This is an official version.

Copyright © 2006: Queen’s Printer,
St. John's, Newfoundland and Labrador, Canada

Important Information
(Includes details about the availability of printed and electronic versions of the Statutes.)

Newfoundland Regulation 1998


NEWFOUNDLAND REGULATION 65/98

NEWFOUNDLAND REGULATION 65/98

Nurse Practitioner Primary Health Care Regulations
under the
Registered Nurses Act

(Filed June 29, 1998)

Under the authority of section 22.1 of the Registered Nurses Act, the council with the approval of the minister makes the following regulations.

Filed at St. John’s, June 29, 1998.

Pamela Baker
President of the Council of the
Association of Registered Nurses of
Newfoundland

Joan Marie Aylward
Minister of Health and Community Services

REGULATIONS

Analysis


        1.   Short title

        2.   Definitions

              PART I
EXPECTATIONS FOR CONSULTATION

        3.   Collaborative relationship

        4.   Specialist consultation

        5.   Transfer of care

        6.   Forms of consultation

        7.   Consultation required

        8.   Consultation documentation

              PART II
CLINICAL EXPECTATIONS FOR CONSULTATION

        9.   Clinical expectations for consultation

              PART III
DIAGNOSIS

      10.   Sch A description

      11.   Conveying a diagnosis

              PART IV
DIAGNOSTIC TESTS

      12.   Sch B description

      13.   Special assistance

              PART V
PRESCRIPTIVE AUTHORITY

      14.   Sch C description

      15.   Over the counter medication

      16.   Prescription renewal

      17.   Prescription renewal requirements

      18.   Prescription inquiries

      19.   Annual review of Schedules

Schedule A

Schedule B

Schedule C


Short title

        1. These regulations may be cited as the Nurse Practitioner Primary Health Care Regulations.

Definitions

        2. In these regulations

             (a)  "acute illness or injury" means illness or injury with gradual or sudden onset that requires intervention;

             (b)  "chronic illness or injury" means long term illness or injury previously diagnosed and with a management plan determined by a physician and requiring consultation and collaboration for ongoing care;

             (c)  "collaboration" means a nurse practitioner working together with a patient and one or more health professionals within a primary health care team to achieve a common goal;

             (d)  "consultation" means the consultative interaction between a nurse practitioner and a primary care physician, initiated by specific request of the nurse practitioner for an opinion, recommendation or concurrence in the treatment of a patient;

             (e)  "intervention categories" include

                      (i)  emergent – illness or injury that is potentially threatening to life, limb or function and requires immediate intervention,

                     (ii)  urgent – serious illness or injury requiring emergency intervention, and

                    (iii)  non-urgent – minor illness or injury requiring intervention;

              (f)  "primary care physician" means a general practitioner, family practitioner or other non-specialist practitioner;

             (g)  "primary health care" means essential health care made universally accessible to individuals and families in the community by means acceptable to them through their full participation and at a cost that the community and the country can afford, and includes health promotion, injury and illness prevention, cure, rehabilitation and support; and

             (h)  "nurse practitioner" means a registered nurse who meets the requirements for licensure by the Association of Registered Nurses of Newfoundland (ARNN) for practice as a nurse practitioner within the primary health care model.

PART I
EXPECTATIONS FOR CONSULTATION

Collaborative relationship

        3. A nurse practitioner

             (a)  shall establish and document a collaborative working relationship with a primary care physician; and

             (b)  may establish working relationships with other health professionals,

for the purposes of consultation.

Specialist consultation

        4. Consultation will normally occur with a primary care physician with whom a collaborative working relationship has been established, but a nurse practitioner may consult with a specialist physician when the primary care physician is not available and if appropriate to the patient needs and practice setting.

Transfer of care

        5. A decision to transfer care shall be made by the nurse practitioner and physician following consultation.

Forms of consultation

        6. A request for consultation may be made in person, by telephone or other electronic communication or in writing.

Consultation required

        7. Consultation may be required at any stage of the nurse practitioner - patient relationship.

Consultation documentation

        8. A nurse practitioner shall document all requests for consultation and outcomes of those consultations.

PART II
CLINICAL EXPECTATIONS FOR
CONSULTATION

Clinical expectations for consultation

        9. A nurse practitioner shall consult with a physician

             (a)  when a diagnosis or treatment plan is unclear or beyond the scope of the nurse practitioner to determine, including situations in which the following conditions are present:

                      (i)  persistent or recurring signs or symptoms that cannot be attributed to a readily identifiable cause,

                     (ii)  signs, symptoms or reports of imaging or laboratory tests suggestive of a previously undiagnosed chronic or systemic illness,

                    (iii)  symptomatic or laboratory evidence of decreased or decreasing function of an organ or system,

                    (iv)  signs of recurrent or persistent infection,

                     (v)  atypical presentation of a common illness or unusual response to treatment,

                    (vi)  signs or symptoms of sexually transmitted disease in a child,

                   (vii)  signs or symptoms of behavioural changes that cannot be attributed to a specific cause, or

                  (viii)  deviation from normal growth or development expectations in an infant or child;

             (b)  in urgent and emergent situations including, when any of the following conditions are present:

                      (i)  signs or symptoms of an acute event that is potentially threatening to life, limb or senses,

                     (ii)  signs or symptoms of obstruction of any system,

                    (iii)  signs of severe or widespread infection,

                    (iv)  fever greater than 39° Celsius in a child aged 3 to 36 months with no identifiable focus of infection,

                     (v)  all signs or symptoms of illness in an infant under 3 months of age,

                    (vi)  blunt, penetrating or other type of wound that may involve damage below the fascia or involve functional impairment, or

                   (vii)  signs or symptoms of a fetal or maternal distress;

             (c)  when a patient’s chronic illness or injury destabilizes, including situations where there is

                      (i)  symptomatic or laboratory evidence of destabilization or unexpected deterioration in the condition of a patient who is being managed for a previously diagnosed illness, or

                     (ii)  imposition of an acute illness or injury on a chronic condition; and

             (d)  regarding reassessment, on an annual basis, of a patient with a chronic condition.

PART III
DIAGNOSIS

Sch A description

     10. Schedule A, Diagnosis, of these regulations includes those illnesses and injuries that expectedly will be encountered in a nurse practitioner’s common practice.

Conveying a diagnosis

     11. The ability of a nurse practitioner to convey to a patient a diagnosis made of an illness or injury contained in Schedule A is qualified by the expectations for consultation with a physician as defined by the graphing key of the Schedule and by other requirements contained in these regulations.

PART IV
DIAGNOSTIC TESTS

Sch B description

     12. Schedule B, Diagnostic Tests, of these regulations includes those tests which will be ordered most commonly, independently by a nurse practitioner in providing care to patients.

Special assistance

     13. Diagnostic tests not included in Schedule B but required for monitoring a patient’s chronic illness or injury may be ordered by the nurse practitioner following consultation with the patient’s physician and the test requisition shall reference the physician’s name.

PART V
PRESCRIPTIVE AUTHORITY

Sch C description

     14. Schedule C, Prescriptive Authority, of the regulations includes those drugs that may be prescribed independently or administered in the course of practice by a nurse practitioner.

Over the counter medication

     15. A nurse practitioner may prescribe an over the counter medication for the purpose of accessing a drug plan which has plan coverage for the over the counter medication.

Prescription renewal

     16. A nurse practitioner may write a prescription for the renewal of a drug prescription, originally written by a physician, only for a patient on that nurse practitioner’s case load who is being managed consultatively with a physician.

Prescription renewal requirements

     17. A prescription renewal written by a nurse practitioner shall contain the full name of the physician who initially prescribed the drug.

Prescription inquiries

     18. Questions regarding prescriptions written at first instance by a nurse practitioner shall be directed to that nurse practitioner.

Annual review of Schedules

     19. The Schedules to these regulations will be reviewed annually by the committee appointed by the minister under section 22.1 of the Act, but may be reviewed more frequently if necessary by a sub-committee that may bring forward recommendations to the committee.


Schedule A

Diagnosis

 

 

Illnesses/Injuries

 

U/E

 

U

 

NU(nc)

 

NU(c)

 

C

 

EYE

 

 

 

 

 

 

 

 

 

 

 

Conjunctivitis

 

 

 

 

 

-

 

 

 

d

 

Hordeolum

 

 

 

 

 

-

 

 

 

d

 

Corneal Abrasion

 

 

 

 

 

-

 

 

 

d

 

Foreign Body

 

 

 

-

 

 

 

 

 

d

 

Hyphema

 

 

 

-

 

 

 

 

 

y

 

Dacryocystitis

 

 

 

-

 

 

 

 

 

y

 

Chalazion

 

 

 

 

 

-

 

 

 

d

 

EAR

 

 

 

 

 

 

 

 

 

 

 

Cerumen Impaction

 

 

 

 

 

-

 

 

 

d

 

Otitis Externa

 

 

 

 

 

-

 

 

 

d

 

Otitis Media

 

 

 

 

 

-

 

 

 

d

 

Serous Otitis Media

 

 

 

 

 

-

 

 

 

d

 

Foreign Body

 

 

 

-

 

 

 

 

 

d

 

Mastoid Diseases

 

 

 

-

 

 

 

 

 

y

 

Labyrinthitis

 

 

 

 

 

-

 

 

 

d

 

NOSE

 

 

 

 

 

 

 

 

 

 

 

Epistaxis

 

 

 

-

 

 

 

 

 

d

 

Sinusitis

 

 

 

 

 

-

 

 

 

d

 

Foreign Body

 

 

 

-

 

 

 

 

 

d

 

Rhinitis

 

 

 

 

 

-

 

 

 

d

 

Allergic Rhinitis

 

 

 

 

 

-

 

 

 

d

 

Injuries (bony/soft tissue)

 

 

 

-

 

 

 

 

 

d

 

UPPER RESPIRATORY TRACT

 

 

 

 

 

 

 

 

 

 

 

Pharyngitis

 

 

 

 

 

-

 

 

 

d

 

Oral Candidiasis

 

 

 

 

 

-

 

 

 

d

 

Tonsillitis

 

 

 

 

 

-

 

 

 

d

 

Laryngitis

 

 

 

 

 

-

 

 

 

d

 

Oral Chancres

 

 

 

 

 

-

 

 

 

d

 

Peritonsilar Abscess

 

 

 

-

 

 

 

 

 

y

 

Gingivitis

 

 

 

 

 

-

 

 

 

d

 

Stomatitis

 

 

 

 

 

-

 

 

 

d

 

OTHER

 

 

 

 

 

 

 

 

 

 

 

Upper Respiratory Tract Infection

 

 

 

 

 

-

 

 

 

d

 

Dental Abscesses

 

 

 

-

 

 

 

 

 

y

 

LOWER RESPIRATORY TRACT

 

 

 

 

 

 

 

 

 

 

 

Influenza

 

 

 

 

 

-

 

 

 

d

 

Exacerbation of Asthma

 

 

 

-

 

 

 

 

 

y

 

Exacerbation of Chronic Obstructive Pulmonary Disease

 

 

 

-

 

 

 

 

 

y

 

Pneumonia (pediatric)

 

 

 

-

 

 

 

 

 

y

 

Pneumonia (adult-community acquired, mild to moderate)

 

 

 

-

 

 

 

 

 

d

 

Pulmonary Tuberculosis

 

 

 

-

 

 

 

 

 

y

 

Bronchiolitis

 

 

 

-

 

 

 

 

 

d

 

Bronchitis

 

 

 

-

 

 

 

 

 

d

 

Croup

 

 

 

-

 

 

 

 

 

y

 

Tracheitis

 

 

 

-

 

 

 

 

 

d

 

CARDIOVASCULAR

 

 

 

 

 

 

 

 

 

 

 

Congestive Heart Failure (unstable)

 

-

 

 

 

 

 

 

 

y

 

Hypertension

 

-

 

 

 

 

 

 

 

y

 

Angina Pectoris (stable)

 

 

 

 

 

 

 

-

 

y

 

Angina Pectoris (unstable)

 

-

 

 

 

 

 

 

 

y

 

Cardiac Dysrhythmias

 

-

 

 

 

 

 

 

 

y

 

Undiagnosed Chest Pain

 

-

 

 

 

 

 

 

 

y

 

PERIPHERAL VASCULAR

 

 

 

 

 

 

 

 

 

 

 

Superficial Thrombophlebitis

 

 

 

-

 

 

 

 

 

d

 

Varicose Veins

 

 

 

 

 

-

 

 

 

d

 

Stasis Ulcers

 

 

 

 

 

-

 

 

 

d

 

Deep Vein Thrombosis

 

-

 

 

 

 

 

 

 

y

 

ENDOCRINE

 

 

 

 

 

 

 

 

 

 

 

Diabetes Mellitus

 

 

 

-

 

 

 

 

 

y

 

Hyper/Hypo Thyroidism

 

 

 

-

 

 

 

 

 

y

 

Gout

 

 

 

-

 

 

 

 

 

d

 

GASTROINTESTINAL

 

 

 

 

 

 

 

 

 

 

 

Ulcers (peptic; duodenal)

 

 

 

-

 

 

 

-

 

y

 

Gastroenteritis

 

 

 

 

 

-

 

 

 

d

 

Hepatitis

 

 

 

-

 

 

 

 

 

y

 

Cholecystitis

 

 

 

-

 

 

 

 

 

y

 

Irritable Bowel Syndrome

 

 

 

 

 

 

 

-

 

d

 

Gastroesophageal Reflux Disease

 

 

 

 

 

 

 

-

 

d

 

Constipation

 

 

 

 

 

-

 

 

 

d

 

Diarrhea with Dehydration

 

 

 

-

 

 

 

 

 

y

 

Acute Diarrhea without Dehydration

 

 

 

 

 

-

 

 

 

d

 

Inflammatory Bowel Disease

 

 

 

-

 

 

 

 

 

y

 

Anal Fissures

 

 

 

 

 

-

 

 

 

d

 

Hemorrhoids

 

 

 

-

 

-

 

-

 

d

 

Pilonidal Lesion

 

 

 

-

 

 

 

 

 

y

 

Gastritis

 

 

 

 

 

-

 

-

 

d

 

GENITOURINARY

 

 

 

 

 

 

 

 

 

 

 

Urinary Tract Infection

 

 

 

 

 

-

 

 

 

d

 

Pyelonephritis

 

 

 

-

 

 

 

 

 

y

 

Renal Calculi

 

 

 

-

 

 

 

 

 

y

 

Epididymitis

 

 

 

-

 

 

 

 

 

y

 

Prostatitis

 

 

 

-

 

 

 

 

 

y

 

Vulvovaginitis

 

 

 

 

 

-

 

 

 

d

 

Vaginitis

 

 

 

 

 

-

 

 

 

d

 

Urinary Stress Incontinence

 

 

 

 

 

-

 

-

 

d

 

Pelvic Inflammatory Disease

 

 

 

-

 

 

 

 

 

y

 

Bartholin’s Duct Abscess

 

 

 

-

 

 

 

 

 

y

 

Bartholin’s Cyst

 

 

 

 

 

-

 

 

 

d

 

Urinary Retention

 

 

 

-

 

 

 

 

 

d

 

Urethritis

 

 

 

-

 

 

 

 

 

d

 

Balanitis

 

 

 

 

 

-

 

 

 

d

 

REPRODUCTIVE

 

 

 

 

 

 

 

 

 

 

 

Dysmenorrhea

 

 

 

 

 

-

 

 

 

d

 

Amenorrhea

 

 

 

 

 

-

 

 

 

y

 

Breast Disorders

 

 

 

 

 

 

 

 

 

 

 

·                     mastitis

 

 

 

-

 

 

 

 

 

d

 

·                     abscess

 

 

 

-

 

 

 

 

 

y

 

·                     lumps

 

 

 

-

 

-

 

 

 

y

 

·                     discharge

 

 

 

-

 

-

 

 

 

y

 

·                     fibrocystic breast disease

 

 

 

 

 

-

 

 

 

d

 

Post Menopausal bleeding

 

 

 

-

 

 

 

 

 

y

 

Dysfunctional Uterine Bleeding

 

 

 

 

 

-

 

 

 

y

 

Menorrhagia

 

 

 

 

 

-

 

 

 

y

 

Premenstrual Syndrome

 

 

 

 

 

-

 

 

 

d

 

Cervicitis (confirmed)

 

 

 

 

 

-

 

 

 

y

 

Labor

 

-

 

 

 

 

 

 

 

y

 

INTEGUMENTARY

 

 

 

 

 

 

 

 

 

 

 

Facial Cellulitis

 

 

 

-

 

 

 

 

 

y

 

Uncomplicated Cellulitis

 

 

 

 

 

-

 

 

 

d

 

Dermatitis

 

 

 

 

 

-

 

 

 

d

 

Impetigo

 

 

 

 

 

-

 

 

 

d

 

Urticaria

 

 

 

 

 

-

 

 

 

d

 

Eczema

 

 

 

 

 

-

 

 

 

d

 

Psoriasis

 

 

 

 

 

 

 

-

 

d

 

Chronic Ulcers

 

 

 

 

 

 

 

-

 

y

 

Sebaceous Cyst

 

 

 

 

 

-

 

 

 

d

 

Foreign Body

 

 

 

-

 

 

 

 

 

d

 

Bites (animal; insect; human)

 

 

 

-

 

 

 

 

 

d

 

Carbuncle

 

 

 

 

 

-

 

 

 

d

 

Furuncle

 

 

 

 

 

-

 

 

 

d

 

Warts

 

 

 

 

 

-

 

 

 

d

 

Minor Burns

 

 

 

 

 

-

 

 

 

d

 

Ingrown Toenail

 

 

 

 

 

-

 

 

 

d

 

Minor Laceration

 

-

 

-

 

-

 

 

 

d

 

Undiagnosed Skin Lesions

 

 

 

 

 

-

 

-

 

y

 

Acne

 

 

 

 

 

 

 

-

 

d

 

INFECTIONS AND PARASITIC DISEASES

 

 

 

 

 

 

 

 

 

 

 

Syphilis

 

 

 

 

 

-

 

 

 

y

 

Gonorrhea

 

 

 

 

 

-

 

 

 

y

 

Chlamydia

 

 

 

 

 

-

 

 

 

d

 

Herpes Virus

 

 

 

 

 

-

 

 

 

d

 

Ocular Herpes

 

 

 

-

 

 

 

 

 

y

 

Condylomata Acuminata

 

 

 

 

 

-

 

-

 

y

 

Tinea Pedis

 

 

 

 

 

-

 

 

 

d

 

Tinea Corporis

 

 

 

 

 

-

 

 

 

d

 

Enterobiasis

 

 

 

 

 

-

 

 

 

d

 

Ascariasis

 

 

 

 

 

-

 

-

 

y

 

Whooping Cough

 

 

 

 

 

-

 

 

 

d

 

Trichomonas

 

 

 

 

 

-

 

 

 

d

 

Herpes Zoster ( Shingles )

 

 

 

 

 

-

 

 

 

d

 

Infectious Mononucleosis

 

 

 

 

 

-

 

 

 

d

 

HIV / AIDS

 

-

 

 

 

 

 

 

 

y

 

MUSCULOSKELETAL

 

 

 

 

 

 

 

 

 

 

 

Strains

 

 

 

 

 

-

 

 

 

d

 

Sprains

 

 

 

 

 

-

 

 

 

d

 

Fractures

 

-

 

 

 

 

 

 

 

y

 

Costochondoritis

 

 

 

 

 

-

 

 

 

d

 

Nonspecific Musculoskeletal Pain

 

 

 

 

 

-

 

 

 

d

 

Bursitis

 

 

 

-

 

 

 

 

 

d

 

Dislocations

 

-

 

 

 

 

 

 

 

y

 

Torticollis

 

 

 

 

 

-

 

 

 

d

 

HEMATOPOIETIC

 

 

 

 

 

 

 

 

 

 

 

Non-Acute Anemias

 

 

 

 

 

 

 

-

 

y

 

NERVOUS SYSTEM

 

 

 

 

 

 

 

 

 

 

 

Bell’s Palsy

 

 

 

 

 

-

 

 

 

y

 

Trigeminal Neuralgia

 

 

 

 

 

-

 

 

 

y

 

Uncomplicated Migraines

 

 

 

-

 

 

 

 

 

d

 

Cluster Headache

 

 

 

 

 

-

 

 

 

d

 

Tension Headache

 

 

 

 

 

-

 

 

 

d

 

Chronic Headache

 

 

 

 

 

 

 

-

 

y

 

Seizures

 

-

 

 

 

 

 

 

 

y

 

Transient Ischemic Attack

 

-

 

 

 

 

 

 

 

y

 

Parkinsonism

 

 

 

 

 

-

 

 

 

y

 

Vertigo

 

 

 

 

 

-

 

 

 

y

 

PSYCHOLOGICAL

 

 

 

 

 

 

 

 

 

 

 

Anxiety

 

 

 

 

 

-

 

 

 

d

 

Depression

 

-

 

 

 

 

 

 

 

y

 

Eating Disorders

 

 

 

 

 

-

 

 

 

y

 

Dementia

 

 

 

-

 

 

 

 

 

y

 

Substance Abuse

 

 

 

 

 

-

 

 

 

d

 

Obesity

 

 

 

 

 

 

 

-

 

d

 

Insomnia

 

 

 

 

 

 

 

-

 

d

 

Psychosis

 

-

 

 

 

 

 

 

 

y

 

OTHER

 

 

 

 

 

 

 

 

 

 

 

Assault/Sexual Abuse

 

 

 

-

 

 

 

 

 

y

 

Child Abuse

 

 

 

-

 

 

 

 

 

y

 

Elder Abuse

 

 

 

-

 

 

 

 

 

d

 

Spousal Abuse

 

 

 

-

 

 

 

 

 

d

Key:              U/E – Urgent/Emergent
                      U- Urgent
                      NU(nc) – Non-Urgent (non-chronic)
                      NU(c) – Non-Urgent (chronic)
                      C – Consultation:  Discretionary (d); Yes (y)

 


EMERGENT CATEGORY

The Emergent Category or Emergencies listed below are serious illnesses or injuries that occur suddenly and threaten life.  The illnesses and injuries listed are those for which the nurse practitioner can independently administer drugs prior to a consultation.  The specific drugs are identified in Schedule C concerning prescriptive authority of nurse practitioners.

Acute Asthma Attack

Acute Poisoning (patient stable)

Anaphylaxis

Cardiac Arrest

Coma

Fluid Resuscitation (massive hemorrhage or other shock syndrome)

Myocardial Infarction

Pulmonary Edema

Severe Pain Control (acute)

Status Epilepticus


Schedule B

Diagnostic Tests

MICROBIOLOGY

Cultures - cervical, vaginal, and urethral

Cultures - GC culture and smear

Cultures - sputum

Cultures - stool

Cultures - urine

Cultures - throat swab for streptococcus screen

Fungal scrapings

Parasites and ova (feces concentration)

Parasites and ova, smear only, special stain

Pertussis scrapings

Pinworm (Scotch tape prep)

 

CYTOLOGY

Cervicovaginal smear (Pap)

 

BIOCHEMISTRY

AC sugar

PC sugar

Creatinine

Glycosylated hemoglobin - Hgb AlC

Potassium

Sodium

Urea

Urinalysis, routine

Urinalysis microscopic

 

IMMUNOLOGY

Monospot screen

Pregnancy tests

 

HEMATOLOGY

CBC and differential

 

FORMS OF ENERGY

EKG

Mammogram (as per screening guidelines)

Obstetrical/pelvic ultrasound (as per screening guidelines 18 to 20 weeks)

X-rays for trauma (limbs) - following consultation with a physician

 

MISCELLANEOUS

Prenatal blood screening (as per provincial guidelines)


Schedule C

Prescriptive Authority

Drugs by Therapeutic Classification

 

Anti-infective Drugs

Amebicides

metronidazole

 

Anthelmintics

piperazine

pyrvinium pamoate

mebendazole

 

Antibiotics

Amino glycosides

gentamicin (not intramuscular or intravenous)

 

Antifungal Antibiotics

nystatin (all forms)

 

Cephalosporins

cephalexin monohydrate

 

Macrolides

erythromycin and its salts

 

Penicillins

amoxicillin

amoxicillin clavulanic acid

ampicillin

cloxacillin sodium

penicillin G

penicillin V

 

Tetracycline

tetracycline

 

Sulfonamides

sultrin vaginal cream

*                              trimethoprim-sulfamethoxazole

 

Urinary Anti-infectives

nitrofurantoin

trimethoprim

 

Autonomic Drugs

                      Antimuscarinics/Antispasmodics

hyoscine butlybromide (up to a maximum of 7 days)

 

      Skeletal Muscle Relaxants

cyclobenzaprine (up to a maximum of 7 days)

 

      Miscellaneous

meclizine nicotine acid and niacin

nicotine transdermal

 

Central Nervous System Drugs

Analgesics and Antipyretics

Nonsterodial Anti-Inflammatory Drugs

ibuprofen

indomethacin

mefenamic acid

naproxen

 

Opiate Agonists

acetaminophen with codeine

codeine phosphate (up to a maximum of 7

                   days)

 

Miscellaneous

phenazopyridine

 

Anxiolytics, Sedatives and Hypnotics

Benzodiazepines

chlordiazepoxide (up to a maximum of
                                                                   10 days)

lorazepam (sublingual or oral up to
                                                                   a maximum of 7 days)

temazepam (up to a maximum of 7 days)


 

Miscellaneous

amitriptyline (up to a maximum of
                                                                   50 mg daily)

hydroxyzine (up to a maximum of 7 days)

 

Gastrointestinal Drugs

Antiemetic

metoclopramide

 

H2 Antagonists

cimetidine

ranitidine

 

Antitussive, Expectorants, and Mucloytics Drugs

 

codeine preparations (up to a maximum of 7 days)

 

Eye, Ear, Nose and Throat Preparations

Anti-infectives

Antibiotics

betamethasone and gentamicin
                                                                   otic preparation

chloromycetin ophthalmic ointment

gentamicin drops and ointment

 

Sulfonamides

sulfacetamide sodium 10% drops
                                                                   and ointment

 

Anti-inflammatory agents

beclomethasone nasal spray

flumethasone pivalate-clioquinol eardrops

hydrocortisone neomycin polymyxin B compound

 

Miscellaneous

fluorescien eye drops and strips

 


Hormones and Synthetic Substitutes

Contraceptives

oral birth control tablets

 

Estrogens

conjugated estrogens vaginal cream

 

 

Local Anaesthetics

lidocaine viscous and spray

lidocaine 1% and 2% with and without epinephrine

tetracaine ophthalmic solution 0.5%

 

Serums, Toxoids and Vaccines

immunizations according to current provincial guidelines

influenza vaccine

 

Skin and Mucous Membrane Drugs

Anti-infectives

Antibiotics

erythromycin topical acne pads

clindamycin acne preparations

framycetin dressings

 

Antivirals

acyclovir oral for shingles

acyclovir topical

 

Anti-inflammatory Agents

coal tar preparations (including LCD)

flumethasone pivalate-clioquinol

hydrocortisone

hydrocortisone-framycetin sulfate-cinchocaine
                                             HCL-Esculin

pramoxine HCL-hydrocortisone acetate-zinc sulfate

triamcinolone dental paste

Vitamins

folic acid

 


Prescriptive Authority During Emergent Situations

 

The listing which follows identifies the independent prescriptive authority of the nurse practitioner during specific emergent situations.

 

Acute asthma attack

salbutamol (Metered Dose Inhaler, nebulizer)

 

Acute poisoning (patient stable)

activated charcoal

 

Anaphylaxis

epinephrine 1:1000

epinephrine 1:10,000 for infants less than 12 months

normal saline intravenous

diphenhydramine hydrochloride intramuscular

 

Cardiac Arrest

normal saline intravenous

 

Coma

naloxone hydrochloride

dextrose 50% with water intravenous

 

Fluid resuscitation (massive haemorrhage or other shock syndrome)

normal saline intravenous

ringer’s lactate intravenous

 

Myocardial Infarct

nitroglycerine sublingual

normal saline intravenous

dextrose 5% with water intravenous

morphine 2.5 mg intravenous (single dose)

 

Pulmonary Edema (adult)

furosemide 40 mg intravenous (single dose)

morphine 2.5 mg intravenous (single dose)

dextrose 5% with water intravenous

 


Severe pain control (acute)

dimenhydrinate (as antinauseant) intramuscular/intravenous

nitrous oxide 50% and oxygen 50% by inhalation

morphine intramuscular 15 mg maximum dose (single dose)

 

Status Epileptics

diazepam intravenous or per rectum

lorazepam intravenous or per rectum

 

Miscellaneous

oxygen

intravenous infusions