Transforming and Supporting Patient Care - Health Professions ...

294Chapter 12 – Profession of NursingConclusionsHPRAC is not recommending that NPs have open prescribing authority asrequested.HPRAC is recommending that the drug regulation under the Nursing Act,1991 be amended to designate drugs and substances by therapeutic class.Specific agents within therapeutic classes, including any terms, limitationsand conditions, would be developed through a new drug approvalsframework, carried out by the proposed Council on Health ProfessionsRegulatory Excellence (CHPRE) on the advice of a new Drugs andTherapeutics Formulary Committee (DTFC).Other Issues: An Emergency Kit and OxygenHPRAC considered the need for an emergency medications kit, or “crashcart” as it is generally described, for NPs. HPRAC heard during theconsultations with colleges and other stakeholders that NPs should havethe knowledge and necessary tools to handle an emergency situation.The standard emergency medications are as follows:• Oxygen: 100 percent for most medical emergencies (sameconcentration for both adults and children).• Epinephrine: Used for anaphylactic shock, severe asthmatic attacknot responsive to inhaled salbutamol, and cardiac arrest. Injectedinto the muscle (0.3-0.5 mg) or IV (0.1 mg).• Nitroglycerin: Used to treat angina (chest pains). Administered underthe tongue (sublingual) at 0.3 to 0.4 mg.• Diphenhydramine or chlorpheniramine: Used for moderate tosevere allergic reactions. Administered in the muscle or IV at 10-50mg, or 1.0 mg/kg in children.• Salbutamol: Bronchodilator for asthmatic bronchospasm. Two puffs(100 micrograms/puff) or one puff for children.• ASA: Administered if acute heart attack suspected. 160-325 mg inadults. 55HPRAC concludes that an emergency kit should be available to NPs asrequired in some practice settings. The CNO will need to establishstandards, protocols and practice guidelines for emergency situations,including a requirement that members maintain current certification inbasic cardiopulmonary resuscitation.55Royal College of Dental Surgeons of Ontario. Guidelines on the Use of Sedation and GeneralAnaesthesia in Dental Practice. For distribution February 2009. In press and referenced withpermission.HPRAC Critical Links January 2009