To help address the worsening situation of overdose deaths arising from the dual public health emergencies (overdose death epidemic and COVID-19 pandemic) Dr. Bonnie Henry issued a Provincial Health Officer order on September 16, 2020. The Order is limited in time to the duration of the overdose death public health emergency, and authorizes Registered Nurses (RNs) and Registered Psychiatric Nurse (RPNs) who have additional educational preparation and experience to:
order and interpret diagnostic tests to make a diagnosis of a problem substance use condition or substance use disorder
make a diagnosis of a problem substance use condition or substance use disorder
prescribe controlled drugs to people who are diagnosed as having a problem substance use condition or substance use disorder; and
refer people with a problem substance use condition or substance use disorder to primary care and specialized health and social services
RN/RPN prescribing aims to both increase the capacity of OAT prescribers as well as reach clients who are not accessing existing OAT services. RNs and RPNs will be expected to screen clients for OUD, make a diagnosis of OUD, facilitate discussions about OAT options, and prescribe sublingual buprenorphine/naloxone when appropriate. RN/RPN prescribers will support clients for buprenorphine/naloxone inductions (office-based, home-based, or microdosing), bridging, and continuations.
These activities are subject to the services being provided in the course of a program approved by a medical health officer (MHO) and being conducted in accordance with the standards, limits and conditions of the British Columbia College of Nurses and Midwives (BCCNM) and within the education program and clinical requirements set by the BC Centre on Substance Use (BCCSU).
MHO approval is needed because prescribing under this order flows from the PHO order which is in support of ameliorating the harms and risks of the public health emergencies by providing access to treatment including by providing opioid agonist treatment and by prescribing pharmaceutical alternatives to illegally produced or street procured drugs.
Due to the Order of the Provincial Health Officer and BCCNM scope of practice, RN/RPN prescribing of Opioid Agonist Treatment (OAT) is approved by site, not individual nurse.
RN/RPN prescribing is currently being piloted at 3 sites across VCH. Further site implementation will be considered once we have completed implementation at these sites and have evaluated the impact of the program.
The following sites are at different stages of implementation:
Site expansion is planned for approximately September 2021, following an initial evaluation of nurse prescribing at the pilot sites.
The application process will start with the completion of the RN/RPN OAT prescribing site application form that will be reviewed by an interdisciplinary committee based on specific criteria. Interested teams can contact the Regional Addiction Program (OATNetwork@vch.ca) to receive communication once site applications are being accepted for review.
Prior to September 2021, sites will be considered for implementing nurse prescribing if there is a clear demonstrated gap in access to OAT in the community.
With operations leadership support, sites must apply to the Regional Addiction Program and local Professional Practice department using the attached site application.
Once approved by the Regional Addiction Program and Professional Practice, the site will be supported to proceed to the Medical Health Officer (MHO) approval process. The site must meet specific requirements and complete the MHO approval request.
Once the site is approved by the MHO, RNs and RPNs identified by leadership to become prescribers will complete 33 hours of online and in-person training through the BCCSU
Site specific procedures and workflows will be developed and implemented to support the new prescribers.
Current regulations and education are not setup to support RN/RPN OAT prescribing in acute care or ED settings. There is no timeline for if or when this would change.
No, sites across the VCH region require approval through the VCH process but do not need to be a VCH program. This is to ensure requirements set out in the Order and scope of practice are met prior to submission to the MHO for final authorization.
No, RN/RPN OAT prescribing can only be done at sites approved by the MHO and is not transferable at this time.
At this time RNs and RPNs can only prescribe sublingual buprenorphine/naloxone.
Work recently began to design practice supports, education, and implementation planning for the expanded scope of practice that came into effect March 1, 2021. There is no clear timeline for when this can be implemented at sites.