1.
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Nurse practitioners prescribe drugs within nurse practitioners’ scope of practice, relevant legislation and their individual competence.
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2.
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Nurse practitioners are accountable for their prescribing decisions.
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3.
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Before prescribing, nurse practitioners ensure their competence to:
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a.
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establish or confirm a diagnosis for the client
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b.
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manage the treatment and care of the client
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c.
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monitor and manage the client’s response to the drug
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4.
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Nurse practitioners use current evidence to support decision-making when prescribing.
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5.
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Nurse practitioners apply relevant
guidelines14 when prescribing.
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6.
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When prescribing, nurse practitioners:
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a.
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consider the client’s health history and other relevant factors (e.g. age, sex, gender, past medical and mental health history, lifestyle, risk factors, and the client’s perspective on their health)
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b.
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undertake and document an appropriate clinical evaluation (e.g. physical examination, mental health examination, review of relevant tests, imaging and specialist reports)
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c.
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obtain and review the best possible medication history for the client using PharmaNet and/or other sources including any traditional medicines, natural health products, non-prescription medications, and substance use, in addition to prescribed medications), and take action to address any discrepancies
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d.
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ask about the client’s drug allergies and ensure drug allergy information is accurately and appropriately documented
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e.
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document the drugs prescribed to the client and the indication(s) for the drugs
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f.
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establish a plan for reassessment/follow-up
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g.
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monitor and document the client’s response to the drugs prescribed (as appropriate)
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7.
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Nurse practitioners undertake medication reconciliation to ensure accurate and comprehensive medication information is communicated consistently across health care transitions.
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8.
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When prescribing, nurse practitioners provide information to clients about:
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a.
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the expected action of the drug
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b.
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the duration of the drug therapy
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c.
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specific precautions or instructions for the drug
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d.
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potential side-effects and adverse effects (e.g. allergic reactions) and action to take if they occur
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e.
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potential interactions between the drug and certain foods, other drugs, or substances
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f.
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recommended follow-up
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9.
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Nurse practitioners complete prescriptions accurately and completely, including:
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a.
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the date the prescription was written
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b.
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client name, address (if available) and date of birth
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c.
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client weight (if required)
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d.
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the name of the drug or ingredients, strength if applicable, and dose
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e.
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the quantity prescribed and quantity to be dispensed
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f.
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dosage instructions (e.g. the frequency or interval, maximum daily dose, route of administration, duration of drug therapy)
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g.
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refill authorization if applicable, including number of refills and interval between refills
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h
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prescriber’s name, address, telephone number, written (not stamped) signature, and prescriber number
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i.
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date of transmission, the name and fax number of the pharmacy intended to receive the transmission, and the practitioner’s fax number if the prescription is being
faxed15
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j.
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directions to the pharmacist not to renew or alter if a pharmacist-initiated adaption would be clinically inappropriate
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10.
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When notified of a pharmacist-initiated prescription adaption, nurse practitioners document the adaption in the client record.
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11.
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Nurse practitioners report adverse drug reactions to the
Canada Vigilance Program.
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12.
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Nurse practitioners prescribe
controlled drugs and substances in accordance with the
Controlled Prescription Program.
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13.
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When prescribing controlled drugs and substances, nurse practitioners meet the Prescribing Drugs standards and also:
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a.
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assess the client in person, or by telehealth with visual assessment if clinically appropriate, except in cases where the client is:
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i.
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known to the nurse practitioner, and/or
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ii.
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being assessed in person by another health care provider
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b.
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document their review of the client’s PharmaNet medication profile
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c.
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document the indication and duration for which the drug is being prescribed, the goals of treatment, and the rationale for the drug’s use over alternatives (if applicable)
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d.
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prescribe the lowest possible dose and the minimum quantity to be dispensed
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e.
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know the risks of co-prescribing opioid and sedative-hypnotic drugs (e.g. benzodiazepines) and limit co-prescribing whenever possible; document the rationale and the follow-up plan if co-prescribing is necessary
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f.
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advise clients about the side effects and risks of controlled drugs and substances as applicable (e.g. physical tolerance, psychological dependence, addiction, diversion)
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g.
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implement evidence-informed strategies for minimizing risk (e.g. treatment agreements, pill counts, urine drug screens, client education about safe storage and disposal)
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| h.
| follow the requirements of the British Columbia Controlled Prescription Program16 including requirements related to securing and disposing of prescription pads; reporting any loss, theft or misuse of the prescription pads; and record retention
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14.
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When authorizing medical cannabis, nurse practitioners meet the Prescribing Drugs standards and also:
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a.
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review the client’s medication profile and history through PharmaNet and other sources
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b.
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document their review of the client’s PharmaNet medication profile
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c.
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document the indication and duration for which medical cannabis is being authorized, the goals of treatment, and the rationale for its use over alternatives
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d.
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advise clients about the side effects and risks of medical cannabis
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e.
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complete medical documents or written orders for cannabis in accordance with the requirements set out in the
Cannabis Regulations17
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f.
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retain any copy of the medical document for cannabis in the client health record
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16.
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Before changing to non-practising or inactive registration with BCCNM (and therefore relinquishing prescribing authority), nurse practitioners take steps to ensure prescription refills and part-fills are managed for clients.
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