[ZASHAGALKA]

Originally Posted by nurse-lou

Candy,

Let me rephrase my original reply. I have no problem developing policies for generalized nursintg tasks. We do this all the time at my facility. Sedation protocols involve MEDICATIONS and prescribing meds is not in the nurses scope of practice. If the facility of the OP has a PharmD involved then that person should be the driving force behind such a policy. Nursing should of course have input in developing such a policy. I wouldn't be comfortable solely developing policy on something that involves giving MEDICATIONS. Yes I titrate them all the time but the sedation policy in my facility is driven by the Intensivist/PharmD/Critical Care Nurse Specialist according to the SCCM (Society of Critical Care Medicine) guidelines. In smaller facilities, such policies are usually driven by nurses but approved by the Medical Director of said ICU.

I NEVER said that nurses shouldn't write policies in general. I don't think that nurses should be the sole writer of policies involving medications.

Our Sedation Protocol, Insulin Protocol, and Electrolyte Replacement Protocol are all written and updated by a protocol committee composed of Nurses and Clinical Pharms. Once written, they are approved by the Medical Committee (The Docs) and Administrative Oversight.

Any Doctor can opt out of using the protocols, but unless specifically d/c'd as an order, they are standing orders, by order of the Medical Committee.

But I'll tell you one thing, If nurses aren't helping to write these protocols, they won't be very effective. You HAVE to involve the end user in the formation of a product if you want to see the product from the end user's point of view.

And I know that doesn't contradict what you said. I'm not challenging your point, but expounding on it.

~faith,
Timothy.

[candyndel]

Generalized nursing tasks...like bed baths? Why would one even need a policy for generalized nursing tasks? That's what our generic nursing programs were for!

If I am administering the MEDICATIONS then I am deciding (and I say that collectively) the best way to monitor their effectiveness. A medication policy such as this one doesnt bestow prescriptive privileges upon the staff nurse, but provides him/her with the tools needed to safely perform the high risk task once ordered.
It also protects the patient from inappropriate orders/useage and serious potential harm (examples: insulin, potassium, "old" propofol useage, nesiritide, ibutilide,etc etc etc ...I cant even get started on SGC's!).
Like I have already said, it is a nurse driven collaborative effort. And if you were my patient, you'd thank me for how much weight I place on patient advocacy in our myriad of nursing roles.

[nurse-lou]

Generalized nursing tasks...like bed baths? Why would one even need a policy for generalized nursing tasks? That's what our generic nursing programs were for!

Actually, I think that it's a JCAHO rule that says something like if you perform it on a pt then there must be a written policy for it. I checked my facilities policy handbook and there are policies for bed baths AND bed making!

At YOUR facility Candy, the protocol may be nurse driven but at my facility which uses intensivists and Critical Care PharmD's, they drive the sedation protocol.

[candyndel]

WOW- That must be some book if you have a policy on every task a nurse does!
Here's the JCAHO reg on nursing policies...

Elements of Performance for NR.3.10
1. The nurse executive, registered nurses, and other designated nursing staff members write
nursing policies and procedures; nursing standards of patient care, treatment, and services;
standards of nursing practice; a nurse staffing plan(s)‡; and standards to measure,
assess, and improve patient outcomes.
2. The nurse executive is responsible for ensuring that nursing policies, procedures, and standards
describe and guide how the nursing staff provides the nursing care, treatment, and
services required by all patients and patient populations served by the hospital and as
defined in the hospital’s plan(s) for providing nursing care, treatment, and services.
3. All nursing policies, procedures, and standards are defined, documented, and accessible
to the nursing staff in written or electronic format.
4. The nurse executive or a designee(s) exercises final authority over those associated with
providing nursing care, treatment, and services.

[msjangir]

sedation of patients on mech. ventlilation depends upon which mode of ventilator pt is on .if pt is on vc we need to sedate pt fully so the pt can getfull volume. whereas on weaning mode we usualy do not use sedation.

mahendra
rn