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   Last modified: June 17, 2005

Proposed RN(EC) drug, lab and diagnostic test list


Feedback

Feedback is important to ensure an inclusive process. Publication allows further comments and concerns to be raised by stakeholders and members at large.

Please forward comments regarding the proposed additions and changes by August 2, 2005 to:

Attention: Jenna Hofbauer
E-mail: jhofbauer@cnomail.org
Fax: 1 416 928-5916
or
Mail:
College of Nurses of Ontario
101 Davenport Rd.
Toronto, Ontario M5R 3P1

 

The College of Nurses of Ontario is pleased to present the recommendations for changes to the Registered Nurses in the Extended Class (RN(EC)) Drug and Laboratory Lists. The process of updating the list helps RN(EC)s keep pace with current practice trends and client needs.

Through a consultative process involving members and the Nurse Practitioner Association of Ontario, review and recommendations by an expert panel, and discussion and rationalization from stakeholders the draft list below has been compiled for publication to members. The proposed additions/changes have been made based on:

  1. CNO practice standards for RN(EC)s; and
  2. that drugs, labs and diagnostic tests are:
    • broadly applicable to primary health care practice of RN(EC)s across Ontario;
    • specific to the treatment of conditions within the RN(EC) scope of practice; and
    • efficacious and cost-efficient.

Proposed Additions to the Drug List

Medication Rationale
*Fusidic acid 1% viscous eye drops
(Fucithalamic)		 Offers further choice for treating bacterial conjunctivitis. Potential to improve adherence to treatment regime (twice daily administration).
*Tobramycin 0.3% ophthalmic solution
(Tobrex)		 Offers further choice for treating bacterial conjunctivitis. Concerns re: applicability to primary health care
*Olopatadine HCL
(Patanol)		 Dual mechanism of action for treating allergic conjunctivitis. Potential to improve adherence to treatment regime (twice daily administration). Offers RN(EC)s additional treatment options for allergic conjunctivitis.
Ethinyl estradiol/drospirenone
(Yasmin)		 Offers further options for women choosing an oral contraceptive agent, similar efficacy and cycle control with other oral contraceptive pills. Possible weight loss. Potential for hyperkalemia.
Ethinyl/etonogestrel (vaginal ring)
(NuvaRing)		 Offers further options for women choosing an hormonal contraceptive agent, novel route, monthly dosing and potential to enhance adherence, similar efficacy and cycle control to oral agents.
Norelgestromin & ethinyl estradiol
(transdermal patch)
(Evra)		 Offers further options for women choosing an hormonal contraceptive option, novel route, weekly regime and potential to enhance adherence, similar efficacy and cycle control to oral agents.
Buproprion
(Zyban)		 Offers a broader range of health promotion and disease prevention strategies for smoking cessation. Concerns due to potential severe side effects.
Naproxyn sodium
(Anaprox)		 Indication for primary dysmenorrhea. Unclear if this drug will enhance what RN(EC)s are currently able to prescribe.
PregVit Option in prenatal vitamin choices, requires prescription due to dose of folic acid (1.1mg), RN(EC)s are able to prescribe folic acid.
Mometasone furoate
(Elocom)		 A moderate potency topical agent for the treatment of dematoses responsive to steroids, once daily dosing.

*stakeholder concerns/comments re: ophthalmic preparations:
– Requires advanced diagnostic capacity
– Consequences of delay/misdiagnosis may be severe
– Adherence to CNO standards of practice for consultation reduces risk of misdiagnosis

 

Proposed Additions to the Drug List “for Renewal Only”

Medication Rationale
Rosiglitazone
(Avandia)		 Pharmacotherapeutic management of Diabetes Mellitus Type 2 (DMT2) is dependent on a range of medications including Thiazolidinediones. RN(EC)s can renew many of the drugs for the management of stable DMT2. Ensuring continuity of care and timely access to a range of drugs will enable optimal management of plasma glucose in clients with DMT2. Scope of practice of RN(EC)s includes the management of stable chronic conditions. Other medications used for glycemic control have been previously authorized “for renewal only.”
Pioglitazone
(Actos)		 As above
Atorvastatin
(Lipitor)		 HMG-CoA Reductase Inhibitors assist with maintenance of stable hyperlipidemia alone and concurrently with Diabetes Mellitus Type 2. Scope of practice of RN(EC)s includes the management of stable chronic conditions. The majority of clients requiring medications for hyperlipidemia are prescribed a “statin.”
Pravastatin
(Pravachol)		 As above
Fluvastatin
(Lescol) 		As above
Lovastatin
(Mevacor)		 As above
Simvastatin
(Zocor) 		As above
Rosuvastatin
(Crestor)		 As above

 

Proposed Revisions to the Drug List

Medication Rationale Recommendations
Vaccinations (Schedule 2) Streamline the options and ensure flexibility to meet recent and future changes. List each vaccine as an individual item. Add diphtheria vaccine.
Rofecoxib (Vioxx) Medication is no longer available. Remove from the list.
Fluconazole (Diflucan) for renewal only Provide further options for women’s health care in the treatment of vulvovaginal candidiasis. Eliminate the criteria “for renewal only”. Change the criteria for prescribing to “for vulvovaginal candidiasis only”. Fluconazole (diflucan) orally (for vulvovaginal candidiasis only).
Terbinafine for topical use only Onychomycosis is a common condition requiring systemic treatment. Concerns due to potential serious side effects. Add for oral use in the treatment of onychomycosis. Terbinafine (topical use; or oral use for the treatment of onychomycosis only).
Salbutamol (inhaler or nebulizer solution) in an emergency or for renewal Spirometry can be ordered by an RN(EC) however, the additional evaluation by salbutamol challenge is helpful in determining a diagnosis of restrictive airway disease (asthma). Salbutamol (inhaler or nebulizer solution) in an emergency, for renewal or for use in spirometry.
Lorazepam (injectable preparation and oral) — in an emergency Sublingual route has a faster onset of action. Add sublingual route. Lorazepam (injectable preparation, oral and sublingual) — in an emergency.

 

Proposed Changes to the Existing Laboratory List

Test Rationale Recommendation
Microalbumin Routine monitoring of nephropathy in Diabetes Mellitus Type 2. Add to the list
Albumin: creatinine ratio (ACR) Routine monitoring of nephropathy in Diabetes Mellitus Type 2. Add to the list
Parathyroid hormone Complex metabolic conditions, not acute or episodic, not illness preventing and is not representative of a condition generally monitored in Primary Health Care. Remove from the list

 

Proposed Additions to the RN(EC) diagnostic test list (radiology tests)

Test Rationale Recommendation
Hip x-ray Required to confirm a diagnosis, acute or chronic condition. Rule out a diagnosis requiring physician consultation. HARP amendments need to be pursued regarding addition of these radiographic views to enable addition to the current approved list. Add to list
Shoulder x-ray Required to confirm a diagnosis, acute or chronic condition. Rule out a diagnosis requiring physician consultation. HARP amendments need to be pursued regarding addition of these radiographic views to enable addition to the current approved list. Add to list
Bone Mineral Density As part of prevention and health promotion and identification of a health condition in peri/postmenopausal well woman care. HARP amendments need to be pursued regarding addition of these radiographic views to enable addition to the current approved list. Add to list

 

Explore the current RN(EC) drug and lab list or read the Practice Standard - Medication (PDF)

 

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