Nursing Practice Updates
Updates focus on changes to legislation, SRNA bylaws, and the introduction of new standards and guidelines.
As of November 5, 2019, the updated Clinical Decision Tools (CDTs) for RNs with Additional Authorized Practice [RN(AAP)s] have been adopted by SRNA 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.
SRNA Practice Advisors may be contacted for answers to your practice questions by email at firstname.lastname@example.org or by phone 306.359.4200 or 1.800.667.9945 (toll free within Canada).
When Take-Home Naloxone (THN) kits were first introduced, RN Specialty Practices were required to support the distribution of kits to clients in a standardized way. Practice has evolved and additional health care providers are also actively distributing kits to meet increased demand. The authority for distribution is currently provided through a Saskatchewan Health Authority medical directive for RNs and other health care providers. As a result, an RN Clinical Protocol is no longer required for THN kit distribution.
Employers have the responsibility to determine the education required and processes used by RNs and other health care providers who distribute THN kits to address the needs of patients and families impacted by the opioid crisis. The goal of the program is to ensure life-saving measures are available and accessible when they are needed.
Questions? Contact a Practice Advisor by email at email@example.com 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 SRNA. 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 firstname.lastname@example.org 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 email@example.com or call 306.359.4200 or 1.800.667.9945 (toll free within Canada).
On March 27, 2019, SRNA 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 SRNA to receive approval to prescribe medications such as suboxone and methadone. These regulatory processes are in follow up to the Bylaw passed by SRNA membership at the 2018 SRNA Annual Meeting. Based on this Bylaw, the SRNA 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 SRNA has developed regulatory processes to minimize harm to the public and develop expectations for safe prescribing. In accordance with the SRNA 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 Saskatchewan Registered Nurses Association (SRNA) 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
- Ask a Practice Advisor: Medical Cannabis
SRNA Nursing Advisors are available to discuss practice questions about cannabis. To contact the SRNA 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 firstname.lastname@example.org
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 Saskatchewan Registered Nurses Association (SRNA) 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:
- Health Canada updates prescribing and dispensing information for Mifegymiso outlines the expectations for prescribing and dispensing Mifegymiso with key information for health professionals.
- 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 SRNA staff to develop council policy that fully defines the educational, practicum, monitoring and audit requirements. The projected timeline to have policies approved by SRNA Council is by Dec. 31, 2018. SRNA 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 SRNA 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.