Moderate (Concious) Sedation by RT?

[OkieICU_RN]

So this week, on to a new hospital for a 13 week travel gig and was required to go through hospital nursing orientation. I was in a moderate sedation competency class and the instructor told us that nursing wouldn't be doing the sedation much longer. Said the task would be assigned to Respiratory Therapy as they are allowed to push drugs and monitor the patient in this U.S. state and it is within their scope of practice.

Upon further discussion, the instructor stated it would have to be an experienced RT, gone through EKG competency, be ACLS certified. Could administer sedation drugs like: Versed, Ativan, Valium, Morphine, Fentanyl and such for purposes of moderate sedation and then monitor the patient until the procedure was complete at which point they would report off to nursing.

Does anyone work in a facility that does this or ever even heard of it?

[Raquel8]

I would freak out if I was the nurse, I love our RTs some are better then others, but even our best RT doesn't thoroughly understand how all the systems and medications work. They ask me all the time whats that for why are the getting it...which is great education but I wouldnt want any of them pushing drugs and not knowing what to look for or what to do if they give too much. ahhhh...that policy at your place needs to be changed asap.

[GreyGull]

I would freak out if I was the nurse, I love our RTs some are better then others, but even our best RT doesn't thoroughly understand how all the systems and medications work. They ask me all the time whats that for why are the getting it...which is great education but I wouldnt want any of them pushing drugs and not knowing what to look for or what to do if they give too much. ahhhh...that policy at your place needs to be changed asap.

Some RNs also ask (hopefully) what the medication in the MDI is for. But then some don't bother asking specifics and actually may not know what the inhaler for which many surveys have suggested. Some RNs just write breathing meds when interviewing the patient even if the patient knows the meds or has the inhalers with him.

Just like RNs who don't work in certain areas like critical care, the RT or CCRN wouldn't expect them to know what nitric oxide or flolan is nor how to manage the many pressors a patient might be on. Do you remember knowing alot of meds from school but then still has to learn their practical applications? Even use a med that you hadn't seen for awhile and still had to refresh on its use? Even given a new med before you had a chance to read about it?

RTs do get considerable amount of pharmacology including the same Pharm 101 and 102 that student nurses take. They will then take the pharmacology specific to respiratory and critical care. If they go from AS to BS-RT, they will probably get two more semesters of pharmacology. If they specialize in an area which requires IFT transport, they will be expected to do all the medications that might be given to stabilize and transport a patient. What about all the RTs that do ECMO? There are a lot less medications used in the bronch suite and chances are you as the nurse would not be present if the RTs are doing the meds for you to freak out which wouldn't to anyone much good.

[GreyGull]

I love our RTs some are better then others, but even our best RT doesn't thoroughly understand how all the systems and medications work.

I guess I should ask if your RTs are RRTs or OJTs or one year grads? Do they also work in the ICUs and is your ICU progressive? Your "best" RT might not even be allowed to do critical care in another hospital.

...that policy at your place needs to be changed asap.

The policy stays. This has been in place for several years and no RN has ever taken offense to having another professional working along side them on transport or ECMO who has a similar scope of practice when it comes to medications or equipment especially since many of the RRTs are now BSRTs. The BSRT will probably be their entry level requirement within the next 10 years. If their present Bills in Congress which are in consideration pass, the BSRTs and Masters degreed RTs will get some additional perks to their scope of practice. Your hospital may still have alot of 1 year cert and OJT techs rather than Registered Respiratory Therapists so don't consider all RTs to be the same.

Not all RNs are trained to do moderate sedation and I would seriously doubt if most RTs would want a nurse who does not work an ICU trying to sedate or do any management of a ventilator patient. Even the ED is very scary for ventilator management if the RNs are not ICU cross-trained and are allowed to utilize some of the same sedation protocols available in the ICU.

[meandragonbrett]

Not all RNs are trained to do moderate sedation and I would seriously doubt if most RTs would want a nurse who does not work an ICU trying to sedate or do any management of a ventilator patient.

Exactly. Look at how many RNs and LPNs don't know how to recognize an obstructed airway much less open the airway and place an oral or nasal. Nor are capable of ventilating with a BVM.

[TigerGalLE, BSN, RN]

We have RTs that do conscious sedation in the bronchoscopy lab and at the bedside in ICU. We have some great RTs that work in that department. They come to the bedside for all bronchs. They prep the patient, chart, set up, administer meds, assist the MD, and recover the patient. This is so helpful for the RN because we trust these professionally trained team members to take care of our patient before, during, and after the procedure. This allows us to either do other tasks or watch and learn during the bronch.

The RTs that assist with the bronchs and give conscious sedation are specially trained and certified. I trust them. And I would allow them to give me versed and fentanyl for a procedure any day.

These RTs also come and assist our pulmonologists with taps and chest tube insertions. I'm a big fan.

[RhondaIndyRN]

RN's in the State of Indiana are administer conscious sedation. It is not in the scope of practice for respiratory therapist or radiology techs to push IV sedation. It was a big deal in IR when nurses were hired in "specials" just for that reason.

Rhonda

[GreyGull]

RN's in the State of Indiana are administer conscious sedation. It is not in the scope of practice for respiratory therapist or radiology techs to push IV sedation. It was a big deal in IR when nurses were hired in "specials" just for that reason.

Rhonda

I remember IN being one of the forerunners for this in the RT world. Without pulling up their whole statute, a quick search did come up with a few examples such as:

http://www.deaconess.com/body.cfm?id=683

[TAVRN]

I am an ICU nurse that is in a bronchoscopy lab as a travel nurse. The RN gives moderate sedation. The RT assists the doctor with suction and handing him some things and getting a BAL. I would not want an RT to give moderate sedation. It is not to be taken lightly. You have to know what to do with an occluded airway vs needing more 02, etc.... Cardiac, resp., ESRD, etc... I do believe that you should know all body systems and how they are all affected with these medications. I like the RT's too, I am just stating my opinion. What if the BP drops or the doc orders too much meds. Are they going to be able to know what to do with the low BP or have the guts to tell the doctor that may be too much medication?

[TicTok411]

That does not sound right at all. I would not feel great about that policy.

[offlabel]

Having an RN give sedation is no guarantee of safety either. It's up to the practitioner that is ordering the sedation to be sure that the person actually giving the medicine is competent, whomever that is.

[TicTok411]

Having an RN give sedation is no guarantee of safety either. It's up to the practitioner that is ordering the sedation to be sure that the person actually giving the medicine is competent, whomever that is.

The facility has policies that the Rn giving the conscious sedation be qualified. As an RN I took a learning module and passed a test before I was considered qualified by the facility and had to do the same as a provider.

[canoehead, BSN, RN]

I say go for it, RT's take sedation, as it's mostly a respiratory issue. But if they take it, they need to take the initial screening, the paperwork, and the recovery. Not just there to push meds, watch the procedure and out. We have an RT come to each sedation, but they are gone as soon as the doc is. They should do this to free up nursing for the hour or more it takes from start to finish.