Prescribing by Nurse Practitioners RN(EC)
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**Revised additions as of July 2007 noted in red

Nurse practitioners are registered nurses (RN) in the extended class (EC). They will identify themselves with the designation RN (EC). For the related article: "Nurse Practitioner is Now a Protected Title" click here.

As well as the controlled acts available to registered nurses, those registered in the extended class have the authority to perform three additional controlled acts:

1. communicating a diagnosis of a disease or disorder,
2. ordering diagnostic ultrasound, and
3. prescribing a defined range of drugs.

In addition, changes to other acts authorize RNs in the extended class to order specific x-rays and laboratory tests, and to certify death in specific circumstances.

Pharmacists will be most interested in prescribing by the nurse practitioner. Please note that a prescription written by a nurse practitioner must show the RN(EC) credentials of the prescriber. A list of drugs that nurse practitioners may prescribe and their restrictions follows (the list starts with Schedule 2 as there is no Schedule 1 at this time).

For those medications that can only be prescribed for certain disease states, the pharmacist may assume that the nurse practitioner is prescribing appropriately and therefore it is not required that you verify that diagnosis with the patient or nurse practitioner. Ontario Drug Benefit will not require a disease state code for adjudication. If you are concerned that medications are being prescribed for disease states other than those listed, you should contact the nurse practitioner or the College of Nurses of Ontario, rather than challenging the patient.

The College of Nurses of Ontario will provide a list of Nurse Practitioners to Ontario Drug Benefit who will assign billing numbers.

Drugs that Registered Nurses in the Extended Class may Prescribe

(amended July 30, 2007)

- Nursing Regulation 275 -

In March 2007, the Ministry amended the Nursing Act, 1991, to include two new drug schedules for RN(EC)s.

This list includes 19 new drugs that RN(EC)s are authorized in legislation to prescribe.

The Ministry last amended the drug list in August 2004.

The Ministry’s changes and additions to the August 2004 list are highlighted in red.

The Ministry has not removed any items in the August 2004 list.


SCHEDULE 2

  • Diphtheria vaccines - single entity or combination drugs
  • Haemophilus b vaccine
  • Hepatitis A vaccine
  • Hepatitis B immune globulin
  • Hepatitis B vaccine
  • Influenza vaccine
  • Measles vaccines - single entity or combination drugs
  • Meningococcal vaccine
  • Mumps vaccine
  • Pertussis vaccine
  • Pneumococcal vaccine
  • Poliomyelitis vaccine
  • Rh (D) immune globulin
  • Rubella vaccine
  • Tetanus vaccines - single entity or combination drugs
  • Tetanus Immune Globulin
  • Varicella vaccine

SCHEDULE 3
  • Acarbose - for renewal only
  • Acebutolol - for renewal only
  • Acetic acid/benzethonium chloride/hydrocortisone compound
  • Acyclovir (oral)
  • Acyclovir (topical preparation)
  • Alendronate sodium - for renewal only
  • Allopurinol - for renewal only
  • Amantadine hydrochloride
  • Amitriptyline - for renewal only
  • Amlodipine besylate - for renewal only
  • Amoxicillin
  • Amoxicillin and clavulanate
  • Aqueous procaine penicillin G - for the purpose of treating sexually transmitted diseases
  • Atenolol - for renewal only
  • Atorvastatin - for renewal only
  • Azithromycin
  • Beclomethasone dipropionate (inhalation) - for renewal only
  • Benazepril - for renewal only
  • Benzathine penicillin G - for the purpose of treating sexually transmitted diseases
  • Benzoyl peroxide
  • Betamethasone sodium phosphate and gentamicin sulfate otic solution
  • Betamethasone valerate
  • Bisoprolol - for renewal only
  • Budesonide - for renewal only
  • Bupropion - for smoking cessation only
  • Bupropion - for renewal of antidepressant therapy
  • Butoconazole nitrate
  • Candesartan cilexetil - for renewal only
  • Captopril - for renewal only
  • Carbamazepine - for renewal only
  • Cefixime - for the purpose of treating sexually transmitted diseases
  • Cefprozil
  • Ceftriaxone sodium - for the purpose of treating sexually transmitted diseases
  • Cefuroxime axetil (oral)
  • Celecoxib - for renewal only
  • Cephalexin
  • Cilazapril - for renewal only
  • Ciprofloxacin extended release
  • Ciprofloxacin HCI
  • Ciprofloxacin HC (otic)
  • Citalopram - for renewal only
  • Clarithromycin (oral)
  • Clindamycin (oral)
  • Clindamycin (topical preparation)
  • Clindamycin phosphate (vaginal cream)
  • Clopidogrel bisulfate — for renewal only
  • Cloxacillin (oral preparation)
  • Collagenase
  • Condylline
  • Conjugated Estrogens
  • Conjugated Estrogens and medroxyprogesterone acetate
  • Cyanocobalamin (Vitamin B12)
  • Desogestrel and ethinyl estradiol
  • Dextrose 50 per cent (injectable preparation) - in an emergency
  • Diazepam (injectable preparation) - in an emergency
  • Diclofenac sodium and misoprostol
  • Dienestrol
  • Diltiazem - for renewal only
  • Diphenhydramine hydrochloride (injectable preparation) - in an emergency
  • Doxycycline hyclate
  • Doxylamine succinate and pyridoxine hydrochloride
  • Econazole
  • Enalapril maleate - for renewal only
  • Epinephrine
  • Epinephrine hydrochloride (injectable preparation) - in an emergency
  • Eprosartan mesylate — for renewal only
  • Erythromycin and benzoyl peroxide
  • Erythromycin and tretinoin
  • Erythromycin base
  • Erythromycin estolate
  • Erythromycin ethylsuccinate
  • Erythromycin ethylsuccinate/sulfisoxazole acetyl
  • Erythromycin stearate
  • Erythromycin with ethyl alcohol lotion
  • Escitalopram - for renewal only
  • Esomeprazole - for renewal only
  • Estradiol-17 beta (micronized)
  • Estradiol-17 beta (transdermal)
  • Estradiol-17 beta (Silastic ring)
  • Estropipate (piperazine estrone sulfate)
  • Estradiol-17 beta hemihydrate
  • Estradiol-17 beta norethindrone acetate
  • Estrone (cone or cream)
  • Ethinyl estradiol and cyproterone acetate
  • Ethinyl estradiol/drospirenone
  • Ethinyl estradiol and ethynodiol diacetate
  • Ethinyl/etonogestrel (vaginal ring)
  • Ethinyl estradiol and levonorgestrel
  • Ethinyl estradiol and norethindrone
  • Ethinyl estradiol and norethindrone acetate
  • Ethinyl estradiol and norgestimate
  • Ethinyl estradiol and norgestrel
  • Etidronate disodium/calcium carbonate - for renewal only
  • Famciclovir
  • Fluconazole (oral) - for vulvovaginal candidiasis only
  • Flunisolide
  • Fluocinolone acetonide
  • Flumethasone pivalate/clioquinol compound
  • Fluoxetine - for renewal only
  • Fluticasone propionate (inhalation) - for renewal only
  • Fluticasone propionate (nasal)
  • Fluvastatin - for renewal only
  • Fluvoxamine - for renewal only
  • Folic acid
  • Formoterol fumarate dihydrate - for renewal only
  • Fosinopril sodium - for renewal only
  • Framycetin sulphate
  • Framycetin sulphate/gramicidin/dexamethasone compound otic solution
  • Furosemide - for renewal only
  • Fusidic acid (topical preparation)
  • Fusidic acid 1% viscous eye drops
  • Gabapentin - for renewal only
  • Gentamicin sulphate (otic, ophthalmic and topical)
  • Gliclazide - for renewal only
  • Glyburide - for renewal only
  • Haloperidol - for chronic nausea in palliation
  • Hydrochlorothiazide - for renewal only
  • Hydrochlorothiazide/amiloride - for renewal only
  • Hydrochlorothiazide/candesartan - for renewal only
  • Hydrochlorothiazide/cilazapril - for renewal only
  • Hydrochlorothiazide/enalapril - for renewal only
  • Hydrochlorothiazide/eprosartan - for renewal only
  • Hydrochlorothiazide/irbesartan - for renewal only
  • Hydrochlorothiazide/lisinopril - for renewal only
  • Hydrochlorothiazide/losartan - for renewal only
  • Hydrochlorothiazide/pindolol - for renewal only
  • Hydrochlorothiazide/quinapril - for renewal only
  • Hydrochlorothiazide/spironolactone - for renewal only
  • Hydrochlorothiazide/telmisartan - for renewal only
  • Hydrochlorothiazide/triamterene - for renewal only
  • Hydrochlorothiazide/valsartan - for renewal only
  • Hydrocortisone (topical preparation)
  • Hydrocortisone-17-valerate
  • Hydroxyzine hydrochloride (oral preparation)
  • Ibuprofen
  • Irbesartan - for renewal only
  • Imiquimod
  • Ipratropium bromide - for renewal only
  • Ipratropium bromide (inhaler or nebulizer solution) - in an emergency
  • Ipratropium bromide/salbutamol sulfate - for renewal only
  • Ketoconazole (topical)
  • Ketoprofen
  • Labetalol - for renewal only
  • Lansoprazole - for renewal only
  • Levocabastine HCl
  • Levofloxacin
  • Levonorgestrel
  • Levonorgestrel releasing intrauterine system
  • Levothyroxine sodium - for renewal only
  • Lidocaine hydrochloride 1 per cent and 2 per cent, with or without epinephrine (local anaesthetic)
  • Lisinopril - for renewal only
  • Lorazepam (injectable preparation, oral and sublingual) - in an emergency
  • Losaratan potassium - for renewal only
  • Lovastatin - for renewal only
  • Mebendazole
  • Medroxyprogesterone acetate (injectable preparation and oral)
  • Mefenamic acid
  • Meloxicam - for renewal only
  • Mestranol and norethindrone
  • Metformin hydrochloride - for renewal only
  • Metoprolol - for renewal only
  • Metronidazole (oral and topical preparations)
  • Minocycline hydrochloride
  • Mirtazapine - for renewal only
  • Misoprostol
  • Mometasone furoate
  • Mometasone furoate monohydrate
  • Montelukast sodium - for renewal only
  • Moxifloxacin
  • Mupirocin
  • Nadolol - for renewal only
  • Naproxen
  • Naproxen sodium
  • Naratriptan - for renewal only
  • Nicotine patch
  • Nifedipine - for renewal only
  • Nitrofurantoin
  • Nitroglycerin SL or spray - in an emergency
  • Norelgestromin and ethinyl estradiol (transdermal patch)
  • Norethindrone
  • Norethindrone acetate/ethinyl estradiol
  • Nortriptyline - for renewal only
  • Nystatin (oral)
  • Ofloxacin
  • Olopatadine HCL
  • Omeprazole - for renewal only
  • Oseltamivir phosphate
  • Pantoprazole (oral) - for renewal only
  • Paroxetine - for renewal only
  • Penicillin V
  • Perindopril erbumine — for renewal only
  • Phenazopyridine HCl
  • Phenytoin - for renewal only
  • Pindolol - for renewal only
  • Pioglitazone - for renewal only
  • Pivampicillin
  • Podophyllum resin
  • PPD-B (Mantoux)
  • Pravastatin - for renewal only
  • PregVit
  • Progesterone
  • Propranolol - for renewal only
  • Quinapril - for renewal only
  • Rabeprazole - for renewal only
  • Raloxifene HCL - for renewal only
  • Ramipril - for renewal only
  • Ranitidine HCL (oral)
  • Risedronate sodium hemi-pentahydrate - for renewal only
  • Rizatriptan - for renewal only
  • Rosiglitazone - for renewal only
  • Rosuvastatin - for renewal only
  • Salbutamol (inhaler or nebulizer solution) - in an emergency, for renewal or for use in spirometry
  • Salmeterol xinafoate - for renewal only
  • Salmeterol xinafoate/fluticasone propionate - for renewal only
  • Sertraline - for renewal only
  • Silver sulfadiazine
  • Simvastatin - for renewal only
  • Sodium cromoglycate (ophthalmic and nasal preparations)
  • Spironolactone - for renewal only
  • Sulfacetamide sodium
  • Sumatriptan - for renewal only
  • Telmisartan - for renewal only
  • Terbutaline sulfate - for renewal only
  • Terconazole
  • Terbinafine (topical use; or oral use for the treatment of onychomycosis only)
  • Tetracycline hydrochloride (oral preparation)
  • Timolol - for renewal only
  • Tiotropium bromide monohydrate - for renewal only
  • Tobramycin 0.3% ophthalmic solution
  • Topiramate - for renewal only
  • Trandolapril - for renewal only
  • Tretinoin (topical)
  • Triamcinolone acetonide
  • Trichloroacetic acid 50-80%, Bichloroacetic acid 50-80%
  • Trimethoprim
  • Trimethoprim and sulfamethoxazole (oral preparation)
  • Valacyclovir hydrochloride
  • Valproic acid - for renewal only
  • Valsartan - for renewal only
  • Venlafaxine - for renewal only
  • Verapamil extended release - for renewal only
  • Zafirlukast - for renewal only
  • Zanamivir
  • Zolmitripan - for renewal only

When circumstances are set out for a drug in Schedule 3, an RN(EC) shall only prescribe the drug in those circumstances. Until now, routes and/or purposes are the two circumstances identified for certain drugs. The August 2004 amendments to Schedule 3 also include the condition “for renewal only” when prescribing certain drugs.

An RN(EC) who prescribes a drug that is authorized “for renewal only” is accountable for all of the following:

· Knowing that the drug has been prescribed for the client on an ongoing basis for a period of time;
· Knowing that the client’s ongoing response to the drug is predictable, typical, and well-established;
· Determining that the client’s condition has not destabilized or deteriorated and that the established drug regimen remains appropriate for the client;
· Writing the prescription as previously prescribed by the physician without changes to dose, route, frequency;
· Consulting with a physician to discuss any question or concern regarding continued use of the drug as originally prescribed.

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