Transforming and Supporting Patient Care - Health Professions ...

289Chapter 12 – Profession of NursingThe CPSO draft guideline also sets out standards that limit dispensing byphysicians to dispensing drugs to their own patients; and using propermethods of procurement to be assured of the origin and chain of custody ofthe drugs being dispensed. The standards include safe storage, recordkeeping,checking expiry dates, proper disposal, appropriate packaging andlabelling; providing appropriate material to patients and an audit system.Selling and Compounding DrugsHPRAC heard little concern about NPs’ competence to sell and compounddrugs, provided there were terms, conditions and limitations attached tothe practice. The CNO has indicated that the practice would occur rarely, incommunities where access to a pharmacy is limited, and where patientsmight need to attend an emergency department to otherwise obtain theprescribed medication. HPRAC was told that NPs should not have theauthority to compound or sell controlled drugs.Some issues were raised relating to the high standards for hygiene andsterile conditions and storage protocols for ingredients that are required forcompounding drugs. It was noted by some that these protocols must beaccounted for in standards of practice. Others indicated that there must bea written prescription for the drug and records of the agents used in thecompounded medication.Similarly, standards of practice should define specifically the requirementsfor records relating to the selling of drugs. No profits should be allowed,and there should be a written prescription and proper documentationrelating to the drugs sold, including such matters as a careful tracking ofthe source of the drug, expiry date, and details of the prescription.ConclusionsHPRAC has concluded that risks associated with dispensing drugs, an entrylevelcompetence for all nurses who are registered in Ontario, can bemitigated by ensuring appropriate standards and quality assuranceprograms are in place. Nonetheless, standards of practice should make itclear that the authority should be exercised to address limited situationswhere a pharmacist or physician is not available. Additionally, HPRAC foundthat NPs have the foundational education to sell and compound drugs,other than controlled drugs. Standards of practice, developed through aninterprofessional process, should be put in place to ensure patient safety.Request 3: Open Prescribing for Nurse PractitionersThe Nursing Act, 1991 authorizes NPs to prescribe drugs that are designatedin the regulations and the circumstances in which a member may prescribethose drugs. While the regulations currently designate individual drugs,amendments to the Act made in 2007 authorize the regulation to designateindividual drugs or categories of drugs. 4343Nursing Act, 2007, c. 10, Sched. B, s. 14 (4).HPRAC Critical Links January 2009