O. Reg. 387/11: GENERAL
filed August 19, 2011 under Nursing Act, 1991, S.O. 1991, c. 32
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made under the
Nursing Act, 1991
Made: July 28, 2011
Approved: August 17, 2011
Filed: August 19, 2011
Published on e-Laws: August 23, 2011
Printed in The Ontario Gazette: September 3, 2011
Amending O. Reg. 275/94
(General)
1. Part III of Ontario Regulation 275/94 is revoked and the following substituted:
PART III
CONTROLLED ACTS
Interpretation
13.2 In this Part,
“controlled substance” means a controlled substance within the meaning of the Controlled Drugs and Substances Act (Canada);
“electronic signature” means electronic information that a person creates or adopts in order to sign a document and that is in, attached to or associated with the document;
“signature” includes an electronic signature.
Procedures
14. All procedures on tissue below the dermis or below the surface of a mucous membrane are prescribed for the purposes of paragraph 1 of section 4 of the Act.
15. (1) For the purposes of clause 5 (1) (a) of the Act, a registered nurse in the general class may perform a procedure set out in subsection (4) if he or she meets all of the conditions set out in subsection (5).
(2) For the purposes of clause 5 (1) (a) of the Act, any member may perform a procedure set out in subsection (4) if the procedure is ordered by a registered nurse in the general class.
(3) No registered nurse in the general class shall order a procedure set out in subsection (4) unless he or she meets all of the conditions set out in subsection (5).
(4) The following are the procedures referred to in subsections (1), (2) and (3):
1. With respect to the care of a wound below the dermis or below a mucous membrane, any of the following procedures:
i. cleansing,
ii. soaking,
iii. irrigating,
iv. probing,
v. debriding,
vi. packing,
vii. dressing.
2. Venipuncture to establish peripheral intravenous access and maintain patency, using a solution of normal saline (0.9 per cent), in circumstances in which,
i. the individual requires medical attention, and
ii. delaying venipuncture is likely to be harmful to the individual.
3. A procedure that, for the purpose of assisting an individual with health management activities, requires putting an instrument,
i. beyond the point in the individual’s nasal passages where they normally narrow,
ii. beyond the individual’s larynx, or
iii. beyond the opening of the individual’s urethra.
4. A procedure that, for the purpose of assessing an individual or assisting an individual with health management activities, requires putting an instrument or finger,
i. beyond the individual’s anal verge, or
ii. into an artificial opening into the individual’s body.
5. A procedure that, for the purpose of assessing an individual or assisting an individual with health management activities, requires putting an instrument, hand or finger beyond the individual’s labia majora.
(5) The following are the conditions referred to in subsections (1) and (3):
1. The registered nurse has the knowledge, skill and judgment to perform the procedure safely, effectively and ethically.
2. The registered nurse has the knowledge, skill and judgment to determine whether the individual’s condition warrants performance of the procedure.
3. The registered nurse determines that the individual’s condition warrants performance of the procedure, having considered,
i. the known risks and benefits to the individual of performing the procedure,
ii. the predictability of the outcome of performing the procedure,
iii. the safeguards and resources available in the circumstances to safely manage the outcome of performing the procedure, and
iv. other relevant factors specific to the situation.
4. The registered nurse accepts accountability for determining that the individual’s condition warrants performance of the procedure.
15.1 (1) For the purposes of clause 5 (1) (a) of the Act, a registered practical nurse in the general class may perform a procedure set out in subsection (2) if he or she meets all of the conditions set out in subsection (3).
(2) The following are the procedures referred to in subsection (1):
1. With respect to the care of a wound below the dermis or below a mucous membrane, any of the following procedures:
i. cleansing,
ii. soaking,
iii. dressing.
2. A procedure that, for the purpose of assisting an individual with health management activities, requires putting an instrument,
i. beyond the point in the individual’s nasal passages where they normally narrow,
ii. beyond the individual’s larynx, or
iii. beyond the opening of the individual’s urethra.
3. A procedure that, for the purpose of assisting an individual with health management activities, requires putting a hand or finger beyond the individual’s labia majora.
4. A procedure that, for the purpose of assessing an individual or assisting an individual with health management activities, requires putting an instrument or finger beyond the individual’s anal verge.
(3) The following are the conditions referred to in subsection (1):
1. The registered practical nurse has the knowledge, skill and judgment to perform the procedure safely, effectively and ethically.
2. The registered practical nurse has the knowledge, skill and judgment to determine whether the individual’s condition warrants performance of the procedure.
3. The registered practical nurse determines that the individual’s condition warrants performance of the procedure, having considered,
i. the known risks and benefits to the individual of performing the procedure,
ii. the predictability of the outcome of performing the procedure,
iii. the safeguards and resources available in the circumstances to safely manage the outcome of performing the procedure, and
iv. other relevant factors specific to the situation.
4. The registered practical nurse accepts accountability for determining that the individual’s condition warrants performance of the procedure.
Prescribing, Dispensing, Selling and Compounding a Drug
16. (1) A member shall not engage in conduct that results, directly or indirectly, in a personal or financial benefit that conflicts with his or her professional or ethical duty to a patient as a result of prescribing, dispensing, selling or compounding a drug.
(2) A member who prescribes, dispenses, sells or compounds a drug shall comply with all applicable federal and provincial law related to prescribing, dispensing, selling or compounding a drug.
(3) A member who is authorized to prescribe, dispense, sell or compound a drug shall not delegate the performance of prescribing, dispensing, selling or compounding a drug to any other person.
(4) A member who is authorized to prescribe, sell or compound a drug shall not prescribe, sell or compound a controlled substance.
Prescribing
17. For the purposes of paragraph 8 of subsection 5.1 (1) of the Act, a member may only prescribe a drug if all of the following conditions are met:
1. The member must have a nurse-patient relationship with the patient for whom the drug is prescribed.
2. The member must prescribe the drug for therapeutic purposes only.
3. The member must ensure that the following information is recorded on the prescription:
i. the name and address of the person for whom the drug is prescribed,
ii. the name, strength (where applicable) and quantity of the drug that is prescribed,
iii. the directions for use,
iv. the member’s name, address, telephone number, title and registration number issued by the College,
v. the member’s signature,
vi. the date on which the drug is prescribed, and
vii. the number of refills, if applicable.
4. The member must retain a copy of the information recorded on the prescription required under paragraph 3 as part of the patient’s health record.
Dispensing
18. (1) For the purposes of paragraph 8 of subsection 5.1 (1) of the Act, a member may only dispense a drug if all of the following conditions are met:
1. The member must have a nurse-patient relationship with the patient for whom the drug is dispensed.
2. The member must not dispense a drug pursuant to a prescription issued by any other person.
3. The member must provide the drug directly to the patient or the patient’s representative.
4. The member must dispense the drug for therapeutic purposes only.
5. The member must have made reasonable inquiries and be satisfied that,
i. the patient does not have reasonable or timely access to a pharmacy,
ii. the patient would not otherwise receive the drug,
iii. the patient does not have the financial resources to obtain the drug if it is not dispensed by the member,
iv. the drug is being dispensed for a patient in conjunction with a health promotion initiative, or
v. dispensing the drug is necessary to test the patient’s response to the drug.
6. The member must dispense a reasonable quantity of the drug having regard to the information provided by the patient in response to the inquiries under paragraph 5.
7. The member must have reasonable grounds to believe that the drug has been obtained and stored in accordance with any applicable legislation.
8. The member must be satisfied that the drug has not expired and will not expire before the date on which the patient is expected to take the last of the drug.
9. The member must ensure that the container in which the drug is dispensed is marked with,
i. an identification number, if applicable,
ii. the member’s name and title,
iii. the name, address and telephone number of the place from which the drug is dispensed,
iv. the identification of the drug as to its name, its strength (where applicable) and, if available, its manufacturer,
v. the quantity of the drug dispensed,
vi. the date the drug is dispensed,
vii. the expiry date of the drug, if applicable,
viii. the name of the patient for whom the drug is dispensed, and
ix. the directions for use.
10. The member must retain a copy of the information set out under paragraph 9 on the container in which the drug was dispensed in the patient’s health record, along with the information provided by the patient in response to the inquiries under paragraph 5.
(2) A registered nurse in the extended class shall not describe himself or herself orally or in writing as a person who is authorized to dispense a drug unless he or she sets out in writing or orally the inquiries that must be made by the member before dispensing a drug to a patient under paragraph 5 of subsection (1).
Compounding
19. For the purposes of paragraph 8 of subsection 5.1 (1) of the Act, a member may only compound a drug if all of the following conditions are met:
1. The member must only compound two or more non-sterile creams or ointments to produce a compounded cream or ointment.
2. The member must ensure that the compounded cream or ointment is for topical use only and for therapeutic purposes.
3. The member must have a nurse-patient relationship with the patient for whom the cream or ointment is compounded.
4. The member must dispense the compounded cream or ointment to the patient or his or her representative or apply it directly to the patient.
5. The member must have made reasonable inquiries and be satisfied that,
i. the patient does not have reasonable or timely access to a pharmacy,
ii. the patient would not otherwise receive the compounded cream or ointment, or
iii. the patient does not have the financial resources to obtain the compounded cream or ointment if it is not compounded by the member.
6. The member must have reasonable grounds to believe that the creams or ointments used in the compounding have been obtained and stored in accordance with any applicable legislation.
7. The member must be satisfied that the creams or ointments used in the compounding have not expired and will not expire before the date on which the patient is expected to apply the last of the compounded cream or ointment.
8. The member must ensure that the container holding the compounded cream or ointment is marked with,
i. an identification number, if applicable,
ii. the name and title of the member,
iii. the name, address and telephone number of the place in which the compounded cream or ointment was compounded,
iv. the identification of the substances used in the compounded cream and ointment, their names, strength and manufacturer,
v. the percentage of each of the creams or ointments used to make the compounded cream or ointment and the quantity placed in the container,
vi. the date the compounded cream or ointment was compounded and the date the compounded cream or ointment was dispensed, if different from the former date,
vii. the expiry date of the compounded cream or ointment,
viii. the name of the patient for whom the cream or ointment was compounded, and
ix. the directions for use.
9. The member must retain a copy of the information set out under paragraph 8 in the patient’s health record, along with the information provided by the patient in response to the inquiries under paragraph 5.
Selling
19.1 (1) For the purposes of paragraph 8 of subsection 5.1 (1) of the Act, a member may only sell a drug if all of the following conditions are met:
1. The member must have a nurse-patient relationship with the patient to whom the drug is sold.
2. The member must sell the drug for therapeutic purposes only and only if he or she dispenses the drug directly to the patient or the patient’s representative or the drug is administered to the patient.
3. The member must have made reasonable inquiries and be satisfied that,
i. the patient does not have reasonable or timely access to a pharmacy,
ii. the patient would not otherwise buy the drug,
iii. the patient does not have the financial resources to obtain the drug if it is not sold by the member, or
iv. the drug is sold in conjunction with a health promotion initiative.
4. The member must have reasonable grounds to believe that the drug has been obtained and stored in accordance with any applicable federal or provincial legislation.
5. The member must be satisfied that the drug has not expired and will not expire before the date on which the patient is expected to take the last of the drug.
6. The member must not sell a drug if the selling provides a profit to him or her or a direct or indirect personal or financial benefit, other than the actual cost of the drug.
7. The member must retain in the patient’s health record a record that the drug was sold to the patient, the price charged and the information provided by the patient in response to the inquiries under paragraph 3.
(2) A registered nurse in the extended class shall not describe himself or herself orally or in writing as a person who is authorized to sell a drug unless he or she sets out in writing or orally the inquiries that must be made by the member before selling a drug to a patient under paragraph 3 of subsection (1).
Administration of a Substance by Injection or Inhalation
20. For the purposes of paragraph 6 of subsection 5.1 (1) of the Act, a member may only administer a substance by injection or inhalation if,
(a) he or she has a nurse-patient relationship with the patient for whom the administration of a substance by injection or inhalation is performed; and
(b) the procedure is performed only for therapeutic purposes.
2. Schedules 2 and 3 to the Regulation are revoked.
Commencement
3. This Regulation comes into force on the later of the day subsection 18 (7) of the Regulated Health Professions Statute Law Amendment Act, 2009 comes into force and the day this Regulation is filed.
Made by:
Council of the College of Nurses of Ontario:
Anne L. Coghlan
Executive Director and Chief Executive Officer
Evelyn Kerr
Vice-President
Date made: July 28, 2011.