General Regulations

Linked below are the official policies published by the College and Association of Registered Nurses of Alberta, the College of Physicians and Surgeons of Alberta, and the Alberta College of Pharmacy, which CRMC has adopted as its official policies for medication management (all of them are applicable to all regulated members of staff of CRMC).

CRNA Medication Management Standards - March 2021 (web link)

CPSA Prescribing Tools & Resources - 2021 (web link)

CPSA Prescribing: Administration - April 2017 (web link)

ACP Transmission of Prescriptions - February 2021 (web link)

ACP Electronic Transmission of Prescriptions Allowed in Limited Circumstances - March 2016 (web link)

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Medication Reconciliation Policy

CRMC's Medications Reconciliation Policy may be found by clicking on this link.

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!!! High-risk / High-alert Medications Policy !!! (ROP 1.7 Accreditation Canada)

Cranston Ridge Medical Clinic does not accept nor store within its premises high-risk medications such as Potassium, Insulin, Narcotics, Chemotherapeutic agents, or Heparin (PINCH medications). This policy is permanent, not subject to change, and is strictly enforced by the Clinical Manager (Dawid Karczewski) and the Health and Safety Officer of CRMC (Anita Sondej) who, in conjunction, monitor the in/outflow of all sample medications and emergency medications on a weekly basis.

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Regulations regarding Registered Nurses and Nurse Practitioners distributing sample medications:

Guideline 37:

Nurses are authorized to dispense medication in a particular practice setting:

1. when supported by practice setting policy

2. based on client need

3. when there is no pharmacist available*

4. when following ACP’s standard for dispensing

"STANDARD 7 (web link):

Each time a pharmacist or a pharmacy technician dispenses a Schedule 1 drug or blood product pursuant to a prescription, the pharmacist or the pharmacy technician must ensure that:

a) the prescription is filled correctly,

b) appropriate dispensing procedures are used,

c) the drug or blood product is packaged properly,

d) the container is labeled properly, and

e) a final check is performed".

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Accepting Samples from Representatives

Samples of medication are often provided by pharmaceutical companies free of charge to specific authorized health-care providers. The Canada Food and Drug Regulation (2023) C.R.C., c.87, in the subsection C.01.048 (1.1), states that "a person may distribute or cause to be distributed a prescription drug as a sample under subsection (1) only to a practitioner or pharmacist who is entitled, under the laws of the province in which they are practising, to prescribe or dispense that drug, as the case may be." Family Physicians are considered medical practitioners. As per CRNA's regulations only nurse practitioners, among all nurses, are authorized to accept medication samples from pharmaceutical companies. CRNA's standards specifically state that registered nurse prescribers "must not accept medication samples from pharmaceutical companies."

 

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When Distributing Sample Medications

• Nurses need to be aware of the following risks associated with sample medication:

• Sample medications are often dispensed without clear instructions for use. Errors of all types have occurred when clients are unclear about the use of sample medication (ISMP, 2007a).

• Sample medication packaging may not contain adequate or clear information related to administration, safe storage, handling or disposal of the medication and often do not come in child proof containers.

• Extended storage of sample medications may lead to the distribution of expired drugs.

• Distribution of sample medications may bypass the client seeing the pharmacist. Therefore, drug interactions with other prescription and non-prescription medication may not be explored.

• Distribution of sample medications may bypass the recording of the medication on the Provincial electronic health record.

• Clients supplied with sample medications often do not receive the monitoring required to detect possible adverse effects.

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* This rule is formulated in a way that appears vague and open to interpretation. CRMC interprets this as "no pharmacist immediately available in the building".

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Verbal Orders for Medications

CRMC does not allow for any verbal order for medications. All prescriptions must be received in writing either via EMR or via fax. The full name and PRAC-ID of the prescriber must be identified clearly and the signature must be legible.

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Minimum Qualification for Medication Management at CRMC

Acceptance of new medications - MDs and NPs

Ordering of medications - MDs, NPs, and RN Prescribers

Dispensing of medications - MDs, NPs, RNs, and LPNs

Access to and use of emergency medications needed during CPR or First Aid - all members of staff