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This is an official version. Copyright © 2006: Queen's Printer, Important Information
Newfoundland Regulation 1998 Nurse Practitioner Primary Health Care
Regulations (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 Pamela
Baker Joan Marie
Aylward REGULATIONS Analysis 1. Short
title 2. Definitions PART I 3. Collaborative
relationship 4. Specialist
consultation 5. Transfer
of care 6. Forms
of consultation 7. Consultation
required 8. Consultation
documentation PART II 9. Clinical
expectations for consultation PART 10. Sch
A description 11. Conveying
a diagnosis PART IV 12. Sch
B description 13. Special
assistance PART V 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 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 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 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 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 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
Key:
U/E Urgent/Emergent 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 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 lorazepam (sublingual or oral up to temazepam (up to a maximum of 7 days) Miscellaneous amitriptyline (up to a maximum of 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 chloromycetin ophthalmic ointment gentamicin drops and ointment Sulfonamides sulfacetamide sodium 10% drops 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 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 ©Earl G. Tucker, Queen's Printer |