I am an RN on a palliative-care pain team. Recently, a physician wrote a medical directive for the use of narcotics with our clients. Is there anything I should be aware of before acting on this directive?

You cannot implement this directive because it is for narcotics. Prescribing and administering narcotics is subject to the federal Controlled Drugs and Substances Act and the Narcotic Control Regulations. The latter legislation defines a narcotic prescription as “an authorization given by a practitioner that a stated amount of the narcotic be dispensed for the person named in the prescription.” Consequently, prescriptions for narcotics must be client-specific. A medical directive for a group of clients does not fulfill the federal legislative requirements.

With the Office of Controlled Substances, the College, along with other organizations across Canada, continues to explore issues around prescribing narcotics and controlled substances through medical directives. The College will communicate with members through The Standard and the website when new information is available.

In the meantime, the College has heard of strategies developed by members to meet the federal requirements. For example, several practice settings have adopted sets of pre-printed orders that are easily individualized for each client and signed by the physician prior to implementation.