O. Reg. 336/23: GENERAL

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ontario regulation 336/23

made under the

Nursing Act, 1991

Made: October 13, 2023
Approved: November 2, 2023
Filed: November 6, 2023
Published on e-Laws: November 6, 2023
Published in The Ontario Gazette: November 25, 2023

Amending O. Reg. 275/94

(GENERAL)

1. Subsection 16 (3) of Ontario Regulation 275/94 is revoked.

2. The Regulation is amended by adding the following section immediately after the heading “Prescribing”:

16.1 (1) A member who is a registered nurse in the General class is only authorized to prescribe a drug described in Schedule 2 if the member satisfies the requirements in subsections (2) to (5).

(2) A member who is a registered nurse in the General class may only prescribe a drug described in Schedule 2 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.

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.

(3) Where a route of administration or other specification is indicated with respect to a drug described in Schedule 2, a member who is a registered nurse in the General class and who is authorized to prescribe such a drug shall only prescribe the drug in compliance with the specification and in accordance with the route of administration.

(4) A member who is a registered nurse in the General class shall not prescribe a drug described in Schedule 2 unless the member,

(a) has successfully completed education approved by the Council that was specifically designed to educate registered nurses to safely, effectively and ethically prescribe drugs and communicating diagnoses to a patient or their representative where the purpose of that communication is for prescribing a drug; or

(b) is taking part in the education mentioned in clause (a) and prescribes the drug under the supervision of a person who is authorized to prescribe the drug under a health profession Act as defined in the Regulated Health Professions Act, 1991.

(5) A member who is a registered nurse in the General class shall not perform the controlled act of communicating to a patient or their representative a diagnosis made by the member where the purpose of that communication is for prescribing a drug, unless that member,

(a) has successfully completed the education mentioned in clause (4) (a); or

(b) is taking part in the education mentioned in clause (4) (a) and communicates the diagnosis under the supervision of a person who is authorized to prescribe the drug and communicate a diagnosis under a health profession Act as defined in the Regulated Health Professions Act, 1991.

3. (1) Subsection 17 (1) of the Regulation is amended by striking out the portion before paragraph 1 and substituting the following:

(1) A member who is a registered nurse in the extended class may only prescribe a drug if all of the following conditions are met:

. . . . .

(2) Subsection 17 (2) of the Regulation is amended by striking out “For the purposes of paragraph 8 of subsection 5.1 (1) of the Act, a member” at the beginning and substituting “A member who is a registered nurse in the extended class and”.

4. Section 18 of the Regulation is revoked and the following substituted:

18. (1) A member who is a registered nurse in the extended class may only dispense a drug if all of the conditions set out in subsection (5) are met.

(2) A member who is a registered nurse in the General class may only dispense a drug described in Schedule 2 that the member prescribed if all of the conditions set out in subsection (5) are met.

(3) A member who is a registered nurse or a registered practical nurse may dispense a drug prescribed under section 16.1 if the dispensing is ordered by the member who prescribed the drug under that section and all of the conditions set out in subsection (5) are met.

(4) When dispensing a drug under clause 5 (1) (b) of the Act, a member who is a registered nurse or a registered practical nurse shall only dispense the drug if all of the conditions set out in subsection (5) are met.

(5) For the purposes of subsections (1) to (4), the following conditions must be met:

1. The member must have a nurse-patient relationship with the patient for whom the drug is dispensed.

2. The member must provide the drug directly to the patient or the patient’s representative.

3. The member must dispense the drug for therapeutic purposes only.

4. The member must have reasonable grounds to believe that the drug has been obtained and stored in accordance with any applicable 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 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 along with the name and title of the prescriber if the member is not the prescriber,

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.

7. The member must retain a copy of the information set out under paragraph 6 on the container in which the drug was dispensed in the patient’s health record.

5. Section 20 of the Regulation is revoked and the following substituted:

20. (1) A member who is a registered nurse in the extended class may only administer a substance by injection or inhalation if all of the conditions set out in subsection (5) are met.

(2) A member who is a registered nurse in the General class may only administer by injection or inhalation a substance described in Schedule 2 that the member prescribed, where that substance may be administered by injection or inhalation, if all of the conditions set out in subsection (5) are met.

(3) A member who is a registered nurse or a registered practical nurse may administer by injection or inhalation a substance prescribed under section 16.1, where that substance may be administered by injection or inhalation, if the administering is ordered by the member who prescribed the substance and all of the conditions set out in subsection (5) are met.

(4) It is a standard of practice of the profession that, when administering a substance by injection or inhalation under clause 5 (1) (b) of the Act, a member who is a registered nurse or a registered practical nurse shall only administer the substance if all of the conditions set out in subsection (5) are met.

(5) For the purposes of subsections (1) to (4), the following conditions must be met:

(a) the member 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.

6. (1) Subsection 35 (1) of the Regulation is amended by striking out “section 4 of the Act” and substituting “section 4 or 4.1 of the Act”.

(2) Section 35 of the Regulation is amended by adding the following subsection:

(4) Despite subsection (1), a member who is a registered nurse in the General class may not delegate the controlled acts of prescribing a drug or communicating to a patient or to their representative a diagnosis made by the member where the purpose of that communication is for prescribing a drug as authorized under paragraph 5 of section 4.1 of the Act.

7. The title of Schedule 1 to the Regulation is revoked and the following substituted:

Schedule 1
Facilities

8. The Regulation is amended by adding the following Schedule:

Schedule 2
Drugs that may be prescribed by Registered Nurses in the General Class

Immunization

Any vaccines for the prevention of bacterial and viral disease

Contraception
(excludes intra-uterine devices/contraceptives and contraceptive implants)

Any hormonal contraceptives for systemic use (oral and injectable)

Any intravaginal contraceptives

Travel Health

For the purpose of malaria prevention, any of the following drugs:

A. Aminoquinolines

B. Biguanides

C. Methanolquinolines

D. Doxycycline

For the prevention and/or treatment of traveller’s diarrhea, any of the following drugs:

A. Norfloxacin

B. Ciprofloxacin

C. Levofloxacin

D. Azithromycin

E. Rifaximin

Topical Wound Care

For cracked nipple care, a combination of all three of the following:

A. Betamethasone 0.1%

B. Mupirocin 2% ointment

C. Miconazole powder to a final concentration of 2%

For symptom management of odorous wounds, the following drug:

A. Metronidazole for topical use

Any antibiotics for topical use

Smoking Cessation

For the purpose of smoking cessation, any of the following drugs:

A. Bupropion hydrochloride

B. Varenicline tartrate

Anaesthetics

For the purpose of pain relief related to immunization and/or topical wound care, the following drugs:

A. Any anaesthetics used topically.

Allergic Reaction

For the purpose of treating anaphylaxis, the following drug:

A. Epinephrine

Over-the-counter Medication

Any drug or substance that may lawfully be purchased or acquired without a prescription and is available for self-selection in a pharmacy.

Commencement

9. This Regulation comes into force on the later of the day subsection 2 (1) of Schedule 22 to the Stronger, Healthier Ontario Act (Budget Measures), 2017 comes into force and the day this Regulation is filed.

Made by:
Pris par :

Council of the College of Nurses of Ontario:
Le Conseil de l’Ordre des infirmières et infirmiers de l’Ontario :

Silvie Crawford

Executive Director and CEO / Présidente et Directrice générale

Rodolfo D. Lastimosa JR.

Vice-President RPN / Vice-Présidente IAA

Date made: October 13, 2023
Pris le : 13 octobre 2023

 

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