Moderate (Concious) Sedation by RT?

  1. 0 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?
  2. Visit  OkieICU_RN profile page

    About OkieICU_RN

    OkieICU_RN has '5' year(s) of experience. From 'Oklahoma'; Joined Feb '06; Posts: 166; Likes: 29.

    18 Comments so far...

  3. Visit  CCL RN profile page
    0
    Terrible idea. Yet another part of nursing that we nurses are allowing to be taken away from us.
    Nurses can no longer administer CS? Huh??

    Something has to give. For me, I would end my travel assign. there and tell them exactly why...
    Last edit by CCL RN on Apr 8, '11
  4. Visit  sunnycalifRN profile page
    0
    When I was an RT, I used to work at a hospital that allowed the RT to do light sedation during bronchoscopy. Only fentanyl and versed were used. However, after an RT in Southern Calif was convicted of being an "angel of death", the State cracked down on RT and the practice of RT's doing light sedation was prohibited.
  5. Visit  meandragonbrett profile page
    1
    I'd definitely be going to my BON over it.
    love-d-OR likes this.
  6. Visit  Nccity2002 profile page
    0
    Scary...
  7. Visit  ckh23 profile page
    1
    I'm curious to know what state this is in. I would look it up to verify if this in fact the case. Possible the state BON may be able to shed some light on this. Not saying anything bad about RT's here, but this sounds incredibly dangerous regardless of the "classes" they need to attend. I also don't see how assessing someone during and after conscious sedation is NOT an RN responsibility.
    CCL RN likes this.
  8. Visit  GreyGull profile page
    1
    Quote from sunnycalifRN
    When I was an RT, I used to work at a hospital that allowed the RT to do light sedation during bronchoscopy. Only fentanyl and versed were used. However, after an RT in Southern Calif was convicted of being an "angel of death", the State cracked down on RT and the practice of RT's doing light sedation was prohibited.
    In California, RTs can do conscious sedation. They have not had their practice limited by Efren Saldivar, "Angel of Death", who deliberately killed patients. That would be absurd since there are RNs who also have been convicted of similar crimes involving medications. However, they do now have to take an Ethics course on "thos shall not kill the patients and when to report a co-worker who might be killing the patients".

    Quote from recent rulings to clarify or support RT legislation.

    The United States Drug Enforcement Association (DEA) has added Respiratory Care Practitioners to their list of licensed medical professionals who are authorized to administer controlled substances, provided the administration of the controlled substance has been ordered by a physician and such administration is related to a respiratory care procedure.
    This also is not new since RTs have been involved with administering some form of sedation in several states since licensure in the 80s and it expanded in the 90s as the majority of the states required licensure. The AARC also had a listserv or forum on Moderate Sedation which may be on their Connect forum. The discussion group consisted of many notable managers, including a few RNs, from around the country including California and the CSRC regional officers. Usually, the scope of practice for RCPs in each state is written "open ended" as it pertains to the respiratory or cardiopulmonary system which allows them to have expanded practice as needed for ICUs, transport, cath lab and ECMO.
    Last edit by GreyGull on Apr 10, '11
    SkylerW likes this.
  9. Visit  sunnycalifRN profile page
    0
    Quote from GreyGull
    In California, RTs can do conscious sedation. They have not had their practice limited by Efren Saldivar, "Angel of Death", who deliberately killed patients. That would be absurd since there are RNs who also have been convicted of similar crimes involving medications. However, they do now have to take an Ethics course on "thos shall not kill the patients and when to report a co-worker who might be killing the patients".

    Quote from recent rulings to clarify or support RT legislation.



    This also is not new since RTs have been involved with administering some form of sedation in several states since licensure in the 80s and it expanded in the 90s as the majority of the states required licensure. The AARC also had a listserv or forum on Moderate Sedation which may be on their Connect forum. The discussion group consisted of many notable managers, including a few RNs, from around the country including California and the CSRC regional officers. Usually, the scope of practice for RCPs in each state is written "open ended" as it pertains to the respiratory or cardiopulmonary system which allows them to have expanded practice as needed for ICUs, transport, cath lab and ECMO.
    GreyGull,

    I stand corrected. I should say, the hospital that I worked at (you probably know which one), changed their policy and forbade RT's from doing light sedation during bronchoscopy. I know that my present employer will not allow RT's to do light sedation. But, it was the Efren Saldivar case, which prompted the change.
  10. Visit  OkieICU_RN profile page
    0
    @GreyGull - so are RTs the ones who are performing all moderate sedation in your facility or all ICU sedations or only for respiratory related sedation such as a bronch?
  11. Visit  GreyGull profile page
    0
    Quote from OkieICU_RN
    @GreyGull - so are RTs the ones who are performing all moderate sedation in your facility or all ICU sedations or only for respiratory related sedation such as a bronch?
    Bronchs and transport where they can give several different medications for intubation and ventilation especially if the RN is busy intubating.

    You must remember there are not that many RTs and they also do standby when moderate sedation is done by the RNs in the ED and other areas of the hospital.
  12. Visit  JackieBPFT profile page
    0
    Would you be able to provide the reference for RTs providing sedation. I have look at the DEA website but am unable to locate it.
    Thxs
  13. Visit  GreyGull profile page
    0
    These are some of the states referring to the DEA change. I will try to contact someone in the Cardiopulmonary Dept later to see if they can send you the info you are seeking. I thought I could find California's statement since I know it was included in there but I don't have access to that part of the RCB. Maybe one of the RTs can get the statement for you through their professional association, AARC.

    NC
    http://www.ncrcb.org/Final-Declarato...%207-12-07.pdf

    OK
    http://www.okmedicalboard.org/respir...s_sedation.pdf

    SC
    http://www.llr.state.sc.us/pol/medic...Substances.htm
  14. Visit  Raquel8 profile page
    1
    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.
    CCL RN likes this.


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