Rad Tech's pushing IV Narcotics for sedation

[GeanineRN]

I have worked in an interventional radiology department for the last 4 1/2 years. We have 2 rooms, 4 rad techs, and 2 RN's. Our techs do conscious sedations and push IV narcotics. I was told that this is ok, because they are doing it under "direct supervision of the physician". The RN is in another case, or off for the day. But there is always a RN on duty. Never are we off the same day.

We also have a narcotic sign out sheet, and our techs also sign out these narcotics. Is this a practice at other hospitals?

I don't have a nurse manager, and my supervisor is a Rad Tech. She does not know my licensure. Our techs for our state, are not licensed. They are registered with their national registry. But not licensed to practice by our state.

[Gompers, BSN, RN]

Just wanted to mention that the reason some radiology/nuclear medicine techs (like my dad and his coworkers) are allowed to start the IVs for these patients is that they are certified in phlebotomy as part of their orientatoin. So legally, they are fine to start the IVs, and while they do administer the contrast, they do it only when the radiologist is present, either in the actual room of the test or in the adjacent room that has the cameras and computers in it.

[traumaRUs, MSN, APRN]

What about your hospital's Risk Manager?

[dianah, ASN]

The "contrast" the nuc. med. techs administer is not iodinated contrast, but a radioactive isotope, which they are trained and licensed to administer.

Agree with above poster, speaking to risk management is a GREAT idea! Keep us posted.

[NRSKarenRN, BSN, RN]

practice standards for medical imaging and radiation therapy

[color=#336699]2006 american society of radiologic technologists

http://www.asrt.org/content/rts/practicestandards/practice_standards.aspx

cardiovascular- interventional technology

clinical performance standards

standard four – implementation

the practitioner implements the action plan.

the practitioner:

1. implements the action plan in conjunction with the cardiovascular team.

2. explains each step of the action plan to the patient as it occurs.

3. positions the patient properly for the procedure to include appropriate immobilization.

4. monitors ecg, bp, respiration, oxygen saturation and level of consciousness pre-, peri- and post procedure.

5. starts and maintains iv access per orders when applicable.

6. starts and maintains oxygen administration per orders when applicable.

7. uses principles of sterile technique according to the protocol for the exam requested.

8. prepares, sets and implements appropriate technical parameters such as generators, power

injectors, etc.

9. obtains and documents appropriate data in the record pre-, peri- and postprocedure.

10. administers medications at the physician’s request according to policy.

http://www.asrt.org/media/pdf/standards_cv.pdf

dig out your facilities policy and procedure book---should be a policy on this issue to cover both techs and nurses. no policy, discuss with manager and bring to attention of risk management.

[ZASHAGALKA, RN]

10. Administers medications at the physician’s request according to policy.

Yeah, but, do they have the training and legal authority to give and then, evaluate the EFFECTS of a narcotic, once given?

Narcotics are different than other meds, obviously.

It doesn't matter what their rules say if DEA doesn't give them authority to handle narcotics. And If an RN hands them that narc to give, that's a violation of FEDERAL law. Not to mention possibly an illegal delegation of authority.

And it doesn't matter what their rules say if they don't know how to evaluate and document the effects of a narcotic on an 'IV Conscious Sedation' flowsheet.

I don't see how this is legal. Not beating up on the guys. But it's simply a scope of practice issue. It's not enough that their scope of practice states they can give drugs under a physician.

NARCOTICS ARE DIFFERENT.

~faith,

Timothy.

[dianah, ASN]

Big three words: "according to policy." Policy dictated by JCAHO and risk management.

[radrjp]

I am a nursing supervisor and a rad tech. In the state of Kentucky, RT's can give sedation and monitor patients in the IR suites. There is a sedation class that they must attend first and an annual competency test. Although it is not required I am getting my techs ACLS certified.