In emergency situations, can RNs and RPNs administer naloxone by injection or inhalation without an order?
Yes, but you have to consider provisions under the Regulated Health Professions Act, 1991 (RHPA) and your practice environment to determine if you can. Here is why: In most cases, RNs and RPNs need an order to perform the controlled act of administering a substance by injection or inhalation. However, the RHPA 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. Nevertheless, your practice environment (such as the client population, types of services you provide and chance of unpredictable events occurring) affect whether or not this 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 probably be expected to administer, you can work with other health professionals and your employer to have an order in place for when you need to provide 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 activity 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 activity
- having the knowledge, skill and judgment to perform the activity safely and ethically
- ensuring the practice environment has the appropriate resources to perform the activity safely, and managing reasonably expected outcomes
- participating in all aspects of assessment and management of the activity and its outcomes, and documenting this information
The clinic where I work has started stocking naloxone for distribution to clients who are at risk for opioid overdose. As a nurse, am I authorized to distribute naloxone to clients?
Nurses are permitted to distribute naloxone when it is indicated for emergency use for opioid overdose outside hospital settings. Naloxone no longer requires a prescription under such circumstances.
You should ensure that your practice setting supports nurses performing this activity and review any relevant legislation that is specific to your practice setting. You should also ensure that you adhere to the Medication practice standard and educate the client about their medication.
CNO does not require nurses to complete any specific training or education to distribute naloxone. However, as with any activity or procedure you are performing, you must ensure that you have the knowledge, skill and judgment required to distribute naloxone safely.
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.