College of Licensed Practical Nurses of British Columbia

College of Licensed Practical Nurses of British Columbia COLLEGE OF LICENSED PRACTICAL NURSES OF BC Extraordinary Board Meeting April 21, 2013 Held at: Delta Burnaby Hotel: Veranda/Portico Room Board Directors Present: Ms. B. Eagle, LPN Board Member, Chair Mr. G. Gibault, Public Board Member Mr. P. Khakzad, Public Board Member Mr. W. Mamaril, LPN Board Member Mr. S. Monteith, LPN Board Member Ms. S. Neden, LPN Board Member, Vice-Chair Ms. M. Overton, LPN Board Member Ms. M. Stevens, LPN Board Member Ms. J. Vereecken, LPN Board Member Regrets: Ms. S Henderson, LPN Board Member Ms. M. Spina, Public Member Staff Present: Ms. Carina Herman, Executive Director/Registrar Ms. Wendy Winslow Director, Policy & Practice Ms. Sara Telfer, Deputy Registrar Ms. Janice Harvey, Nursing Policy Consultant Ms. Megan Waldie, Recorder Guest: Ms. Jo Wearing, Consultant MINUTES Ms. Carina Herman joined the meeting via teleconference. Meeting Called to Order: 8:06 am 1.0 Opening Remarks The Chair welcomed the Board and staff. 2.0 Agenda The Board of Directors reviewed the proposed agenda, and agreed to the addition of 2.2 Correspondence; the agenda was accepted as amended. 2.2 Correspondence The Board Chair, Barb Eagle, read correspondence informing the Board of her resignation from the Board of Directors as of today; she has accepted the Nursing Practice Advisor position starting May 6, 2013. To be transparent and ensure there is no perceived conflict of interest she will withdraw her vote from today; but participate as Chair and in the discussion if all Board members agree. Congratulations on your new position and thank you for all your hard work as Board Chair. 3.0 Motion Required 3.1 Approval of 2012 CLPNBC Financial Statements The Board reviewed the draft financial statements put forward for approval by the Auditors BDO. The group discussed changes from the previous copy that was reviewed; members noted the significant changes as posting errors were discovered in line by line analysis. Staff confirmed this will not be a qualified audit. Page 1 of 4

College of Licensed Practical Nurses of British Columbia Motion 2013_031: the Board accepts the audited financial statements as submitted by the firm BDO for the year-end December 31, 2012, subject to any minor changes in the wording to the notes or reclassification of the balances prior to being included in the Annual Reports per Bylaw 32(3) and submitted to the Minister in accordance with section 18(2) of the Health Professions Act. 3.2 Annual General Meeting Resolution The Board reviewed the resolution put forward for this year s Annual General Meeting (AGM). The Resolution does meet the criteria set out by CLPNBC. Staff will be asking for Board volunteers to respond to questions asked by membership at the AGM. At 8:43 am the Board meeting was adjourned to complete the education session and to review changes to the Standards, Limits, and Conditions that were requested by the Board. The Board moved back into the regular session at 10:43 am. 3.2 Limits and Conditions Current Regulation Limits are developed to clarify what Licensed Practical Nurses (LPNs) are permitted to do within their scope of practice. Conditions identify circumstances under which LPNs may carry out an activity. Motion 2013_032: in the absence of a revised regulation, exercise the College s authority to implement standards, limits, and conditions for LPN practice to the extent possible under the current Nurses (Licensed Practical) Regulation. Motion 2013_033: approve limits and conditions found in Appendix C relevant to nursing activities LPNs can carry out with clinical guidance. Motion 2013_034: approve limits and conditions found in Appendix D relevant to nursing activities LPNs can carry out with an order or clinical direction as of changes made, April 21, 2013. Motion 2013_035: approve limits and conditions found in Appendix E for entrylevel LPN practice in identified New Practice settings for LPNs, with changes made as of April 21, 2013. Motion 2013_036: approve limits and conditions found in Appendix F for LPN practice in identified post-basic settings, as of changes made April 21, 2013. Motion 2013_037: approve limits and conditions found in Appendix G for activities outside the scope of practice, as of changes made April 21, 2013. Page 2 of 4

College of Licensed Practical Nurses of British Columbia Action Item: the Board approved limits and conditions under the current regulation take effect immediately with a transition of gradual implementation with CLPNBC staff, registrants, and employers working collaboratively. Motion 2013_038: when an LPN is currently carrying out nursing activities that require additional education, employers may assess the LPNs competence against the employers standards for additional education. Motion 2013_039: when an LPN is currently carrying out nursing activities that require a named agency, employers may assess the LPNs competence against the provincial standard set by the named agency. 4.0 Call for Election Provision in the CLPNBC Bylaws requires the Board to elect a Chair and Vice-Chair from among its members. Call for nomination of Chair and Vice-Chair; official 30 day notice given, effective today. Interested candidates should put their name forward to the Executive Director executivedirector@clpnbc.org. Staff provided an explanation of the ballots and mailing process. Member Sylvia Neden will be acting Chair until the election process is complete. Board members discussed the election process; and that the expiry of the terms of office for four (4) elected board members will be up in September. To provide continuity the Board requested that member Sylvia Neden act as Chair until the September meeting when the new Board members are orientated. Meeting suspended 12:30 pm 5.0 Jo Wearing Jo Wearing, regulatory consultant, reflected on the past three years of working with the Board. A tremendous amount of work has been done, moving forward without confirmation of what is going to come shows courage and trust in the work that has been done; this is just the starting point of new journey for CLPNBC thank you. Moved back into the meeting 12:39 pm 4.0 Call for Election continued Motion 2013_040: that Sylvia Neden be appointed as acting Chair for the CLPNBC Board until the first Board meeting in September 2013. Motion 2013_041: that Muriel Overton be appointed as acting Vice-Chair until the first Board meeting in September 2013. Staff notified the Board that confirmation has been received from the Board Resourcing Office (BRDO) that a new public member has been appointed. The Board discussed the requirements in the Health Professions Act for appointed and elected membership ratio; staff will look into the requirements of filling the vacancy and report back to the Board. The Board meeting was adjourned 12:54 pm Page 3 of 4

College of Licensed Practical Nurses of British Columbia APPROVED BY THE BOARD OF DIRECTORS Barb Eagle, Chair Signed on Encl. Appendix C Appendix D Appendix E Appendix F Appendix G Page 4 of 4

APPENDIX C CLPNBC Limits and Conditions for Acting with Clinical Guidance Nursing Activity Approved 1 Limit/Condition 1. Assessment of the external ear canal up to the ear drum or assessment beyond the anal verge 2. Providing personal hygiene care beyond the labia majora up to the cervix 3. Inserting a hearing aid into the external ear canal up to the ear drum None LPNs are limited to the insertion of tampons. None 4. Assessing the integrity of the ear drum by applying air under pressure using an otoscope 5. Applying ultrasound with a bladder scanner or Doppler for assessment of peripheral pulses LPNs who assess the integrity of the ear drum must successfully complete additional education required to syringe ears. LPNs do not assess the ankle-brachial index (ABI). 6. Using an automatic external defibrillator in the course of emergency cardiac care LPNs are limited to the use of stand-alone fully automated external defibrillators (AEDs). LPNs expected to use AEDs must successfully complete a cardiopulmonary resuscitation (CPR) course for health professionals that includes the use of AEDs. 1 Approved at the April 21, 2013 Board meeting; inclusive of changes as directed by the Board Page 1 of 9

APPENDIX E CLPNBC Limits and Conditions for Acting with an Order or Clinical Direction Nursing Activity 1. Applying restraints 2. Taking heel pricks Approved 2 Limit/Condition LPNs are limited to applying restraints only when an order is in place. LPNs who carry out heel pricks must successfully complete additional education. 3. Taking ECGs LPNs may take electrocardiograms (ECGs) when a health care professional authorized to read the ECG is immediately available. LPNs who take ECGs must successfully complete education through a named agency (to be determined). 4. Telemetry LPNs are limited to the care of clients on telemetry who have established care needs and whose condition is expected to follow an anticipated path. LPNs who care for clients on telemetry, work in a team nursing approach with an RN. LPNs are not responsible to monitor (read/interpret) telemetry readings. LPNs require additional education to provide care to clients on telemetry. 5. Performing any wound care, IV starts and peritoneal dialysis Wounds Licensed Practical Nurses (LPNs) do not carry out any form of sharps debridement including conservative sharps wound debridement (CSWD). LPNs are limited to the care of wounds with established care needs that are expected to follow an anticipated path. LPNs must successfully complete additional education and follow decision support tools when they: Care for a tunnelled wound (including probing, irrigating and packing) Apply compression dressings Provide negative-pressure wound therapy (VAC dressings) Intravenous Therapy (IV) starts LPNs are limited to starting IVs with short peripheral devices. LPNs who start IVs must successfully complete a formal post basic nursing course given by a school that has a College of Licensed Practical Nurses of British Columbia (CLPNBC) recognized entry-level PN program 3. Peritoneal Dialysis LPNs are limited to the care of clients receiving peritoneal dialysis who have established care needs and whose condition is expected to follow an anticipated path. LPNs who carry out peritoneal dialysis must successfully complete education through a named agency (to be determined). 2 Approved at the April 21, 2013 Board Meeting; inclusive of changes as directed by the Board 3 The course will be designed to teach the competencies included in the Canadian Practical Nurse Registration Examination Blueprint 2012-2016. Page 2 of 9

APPENDIX E Nursing Activity 6. Injecting substances for purposes such as hypodermoclysis and TB skin testing 7. Administering inhaled substances Approved 2 Limit/Condition LPNs who participate in tuberculosis (TB) skin testing by providing the intradermal injection must successfully complete additional education. LPNs do not read/interpret TB skin tests. LPNs do not administer Botox or facial fillers or carry out sclerotherapy. LPNs do not administer or monitor clients taking nitrous oxide. LPNs do not assist in administration of inhaled substances for purposes of anaesthesia/procedural (conscious) sedation. LPNs do not care for clients under general anesthesia, or conscious sedation. 8. Caring for clients using ventilators, and CPAPS and BPAPS LPNs are limited to the care of clients on ventilation who have established care needs, and whose condition is expected to follow an anticipated path. LPNs who care for clients on ventilators, must successfully complete education for the care of adults who use ventilators or for the care of children who use ventilators through a named agency (to be determined). LPNs are limited to the care of clients using continuous positive airway pressure (CPAPs) and bi-level positive airway pressure (BPAPs) where the use of the device is part of the client s established care for sleep apnea. LPNs who care for clients using CPAPs and BPAPs with established care needs must successfully complete additional education. 9. Administering a substance by irrigation LPNs do not irrigate ostomies. LPNs do not irrigate percutaneous tubes (such as nephrostomies and t-tubes) except for those tubes LPNs are permitted to irrigate at entry-level 4. LPNs who change dressings on chest tubes must successfully complete additional education. 10. Instilling a substance enterally or parenterally LPNs do not start transfusions of blood or blood products. LPNs may monitor the client receiving blood or blood products in a team nursing approach with an RN. LPNs do not start or monitor parenteral nutrition. LPNs may provide care 5 to the client receiving parenteral nutrition in a team nursing approach with an RN. LPNs do not administer radiopaque dyes via parenteral instillation. LPNs who assess Central Venous Access Device (CVAD)/central venous line insertion sites may measure a visible central venous line on a client with established care needs and whose condition is expected to follow an anticipated path. LPNs who measure a visible central venous line must successfully complete additional education. LPNs do not access central venous access devices/central venous lines or change dressings for CVADS/central venous lines. 4 These tubes will also be specified in the LPN scope of practice document. 5 Consistent with entry-level competencies Page 3 of 9

APPENDIX E Nursing Activity 11. Putting an instrument or a device into the external ear canal 12. Activities beyond the point in the nasal passages where they normally narrow Approved 2 Limit/Condition LPNs who participate in hemodialysis must take a post basic course. LPNs do not remove foreign objects or ear wax using a curette or other instrument. LPNs are limited (in suctioning beyond the nasal passages where they narrow) to the care of clients with established care needs for suctioning and whose condition is expected to follow an anticipated path. LPNs suctioning beyond the nasal passages where they normally narrow must successfully complete additional education. LPNs who carry out nasal pharyngeal swabs must successfully complete additional education. LPNs do not insert nasogastric (NG) tubes or oral gastric tubes (OG) or carry out nasal pharyngeal washes. 13. Catheterization via the urethra 14. Activities into the vagina LPNs who catheterize clients with a coude tip catheter must successfully complete additional education. LPNs do not insert vaginal packing. LPNs who remove vaginal packing must successfully complete additional education. LPNs who insert or remove pessaries must successfully complete additional education. LPNs do not carry out pelvic or vaginal examinations, perform cervical cancer screening, or insert an instrument or substance into or beyond the cervix. 15. Activities beyond the anal verge LPNs who carry out digital stimulation and rectal disimpaction must successfully complete additional education. LPNs who insert rectal tubes must successfully complete additional education. LPNs do not insert or advance scopes for rectal/bowel examinations. 16. Activities into an artificial opening of the body LPNs are limited to suctioning tracheostomy tubes in clients who have established care needs and whose condition is expected to follow an anticipated path. LPNs who suction clients with tracheostomies and change inner cannulas must successfully complete additional education. LPNs do not change outer tracheostomy cannulas. LPNs are limited to digital examination of colostomies for clients with well-established colostomies and whose condition is expected to follow an anticipated path. LPNs who carry out a digital examination of a colostomy must successfully complete additional education. LPNs are limited to the insertion of well-established suprapubic catheters and gastrostomy tubes. LPNs who insert well-established suprapubic catheters and gastrostomy tubes must successfully complete additional education. Page 4 of 9

APPENDIX E Nursing Activity 17. Syringing the ears Approved 2 Limit/Condition LPNs are limited to gentle syringing of ears with water that is under pressure equal to or less than the pressure created by an ear bulb syringe. LPNs who syringe ears must successfully complete additional education that includes the competencies required to assess the integrity of the ear drum. 18. Applying ultrasound for diagnostic or imaging purposes including any application of ultrasound to a fetus 19. Compounding any drug 20. Administering any drug LPNs do not apply external fetal monitors or provide fetal health surveillance via a Doppler. LPNs are limited to practice in post-partum settings. LPNs do not carry out an ABI procedure. None LPNs may change IV bags infusing via peripheral access (not central or midline) containing Ringers or potassium chloride (KCL) when the IV bag has the Ringers or KCL premixed commercially or prepared and premixed in a pharmacy. LPNs who change IV bags containing KCL or Ringers must successfully complete additional education. LPNs who give any other IV medications must successfully complete a formal post basic nursing course given by a school that has a CLPNBC recognized PN program 6. LPNs do not give IV push medications or give IV medications through a CVAD/central venous line or a mid-line catheter. LPNs do not give medications via intrathecal or intra-osseous routes, or into epidural and/or perineural spaces. LPNs do not assist in administration of medications or inhaled substances for purposes of anaesthesia/procedural (conscious) sedation. LPNs do not provide care for clients under general or intrathecal anesthesia, or under conscious sedation. LPNs who care for clients recovering from epidural anesthesia must successfully complete additional education. 21. Dispensing any drug 22. Compounding or dispensing a therapeutic enteral diet LPNs giving immunizations must complete the approved BCCDC immunization program and are limited to immunizing clients four years of age and older. LPNs are limited to dispensing 7 medications that have been previously dispensed by a pharmacist. None 6 The course is designed to teach the competencies (knowledge, skill, judgment and attitude) included in the Canadian Practical Nurse Registration Examination Blueprint 2012-2016. 7 Previously addressed by CLPNBC as re-packaging or transferring a medication to a client for self-administration while out on a pass Page 5 of 9

APPENDIX E CLPNBC Limits and Conditions in New Practice Settings for LPNs In the following practice settings Licensed Practical Nurses (LPNs) have an orientation that allows them to apply entry-level competencies in new practice settings. Practice Setting Post-Partum LPNs care for mothers and newborns anticipated to require routine post-partum care after an uncomplicated delivery and a period of stabilization. Approved 8 Limit/Condition LPNs are limited to providing care for mothers and newborns with established care needs and whose condition is expected to follow an anticipated path. LPNs do not care for antenatal clients or care for intra-partum (laboring) women including being the second nurse at a delivery. LPNs require an unit orientation consistent with LPN entry-level competencies that includes: infant resuscitation as part of a cardiopulmonary resuscitation (CPR) course for health professionals newborn and maternal assessment, including breast-feeding consistent with the Perinatal Services British Columbia (PSBC) Newborn Clinical Pathway and the Postpartum Clinical Pathway. LPNs caring for neonates in post-partum settings do so only when a Registered Nurse/Nurse Practitioner/Medical Doctor is immediately available for assistance, should client care requirements exceed entry-level LPN competencies. Emergency Room LPNs require an unit orientation that is consistent with LPN entry-level competencies 9. LPNs do not triage clients in emergency rooms (ERs). LPNs are limited to carry out assessment of clients in ER following initial assessment (or triage) by the RN. LPNs may care for triaged level 4 and 5, and admitted clients in ER settings using a team nursing approach with an RN. LPNs do not care for triaged 10 level 1 or 2 or 3 clients in ER settings. Mental Health and Substance Misuse LPNs who work in settings where mental health and substance misuse 11 is 8 Approved at the April 21, 2013 Board Meeting; inclusive of changes as directed by the Board 9 Exception to entry-level LPN practice- see Appendix D- Activities that Require an Order or Clinical Direction LPNs may take electrocardiograms (ECGs) when a health care professional authorized to read the ECG is immediately available. LPNs who take ECGs must successfully complete education through a named agency (to be determined). See page two, nursing activity #3. 10 Canadian Triage and Acuity Scale (CTAS) - Level 1 Resuscitative; Level 2 Emergent; Level 3 Urgent; Level 4 Less Urgent; Level 5 Non-urgent. Exception to entry-level LPN practice- see Appendix D-Activities that Require an Order or Clinical Direction LPNs may take electrocardiograms (ECGs) when a health care professional authorized to read the ECG is immediately available. LPNs who take ECGs must successfully complete education through a named agency (to be determined). See page two, nursing activity #3. Page 6 of 9

APPENDIX E Practice Setting Approved 8 Limit/Condition the primary diagnosis require an orientation that is consistent with LPN entrylevel competencies. LPNs who work in settings where mental health and substance misuse is the primary diagnosis, work in a team assignment model and care for clients with established care needs and whose condition is expected to follow an anticipated path. LPNs who work in settings where mental health and substance misuse is the primary diagnosis and who graduated from a program other than the new Provincial Practical Nurse Curriculum (PPNC), must successfully complete a nursing course given by a school that has a CLPNBC recognized PN program 12. 11 This does not refer to clients requiring detoxification. 12 The course will be designed to teach the mental health and substance misuse competencies found in the PPNC. Page 7 of 9

APPENDIX F CLPNBC Limits and Conditions for LPN Practice Requiring Post-Basic Education Post Basic Practice The following nursing activities are beyond entry-level LPN preparation. Licensed Practical Nurses require formal post basic education (using a named agency) to prepare them to carry out these activities. Post-Basic Practice Hemodialysis Nursing Approved 13 Limit/Condition LPNs who participate in hemodialysis must successfully complete additional education through a named agency (to be determined). LPNs are limited to use of an arteriovenous (AV) fistula or AV graft. LPNs are limited to care of clients with established care needs for hemodialysis, whose condition is expected to follow an anticipated path. A Registered Nurse (RN) must be on site and immediately available for assistance should client care requirements exceed the LPN scope of practice and the LPN s individual competence. Perioperative Nursing LPNs must successfully complete education through a named agency (to be determined) to work in the Operating Room (OR) or in a scrub or circulating role in any perioperative setting 14. LPNs may carry out the scrub role or the second circulating role (when a formal distinction exists in the facility between the primary and second circulating role). LPNs do not assist in administration of medications or inhaled substances for purposes of anaesthesia or procedural (conscious) sedation. LPNs do not care for clients under general, intrathecal or epidural anesthesia, or conscious sedation 15. LPNs do not recover clients in the initial post-operative period. LPNs who work in ambulatory care settings (i.e. surgical daycare, endoscopy clinics and ophthalmology clinics) and surgeons offices and clinics, provide care in a team nursing approach with an RN. 13 Approved at the April 21, 2013 Board Meeting; inclusive of changes as directed by the Board 14 Perioperative LPNs practice in a variety of perioperative settings, including: hospital stays, ambulatory settings, and surgeons offices and clinics. (Canadian Council for Practical Nurse Regulators- Standards of Practice and Competencies for Perioperative Licensed Practical Nurses, p. 4, 2010) 15 This does not preclude LPNs from providing other care for clients in the perioperative circulating or scrub role. Page 8 of 9

APPENDIX G CLPNBC Limits for Activities Outside the Scope of LPN Practice Nursing Activity Apply electricity Apply laser Administer allergy challenge testing or desensitization treatments Laryngeal Mask Airways (LMAs) Approved 16 Limit/Condition LPNs do not apply electricity 17 to destroy tissue or affect the heart or nervous system (exception: fully automated standalone AEDs). LPNs do not apply laser that cuts or destroys tissue. LPNs do not administer or participate in allergy challenge testing or desensitization treatments. LPNs do not insert LMAs. 16 Approved at the April 21, 2013 Board Meeting; inclusive of changes as directed by the Board 17 Examples include applying electricity for the purposes of cautery, defibrillation and ECT. Page 9 of 9