Conscious Sedation by "qualified" persons...

Specialties Radiology

Published

As an RN, I am having a hard time with this. I came from a hospital that was very by the book, no ambiguous policy's etc. Things were very clear. If you were not atleast an RN, and have ACLS, and a CS class you did not push any form of sedation, narcotic, or any other IV drug for that matter. I have techs giving Benadry, fentanyl, versed, and the list goes on. The unit has recently decided they need to be ACLS certified, but I can think of plenty of nurses who may be ACLS but still have no business pushing sedation.

I have contacted the state boards of nursing, and JCAHO. No one is giving me anything but "qualified persons=ACLS and yearly competency", per each hospitals policy.

Can I get some feed back. I work in IR, and they are very anti RN, i get the feeling the techs think they can do my job! I just feel there is more to giving drugs and monitoring the patient. It goes to the whole system and understanding it as a whole.

Any input either way is greatly appreciated.:coollook:

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Specializes in RETIRED Cath Lab/Cardiology/Radiology.

What are the area hospitals doing?

What does your Risk Mgmt say?

Check JCAHO's requirements (I think you can access them online).

Check your state's requirements; interpretation of tech and RN scope of practice varies from state to state.

However it is set up, be sure your practice is supported by your P & P, and JCAHO recommendations. And document, document, document.

Good luck!

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JCAHO says "qualified Persons", state board has no stand on it as long as the RN is working withing her/his scope of practice. Risk management, I have no idea. I think if they had a family member on the talbe they would request an RN. I know I would.

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Specializes in RETIRED Cath Lab/Cardiology/Radiology.

How about ARNA (American Radiological Nurses Association)? Is there a chapter in your area, or somewhere on their site (http://www.arna.net, I believe) where you can pose this question?

Are there any IR sites where you can ask?

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Specializes in Critical Care.
JCAHO says "qualified Persons", state board has no stand on it as long as the RN is working withing her/his scope of practice. Risk management, I have no idea. I think if they had a family member on the talbe they would request an RN. I know I would.

Only PROFESSIONAL nurses in the State of Arkansas can give medications. (Docs can, but only NURSES can do this as an act prescribed by a doc.)

Your NPA specifically states, up front, in its definitions:

(6) “Practice of professional nursing” means the performance for compensation of any acts involving:

(A) The observation, care, and counsel of the ill, injured, or infirm;

(B) The maintenance of health or prevention of illness of others;

© The supervision and teaching of other personnel;

(D) The delegation of certain nursing practices to other personnel as set forth in regulations established by the board;

or

(E) The administration of medications and treatments as prescribed by practitioners authorized to prescribe and treat in

accordance with state law where such acts require substantial specialized judgment and skill based on knowledge and

application of the principles of biological, physical, and social sciences;

Sounds to me like your NPA specifically forbids this practice. And in case that isn't clear, your board has clarified this in their rules:

Rules. Chapter 5:

E. NURSING TASKS THAT SHALL NOT BE DELEGATED

By way of example, and not in limitation, the following are nursing tasks that are not within the scope of

sound nursing judgment to delegate:

1. Physical, psychological, and social assessment which requires nursing judgment, intervention,

referral, or follow-up;

2. Formulation of the plan of nursing care and evaluation of the client's response to the care rendered;

3. Specific tasks involved in the implementation of the plan of care which require nursing judgment or

4. The responsibility and accountability for client health teaching and health counseling which

promotes client education and involves the client's significant others in accomplishing health goals; and

5. Administration of any medications or intravenous therapy, including blood or blood products.

6. Receiving or transmitting verbal or telephone orders;

7. Registered nurse practitioners and advanced practice nurses shall not delegate to unlicensed

ancillary staff the calling in of prescriptions to the pharmacy.

CLEARLY, in the state of Arkansas, giving prescribed medications is the act of a PROFESSIONAL NURSE that CANNOT be delegated. It is in fact, a violation of law. I'd point this out to your risk manager. The lawsuit potential for both the nurse that allows this under his/her license, AND the hospital, is astronomical.

If I were a lawyer, and anything adverse happened, I could EASILY prove both an established duty and a failure to meet that duty if anyone but a nurse and/or doc is pushing the IV med that was the proximal cause of the event.

~faith,

Timothy.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

position statement: iv conscious sedation

http://www.arsbn.org/possition_st/94_1.pdf

the arkansas state board of nursing has determined that it is within the scope of practice of a

registered professional nurse to administer pharmacologic agents via the intravenous route to produce conscious sedation. optimal anesthesia care is best provided by qualified

anesthesiologists and certified registered nurse anesthetists. however, the board recognizes that the demand in the practice setting necessitates non-crna rns providing iv conscious sedation. employing facilities should have policies and procedures to guide the registered nurse. the attached guidelines have been adopted by the arkansas state board of nursing.

adopted november, 1994

....endorsed by

american radiological nurses association

see pgs 2 & 3 of above link

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Specializes in Critical Care.
Position statement: IV CONSCIOUS SEDATION

http://www.arsbn.org/possition_st/94_1.pdf

See pgs 2 & 3 of above link

It was my understanding that the OP was worried about supervising radiology techs while THEY gave the drugs.

~faith,

Timothy.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

previous post and links:

rad tech's pushing iv narcotics for sedation - allnurses.com ...

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Wow, thanks for all the informatioin!

I have contacted SBN in Tennessee, where I work. Their response was "qualified persons as stated for each individual hospital policy" JCAHO said the same thing. Both feel that if the hospital wants to say anyone can give CS if they have ACLS, and have taken a 10 question CS test, then that is OK.

I Guess if a physician sees the pt for 20 seconds that counts as well as a thourough nursing assessment, and anyone can give the drugs and monitor.

It is a big territory thing, If I don't do the assressment, I don't push the drugs, If I don't push the drugs I am don't have anything to do with that case. It is not meeting Standards of care issues, but apparentyl they are not worried about giving each patient the same quality of care. :-)

Thank You for the input!!!!

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Tennessee Practice Acts

http://www.state.tn.us/sos/rules/1000/1000-01.pdf

http://www.state.tn.us/sos/rules/1000/1000-02.pdf

Conscious sedation requires constant assessment and possibly need for intervention. That cannot be done by a tech.

The Tennessee rules have causes for discuplinary action against the RN license on page 28 & 29 including (m) Failing to supervise persons to whom nursing functions are delegated or assigned.

ALL states specify or imply that the nurse must do no harm and not allow others to harm their patient.

California policy on CS:

http://www.rn.ca.gov/practice/pdf/npr-b-06.pdf

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Medication administration is not within the scope of practice of an RT, with the exception of Contrast media. Most facilities have a competency that documents safe administration of contrast after validation of knowledge base. Then they can only inject contrast when a Radiologist is immediately available.

Our hospital has an Outpatient facility that is associated with us, but they are only authorized to administer contrast when a Radiologist is immediately available on site. This does not include "tele-Rad" coverage.

Nuclear Medicine is an exception to this rule as they commonly drawl blood and inject isotopes. Although their scope is slightly different than the routine radiology technologists, it is not within their scope of practice to administer any other medications, oral or IV.

I hope you find the answers, I have been the NM of large hospital Radiology department for approx three years now and I still learn something new every day.

Good Luck!

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I work under a Rad Tech Manager, No nursing manager to speak of. They are very defensive and say that they have taken the test(10 basic questions), and are ACLS certified, and that the hospital policy supports them giving CS under supervisioin of a Dr. THis is an Interventional area, that runs all its RN's off because they are under the impression that they can do pt assessments themselves.

I feel like I am banging my head against a wall with these people, they keep going back to their "Hospital Policy", I go to my NPA, they have suggested I go higher if I am not happy with this plan of care, but that makes me the bad guy of the Unit. I guess I signed on to be Pt advocate first, so wish me luck and thank you so much for all the great information. The support is greatly appreciated!!!

:monkeydance:

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