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.

NP Practice and the Radiology Information System (RIS)

Nurse Practitioners (NPs) provide excellent care in primary health care settings and a variety of specialized clinical contexts throughout Saskatchewan. CRNS has become aware of a clinical practice issue that is having negative impacts on patient outcomes and leading to potential patient privacy breaches due to misrouted medical imaging reports. Several of the identified causes are listed here:

  • Many NPs have more than one clinical site where they work. 
  • NPs may concurrently work within and outside of the SHA and order or request medical imaging studies for clients.
  • The CRNS database that verifies registration status of NPs does not contain clinic phone numbers, fax numbers or addresses. Therefore, it is not a resource that enables technologists to appropriately forward medical imaging reports.
  • The Radiology Information System (RIS) can only support one fax number per provider. Providers working at multiple sites must make arrangements with clinic staff at that site (the one with the distribution fax), to create a workflow so that the NP’s can receive their patient’s reports and booking notifications at any/all sites that they are providing patient care.
  • There are many different requisitions/ forms that are utilized when NPs order or request medical imaging studies in the various settings where they work.
  • Paper requisitions are not handled consistently by all SHA facilities. The SHA Medical Imaging Department cannot guarantee that the information on the requisition is translated through from request to finalization. The SHA Medical Imaging Department requires one fax for ALL reports and booking confirmations.

These factors can create barriers that lead to delays in care or privacy issues. CRNS is raising awareness of this issue and is recommending the following:

  • NPs ensure that clinic specific information is included on the medical imaging requisitions to enable more timely and accurate delivery of results to the appropriate location. 
  • NPs currently working only in one location may wish to ensure that their contact information is up to date.
  • NPs should update the RIS team each time they change their work location to ensure the best possible outcomes. 
  • NPs working in multiple sites should make arrangements with clinical staff to create a workflow to ensure that they are receiving all of their patient’s results in a timely manner.

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.

The Pediatric Antimicrobial Stewardship Program

On behalf of the Antimicrobial Stewardship Program:

The Saskatchewan Health Authority Antimicrobial Stewardship Program, in collaboration with Dr. Rupesh Chawla (pediatric infectious diseases & antimicrobial stewardship physician, Jim Pattison Children’s Hospital), is pleased to present a pediatric respiratory tract infection (RTI) education bundle for primary care providers. This bundle contains several resources to support clinicians with appropriate antibiotic prescribing for pediatric RTIs and tools to help patients better understand appropriate antibiotic use.

We have created a three-part video series which reviews the appropriate management of common pediatric RTIs (pharyngitis, otitis media, sinusitis, and pneumonia). The videos can be viewed on the Stewardship and Clinical Appropriateness YouTube channel.

An additional live webinar will be during the upcoming World Antimicrobial Resistance Awareness Week (Nov 18-24). The webinar will be presented by Dr. Chawla and Kristin Schmidt, one of the antimicrobial stewardship and infectious diseases pharmacists, on Tuesday, November 21, from 12:00 – 1:00 pm. You can register by sending an RSVP to antimicrobial.stewardship@saskhealthauthority.ca and have your chance to ask the experts your questions.

Supplementary to the video series and live webinar, the education bundle also includes a handout outlining amoxicillin and amoxicillin/clavulanate dosing for common pediatric RTIs. The handout can be found on the Antimicrobial Stewardship Program website.

If you haven’t already done so, the SHA provides access to a free app that you can download on your device (Apple or Android). The app is called Firstline, and it contains valuable information for prescribers, including treatment guidelines for common infections and local antibiogram information for sites across Saskatchewan. For pediatrics, there is the Jim Pattison Children’s Hospital (Mom & Kids Health Saskatchewan).

Finally, to help promote awareness about appropriate antibiotic use among patients, a new poster has been developed that may be displayed in waiting rooms or exam rooms. This is a great tool to prompt conversations with patients about appropriate antibiotic use for them or their children. 

Thank you to all primary healthcare providers who do their part every day to promote antimicrobial stewardship in our province. We hope that you will find this education bundle helpful in continuing to work towards our goals of reducing the growing rates of antimicrobial resistance in Saskatchewan and worldwide.

The National Overdose Response System (NORS)

Dr. Monty Ghosh and Nicole Bootsman prepared the following article on the National Overdose Response System (NORS). NORS is a Canada-wide, toll-free, virtual overdose monitoring service, operated by people with lived, living or shared experience around drug use. The hotline offers 24/7 * 365 individualized and trauma-informed confidential support with operators trained in Mental Health First Aid and psychosis de-escalation.

Review the full article here

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

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