[EMS/ICU/SRNA]

I overheard an ED attending discussing a policy regarding the administration of propofol w/ an RN at work today. Apparently the policy states that propofol or any other medication may be administered to a non-intubated pt if an attending ED/Pulmonary physician is in the room. This would be done for a procedure ie: reduction of a fx....etc. I asked him why anesthesia personnel would not provide the anesthesia. He responded that the ED/Pulmonary physician is able to provide all services that anesthesia could. What do you guys think about this?

[austin heart]

HUGE thread regarding this topic over in the GI section. It is MANY pages long and is pretty informative.

[MmacFN]

I do this in the ER all the time. Its been a policy for years

[gasmn2b]

Definitely something we do all the time around here, probably has a lot to do with the cost and lack of personel to do things like that with anesthesia. But everyone participating should be inseviced on proper techniques and possible outcomes. I know we are.
Just my 2 cents worth though.

[fungirl]

Originally Posted by MmacFN

I do this in the ER all the time. Its been a policy for years

Do you work in the valley or up north??? Which hospital?? Just curious??

[traumaRUs]

We do it too! Of course, we have semiannual competencies and if we are the least bit uncomfortable, we have MD inject propofol.

[TennRN2004]

Originally Posted by austin heart

HUGE thread regarding this topic over in the GI section. It is MANY pages long and is pretty informative.

I would think the ER is a safer place for RNs to be dosing it...just because if there is a question of pt not being able to maintain airway, at least you have a MD at the head of the bed that's used to having to tube patients. I bet a GI doc couldn't tell you the last time they intubuated someone.

[athomas91]

read the package inserts.... then decide if it is a good idea.

[MmacFN]

hey there

I actually live in Arizona and it is common practice to use diprivan here in the ER both for closed reductions, cardioversions and some docs like to use it to intubate. The state nsg board clearly says that we (RNs) may titrate diprivan on our own but that in order to push it there must be a direct order from a physician who should be standing in the room for some procedure.

Ive also used it when the GI docs come up to sedate patients. I have never had a problem with diprivan as i is a drug im very farmiliar with. The half life alone and how quickly patients come back to baseline makes it much safer than giving massive doses of versed and morphine, as we did in the past.

[midwestsrna1]

Originally Posted by athomas91

read the package inserts.... then decide if it is a good idea.

I agree...after studying anesthesia, I would never agree to push propofol as an RN on a non-intubated patient without an anesthesia provider present. Somehow the "we do it all the time" doesn't seem like it would sound very good in court. The fact of the matter is that patients have died in this situation and propofol can be a very dangerous drug in the wrong hands! Good luck to all of you.

ps. Early in my ICU career, a fellow nurse who did a lot of legal consulting, encouraged me to carry my own malpractice insurance. She said she had seen many situations where the hospital's interests did not allign with the RN's interests. It may be in their best interest to paint you as incompetent, not following official policy (even if it is done frequently), etc. This seems like a perfect example of that to me.