, and dispensing of naloxone outside of hospital settings no longer require the use of a decision support tool (DST), additional education, and competencies.
  • The limits and condition for dispensing naloxone in both in hospital and outside of hospital settings have been rescinded. In this instance, nurses follow the Dispensing Medications practice standard as well as other applicable scope of practice and practice standards.

    Please note:

The limits and conditions for compounding and administering naloxone to clients in hospital settings have not changed. Due to the Schedule I status of naloxone in hospital settings, nurses must continue to follow an established DST and must successfully complete additional education when compounding and administering naloxone to clients in hospital settings.

Changes to the Dispensing Medications standard:

Nurses follow the Dispensing Medications practice standard when dispensing medications to their client or the delegate of their client, and can only dispense medications for clients under their care. The dispensing of naloxone is an exception in response to a public health issue. In this instance, the nurse may be dispensing to a person who is not their client or their client’s delegate but who may encounter another person outside of a hospital setting who is experiencing a suspected opioid overdose.

Nurses dispensing naloxone to persons who are not their client must teach that person how to respond appropriately to an opioid overdose and follow applicable organizational policies and processes.

This change will take effect Jan. 6, 2017.

NP scope change: suboxone

Expanding the reach of opioid substitution treatment services in BC is a Ministry of Health priority.

Suboxone prescribing

Prescribing buprenorphine-naloxone occurs in the context of addiction treatment, a complex area of practice that is emerging internationally for nurse practitioners. The process of initiation or ‘induction’ with buprenorphine-naloxone (suboxone) is complex and requires careful assessment of the client using a “Clinical Opiate Withdrawal Scale.” Continuation prescribing, however, is less complex than induction.

The CRNBC Board on Dec. 2 approved the expansion of NP scope to include continuation prescribing of suboxone. This change has been incorporated into the NP scope document and comes into effect Jan. 6, 2017.

A note regarding NP prescribing of opioid substitution therapy

CRNBC is working with the Ministry of Health, the College of Physicians and Surgeons of BC and the College of Pharmacists of BC to develop standards, limits and conditions for additional opioid substitution therapy prescribing, including methadone.

We will be communicating with nurse practitioners as this work progresses. Please email practice@crnbc.ca if you have questions.

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