Endoscopy Center without RN in procedure room ??

[hatfieldrocks]

Hi! I work at an endoscopy center in Indiana. Right now we have 4 rooms running all day. Each room has a M.D., CRNA, RN, and Tech (sometimes interchanged with CST). We give propofol, administered by CRNA. The RN is responsible for charting and helping with the procedure. While the tech is responsible for assisting the RN or maintenance of equipment. Our facility is looking at implementing a new system where the RN is no longer needed in the procedure room. The CRNA and tech/cst will split the duties of the RN. I was curious if anyone is familiar with this technique? If so, what are the pros vs cons. Thanks!

[Student Mom to Three]

Kind of taking this thread on a tangent....but my experience has been that insurance will only cover conscious sedation for the scoping unless there is a medically justifiable reason for deep sedation. We only have an anesthesiologist once per week for those with severe sleep apnea, huge BMI, those who had an unsuccessful conscious sedation in the past, etc.

When we do have the anesthesiologist in the room we also have the MD and an RN. Seems like it would be easier to do without the tech in the room. The RN can assist in monitoring the patient and help with the procedure. At our facility the techs can do simple polypectomies and biopsies, but cannot clip, inject saline or epi or tattoo. The RN has to be present for these things.

When we don't have the anesthesiologist it is the MD and the sedation RN in the room. If there are multiple polyps, random biopsies or something equally time consuming the RN will call for another RN or tech to assist. That "assist" person is also responsible for cleaning and setting up the room.

I think our process is pretty slick and works well.....of course it is the only system I know!!

[MissChrissy]

Kind of taking this thread on a tangent....but my experience has been that insurance will only cover conscious sedation for the scoping unless there is a medically justifiable reason for deep sedation. We only have an anesthesiologist once per week for those with severe sleep apnea, huge BMI, those who had an unsuccessful conscious sedation in the past, etc.

When we do have the anesthesiologist in the room we also have the MD and an RN. Seems like it would be easier to do without the tech in the room. The RN can assist in monitoring the patient and help with the procedure. At our facility the techs can do simple polypectomies and biopsies, but cannot clip, inject saline or epi or tattoo. The RN has to be present for these things.

When we don't have the anesthesiologist it is the MD and the sedation RN in the room. If there are multiple polyps, random biopsies or something equally time consuming the RN will call for another RN or tech to assist. That "assist" person is also responsible for cleaning and setting up the room.

I think our process is pretty slick and works well.....of course it is the only system I know!!

Yeah, I think if the tech can only do that, then there's not too much point in having a tech in the procedure room...

Techs at our facility- we can do savory and balloon dilation, injections with saline and epinephrine), cytology brushings, hemo clips, tattoo w/Indian ink, etc...

We do have to clean up and set up the room too..

We have three main anesthesiologists and a few back up ones and we have two back up CRNAs.

The Anesthesiologists/CRNA 99.9% of the time use propofol and propofol/versed mix.

[MissChrissy]

Kind of taking this thread on a tangent....but my experience has been that insurance will only cover conscious sedation for the scoping unless there is a medically justifiable reason for deep sedation. We only have an anesthesiologist once per week for those with severe sleep apnea, huge BMI, those who had an unsuccessful conscious sedation in the past, etc.

When we do have the anesthesiologist in the room we also have the MD and an RN. Seems like it would be easier to do without the tech in the room. The RN can assist in monitoring the patient and help with the procedure. At our facility the techs can do simple polypectomies and biopsies, but cannot clip, inject saline or epi or tattoo. The RN has to be present for these things.

When we don't have the anesthesiologist it is the MD and the sedation RN in the room. If there are multiple polyps, random biopsies or something equally time consuming the RN will call for another RN or tech to assist. That "assist" person is also responsible for cleaning and setting up the room.

I think our process is pretty slick and works well.....of course it is the only system I know!!

What do the techs do when they're not cleaning up and setting up the room and the RN is currently assisting the doc? Just on standby? Takes very little time to get the room clean/set up and the p.t. positioned. Do the techs compute anything? procedure time? #,location of polyps, methods of removal?

[mkay60]

A tech would not be starting an IV on me. That is way beyond a CNA scope of practice. RN's do the sedation in our unit. CRNAs are used only for less healthy pts. In some Endo centers in our area RNs even do propofol sedation. It seems risky to have only techs with no Endo RNs.

[MissChrissy]

A tech would not be starting an IV on me. That is way beyond a CNA scope of practice. RN's do the sedation in our unit. CRNAs are used only for less healthy pts. In some Endo centers in our area RNs even do propofol sedation. It seems risky to have only techs with no Endo RNs.

That's what on the job training is for. Never had a pt complain about me starting an IV because I was a tech, I guess you'd be our first if you came in lol.

Why would it be risky when there's a CRNA/Anesthesiologist and the Gastroenterologist present?? You've lost me.

[ajw49886]

I find it funny that your techs are starting IV's and ours aren't even allowed to make an IV bag. All these little cost cutting ideas seem rather shady. In our hospital facility the RN's prep and recover the patients, we are also in the procedure rooms. In designated rooms we administer conscious sedation and assist and chart in anesthesia rooms. In the procedure rooms the nurses administer epi, glucagon, contrast dye for ercp's, saline, indigo carmine, tattoo, kenalog, Benadryl and what ever drugs the doctor would need us to order and administer during the procedure. The RN's are the only ones allowed to use injection needles or EUS needles. We also chart the procedure and are responsible for labeling the specimens. I find in troubling that you would phase out RN's. The couple of times I have had emergencies, the tech's by themselves were not useful. I once was in a procedure and the patients variceal banding did not work and proceeded to bleed. Even with two crna's it was necessary to have an RN. While they managed the airway I had to help deal with the sodium moruate ordered by to doctor for the bleeding. It also took two other RN's to help as well. I can honestly say that it is getting tiring to hear other professions downplay the role that the RN plays. I am tired of hearing that anyone could do our job.

[MissChrissy]

I find it funny that your techs are starting IV's and ours aren't even allowed to make an IV bag. All these little cost cutting ideas seem rather shady. In our hospital facility the RN's prep and recover the patients, we are also in the procedure rooms. In designated rooms we administer conscious sedation and assist and chart in anesthesia rooms. In the procedure rooms the nurses administer epi, glucagon, contrast dye for ercp's, saline, indigo carmine, tattoo, kenalog, Benadryl and what ever drugs the doctor would need us to order and administer during the procedure. The RN's are the only ones allowed to use injection needles or EUS needles. We also chart the procedure and are responsible for labeling the specimens. I find in troubling that you would phase out RN's. The couple of times I have had emergencies, the tech's by themselves were not useful. I once was in a procedure and the patients variceal banding did not work and proceeded to bleed. Even with two crna's it was necessary to have an RN. While they managed the airway I had to help deal with the sodium moruate ordered by to doctor for the bleeding. It also took two other RN's to help as well. I can honestly say that it is getting tiring to hear other professions downplay the role that the RN plays. I am tired of hearing that anyone could do our job.

I don't know what you want me to tell you, this has always been the set up at our facility and so far it's worked pretty well. We are an outpatient clinic, not a hospital so we don't deal with ERCP or EUS. The only procedures we do are Colonoscopies/Sigmoidoscopies and EGDs.

We have an RN and LPN supervisor but they are not in the procedure room. In the case of an emergency they can potentially come in the room and assist as needed.

I'm just saying in this setting (outpatient center that doesn't normally deal with dangerously ill patients) a tech is fine with assisting, pre/post-op. Maybe you're saying they let the techs do too much? but I don't really think so. If we use epi via interject during a polypectomy then it's under direct supervisor of the GI doc and he/she will tell us exactly how much to inject out...same with saline and tattoos.

In emergencies, you're right we can't administer medication but we can start a second iv line, assist with suctioning, bagging, CPR..not completely useless..

[GidgetRN, RN]

I am late to this game but I can't imagine the techs assisting the MD's with patient care. Yes it can be learned to do technical aspects of nursing but it takes education and experience to know the signs of a patient tanking and what to do when it happens. Sounds dangerous.

[RNCHN, BSN, RN]

 

SGNA & ASGE has not really laid out a plan for optimal staffing in the GI suite but pharmacy policies and quality policies from TJC are pushing us toward mandating RN in the room for documenting medications, care plans, and implementing verbal orders during the procedure.

 

Removing RN from the room may save money but they'll pay once TJC comes around LOL

[tippeny]

I work with a gastroenterologist who only does Colons & EGDs. We mostly use conscious sedation as our patients are typically healthy. For the less healthy folks (high BMI, cardiac problems, PTSD, anxiety, etc) we use CRNAs and MAC (protocol). When I am in the room doing conscious sedation (RN) we also have a GI tech. They are responsible for assisting the doc with equipment (biopsies, polypectomies, tattoos, lifts, clips...) while I am giving the sedation, taking vitals q5 min, labeling specimens, and such. The GI techs also do the HLD (high level disinfection) of the scopes and order/maintain equipment. RNs also recover the patient afterwards. Our facility tried to have the CRNAs take over and do all sedation. Our facility also does outpatient ortho, urology, podiatry, optical.... procedures. In the end, they didn’t have the staffing to support us. Their plan, however, was to also have a float nurse in the room to label specimens. I have no clue what else the RN would have done, besides stand there filled with boredom!