Design and development of a regulatory framework for assessing nurse and midwife controlled drug prescribing in British Columbia

Harm reduction initiatives were introduced in the Canadian province of British Columbia (BC) to prevent overdose deaths and minimize harms posed by illicit opioids. Initiatives included the expansion of opioid agonist prescribing authority to include registered nurses and registered psychiatric nurses and the introduction of a low-barrier safer supply program to improve access to prescribed pharmaceutical alternatives to illicit drugs. In response to the increase in controlled drug prescribing, the licensing and regulatory body for nurses and midwives, the BC College of Nurses and Midwives (BCCNM), began work to develop a regulatory prescription monitoring program. Designed as a component of BCCNM's Quality Assurance Program, the prescription monitoring program will utilize available prescribing data to review and assess the prescribing practices of nurses and midwives against standards of practice. Although prescription monitoring programs are widely used to monitor the prescribing and dispensing of opioids and other controlled substances, such programs historically have not been designed to include nonmedical prescribers. In the present article, we describe the process undertaken to develop the new program for monitoring and assessing the prescribing of nurses and midwives. We review relevant literature, describe our use of journey and process mapping, and discuss lessons learned and future state considerations as we work toward program implementation.