Questions about naloxone
Health Canada recently made naloxone more accessible without a prescription. The College has received questions from you about how this affects nursing. Here are the answers to two of them. For more information about naloxone, see the Ministry of Health and Long-Term Care’s website.
1. In emergency situations, can RNs and RPNs administer naloxone by injection or inhalation without an order?
In most cases, RNs and RPNs need an order to perform the controlled act of administering a substance by injection or inhalation. However, the Regulated Health Professions Act, 1991 lists several exceptions when people can perform controlled acts in defined circumstances. One of these is when you are providing first aid or temporary assistance in an emergency.
Your practice environment (such as the client population, types of services you provide and chance of unpredictable events occurring) affect whether or not the emergency exception applies.
Here is one example: if you provide care to clients with opioid use disorder at a supervised injection site, your role may include administering naloxone when required. Knowing that you will be expected to administer, you can work with other health professionals and your employer to have an order in place when you are providing first aid or temporary assistance in an emergency. As well, you can advocate for any policies and procedures that may be required.
If the emergency exception does not apply, you need an order to administer naloxone by injection or inhalation. That order could be a direct order or a directive. Whoever has the decision-making authority in the practice environment must identify which option (i.e., emergency exception or order) is appropriate.
Regardless of whether the exception applies, nurses must meet the same expectations as any procedure when administering naloxone.
These expectations include:
being accountable for the decision to perform the controlled act and for its performance
considering the client’s needs and best interests, and determining whether the client’s condition warrants the performance of the procedure
having the knowledge, skill and judgment to perform the procedure safely and ethically
ensuring the practice environment has the appropriate resources to perform the procedure safely, and managing reasonably expected outcomes
participating in all aspects of assessment and management of the procedure and its outcomes, and documenting this information
2. Can nurses teach unregulated care providers (UCPs) to administer naloxone?
Yes, as long as they follow the requirements for teaching outlined in the Working with Unregulated Care Providers practice guideline.
For example, the nurse must:
have the knowledge, skill, and judgment to perform the procedure competently
have the additional knowledge, skill, and judgment to teach the procedure
accept sole accountability for the decision to teach the procedure
Read the Working With Unregulated Care Providers practice guideline for more information and the complete list of requirements for teaching to UCPs.