It all started with a discussion in late 2013 between the College, the B.C. Centre for Disease Control (BCCDC), the Provincial Health Services Authority (PHSA) Professional Practice Office and others involved in harm reduction. How could we work together to tackle the troubling reality that a considerable number of people continue to die of opioid drug overdoses in British Columbia?

Many opioid overdoses are preventable through the administration of naloxone. This medication, also known by the trade name Narcan, reverses the effects of an overdose from opioids such as heroin, methadone, morphine and even fentanyl. At the College we understand that health professionals, including registered nurses, are an important lifeline and resource for people at risk for drug overdoses. In some cases, a registered nurse is their first point of contact for health concerns and information. To help address this growing problem, BCCDC’s Harm Reduction Strategies and Services (HRSS) launched the Take Home Naloxone (THN) Program.

From the launch of the program, many health professionals, including registered nurses, have played an important role in the success of the THN program. That said, registered nurses faced some challenges. At the time of the pilot’s launch, the province’s RN scope of practice required registered nurses to receive an order before dispensing naloxone. This meant nurses couldn’t dispense the take home kits without an order from a physician or nurse practitioner.

To improve access to naloxone by those who need it most, the College was asked if we could consider changes to the RN scope of practice, allowing registered nurses to dispense the drug autonomously without an order.

CRNBC’s policy and practice team considered this issue thoroughly. As a regulator we are committed to being responsive and applying right-touch regulation. This means listening carefully to the nursing and healthcare community. This means using the right amount of regulation to ensure public safety—not too much and not too little. This means nursing standards, limits and conditions that work in the real world.

After speaking with the BCCDC team and others, we set out to take a closer look at what we could do as a nurse regulator to address this concern. Making changes to the RN scope of practice requires careful consideration of all the issues. Public protection is always our number one priority. It was important for us to collaborate with those who work directly with people who are particularly at risk. We held discussions with representatives of BCCDC, the Provincial Health Services Authority and Vancouver Coastal Health. We also consulted with the College of Physicians and Surgeons of B.C. and the College of Pharmacists of B.C.

Through this work, I believe we established a balanced and sound approach. We are pleased to report that this spring, as a result of our collaboration, CRNBC’s Board approved a change to the RN scope of practice. Registered nurses can now dispense naloxone autonomously. Those who dispense naloxone must possess the competencies established by BCCDC and follow decision support tools established by BCCDC.

CRNBC is grateful for the collaborative spirit of everyone involved. In light of recent Fentanyl overdoses across the province, it is important registered nurses and their employers understand this recent change to the RN scope of practice.

I, on behalf of CRNBC, commend the work of the THN program. At least 250 overdoses have been reversed in our province using the kits since they became available. The kits are offered, in at least 88 sites around the province, and come with training on how to administer the drug for the client, and their family or friends if possible.

Every day, healthcare professionals work in partnership to deliver safe competent care and ultimately help save lives. For me personally, this story demonstrates the important role we can play as a responsive nurse regulator who works in the public interest. Good, responsive right-touch regulation protects the public and supports healthcare professionals in what can be life-saving work.

Helpful links and resources:
Nurses can dispense naloxone (Narcan) without an order
Decision Support Tool for Dispensing Naloxone
Nursing Competencies for Dispensing Naloxone
Decision Support Tool (DST) for Naloxone Administration