Nursing Practice Updates

As of November 5, 2019, the updated Clinical Decision Tools (CDTs) for RNs with Additional Authorized Practice [RN(AAP)s] have been adopted by CRNS Council and will be in effect beginning December 1, 2019. As of this date, the older versions of the CDTs will no longer be in effect.

The evidence and best practice guidelines have been reviewed and incorporated into the updated CDTs with in-text sources included. The Interprofessional Advisory Group (IPAG) reviewed, revised and approved all of the CDTs. During this process, it was determined that some Pediatric and Adult CDTs could be merged to streamline the processes. Additionally, charts and tables have been added to support effective and clear messaging about pharmacology options and other information within the CDTs. Language has been updated to reflect non-binary genders, for example people of reproductive age rather than women of childbearing age, and reproductive health rather than women’s health.

While the literature review is complete and all CDTs are updated for evidence-informed best practice for RN(AAP)s to diagnose, treat and prescribe for limited common medical disorders, there are no significant practice changes and no new CDTs.

It is important RN(AAP)s review all CDTs to ensure they are informed about the latest evidence for their practice.

CRNS Practice Advisors may be contacted for answers to your practice questions by email at practiceadvice@crns.ca or by phone 306.359.4200 or 1.800.667.9945 (toll free within Canada).

We have received a number of calls lately about telehealth and the ability to provide this service. Telehealth connects patients and health care providers who provide health services over the phone, computer or any other form of information and communication technologies (ICT).

Providing telehealth to a Saskatchewan resident

To provide telehealth to a Saskatchewan resident, you must be registered and hold a practicing license with the CRNS. The Registered Nurses Act, 1988 in Saskatchewan outlines the need to be registered to engage in the practice of registered nursing and to use protected titles. Information about registration can be found here.

Questions about registration can be directed to Regulatory Services by email at register@crns.ca or by calling 306.359.4200 or 1.800.667.9945 (toll free within Canada).

Providing telehealth to clients who are residents of another province or territory

Each province/territory and country is governed by differing legislation/regulations/bylaws. We encourage you to contact the nursing regulator in that jurisdiction before providing telehealth services to their residents.

A national discussion is currently underway to examine the delivery of telehealth services across the country. We will provide updates on this issues as further information becomes available.

For a confidential consultation about a practice issue, please contact a Practice Advisor by email at practiceadvice@crns.ca or call 306.359.4200 or 1.800.667.9945 (toll free within Canada).

On March 27, 2019, CRNS Council passed the two policies that allow NPs, who regularly see people with Opioid Use Disorder (OUD) or who require methadone for pain, to apply to the CRNS to receive approval to prescribe medications such as suboxone and methadone. These regulatory processes are in follow up to the Bylaw passed by CRNS membership at the 2018 CRNS Annual Meeting. Based on this Bylaw, the CRNS has worked with provincial and national partners, including the Saskatchewan Health Authority, the Ministry of Health, the College of Physicians and Surgeons of Saskatchewan, Interdisciplinary Advisory Committees, and NP Advisory Committee, to develop the education and clinical practicum requirements, and regulatory processes.

The CRNS has developed regulatory processes to minimize harm to the public and develop expectations for safe prescribing. In accordance with the CRNS mandate to set standards for competence and govern prescribing, NPs must meet all requirements prior to receiving approval to prescribe drug therapeutics for OUD and methadone for pain. The NP prescribing of these additional medications will be monitored through the existing Prescription Review Program.

Advancing the NP Scope of Practice by enabling NPs to prescribe drug therapeutics for OUD will increase the number of approved prescribers in Saskatchewan; thereby providing increased access for clients.

Eligible NPs can begin the application process as of April 2, 2019.

With the legalization of recreational cannabis on October 17, 2018, new Cannabis Regulations have replaced the Access to Cannabis for Medical Purposes Regulations (ACMPR). Under the new regulations, a nurse practitioner is defined as an authorized health care provider and is not restricted, under the laws of the province in which they practise, from authorizing the use of cannabis.  The College of Registered Nurses of Saskatchewan (CRNS) has determined that it is within the NPs scope of practice whom have the appropriate knowledge, skills and competencies to safely authorize the use of medical cannabis for Saskatchewan clients.

It is important NPs educate clients on the risks, side effects, safe transportation and storage of medical cannabis. NPs are required to adhere to employer policy for authorizing the use of medical cannabis. Clients authorized by their health care provider are still able to access cannabis for medical purposes by:

• buying directly from a federally-licensed seller,
• registering with Health Canada to produce a limited amount of cannabis for their own medical purposes, and
• designating someone to produce it for them.

Additional resources for NPs:

• Accessing cannabis for medical purposes
• Cannabis for medical purposes under the Cannabis Act: information and improvements
• Medical Document Authorizing the use of Cannabis for Medical Purposes under the Access to Cannabis for Medical Purposes Regulations
• Information for Health Care Practitioners – Medical Use of Cannabis
• Information for Health Care Professionals: Cannabis and the cannabinoids
• Cannabis Legalization Resources
• Controlled Drugs and Substances Act
• New Class of Practitioner Regulations
• Narcotic Control Regulations
• The Drug Schedules Regulations

CRNS Nursing Advisors are available to discuss practice questions about cannabis. To contact the CRNS for practice advice, please call: 1-800-667-9945 or 306-359-4200 (ask to speak to a practice advisor), or you can email at practiceadvice@crns.ca

Mifegymiso is an antihormonal medication consisting of two medications (mifepristone and misoprostol) that work together to block the effects of progesterone for termination of early pregnancy.

Health Canada recently broadened the interpretation of Mifegymiso prescriber to include prescribing health professional, resulting in Nurse Practitioners having the legal authority to prescribe Mifegymiso within Canada. The College of Registered Nurses of Saskatchewan (CRNS) has determined that it is within the NP’s scope of practice whom have the appropriate knowledge, skills and competencies to prescribe Mifegymiso to Saskatchewan patients.

Additional resources for NPs:

• Review the Product Monograph, Patient Medical Information, the Patient Consent Form and the Patient Information card that can be found on the Celopharma website: celopharma.com
• Consider completing the accredited training program through the Society of Obstetricians and Gynecologists of Canada (SOGC); or the online education program through the Celopharma website specific to Mifegymiso inclusive of the Risk Communication

An interdisciplinary advisory group is working with CRNS staff to develop council policy that fully defines the educational, practicum, monitoring and audit requirements. The projected timeline to have policies approved by CRNS Council is by Dec. 31, 2018. CRNS will provide updates as the work progresses.

Starting on October 23, 2018, Health Canada has amended the Food and Drug Regulations to require a warning sticker and patient information handout be provided when dispensing Class A opioids. These requirements will ensure that all Canadians receive consistent information about the risks and safe use of opioids.

Currently in Saskatchewan, NPs licensed with the CRNS are the only authorized practitioners who can dispense opioids. When dispensing Class A opioids, the practitioner is required to ensure:

• The opioid warning sticker be affixed to the opioid bottle, container or package.
• The Opioid Patient Information handout must be given directly to the patient from the practitioner dispensing the opioid.

For more information, visit the Government of Canada’s website.