Administering Antidotes

[BellsRNBSN]

Can an RN ever use her own discretion to administer an antidote (ex: narcan for opioids, acetylcysteine for acetaminophen, etc.), such as in an emergency overdose situation? If so, what specific s/sx have to be observed to warrant the administration of an antidote?

Or does an antidote always have to be ordered by an MD?

[elkpark]

"Antidotes" are medications just like any other, and would need to be ordered by a physician or other individual with prescriptive authority (NP or PA). There may be some situations in which an RN is working under standing orders or protocols which would authorize the nurse to proceed with some medications under stipulated conditions, but those still constitute orders from a physician.

[BellsRNBSN]

Ah yes, that makes sense. Thank you for your response!

What about administering epinephrine (ex: with an Epi pen) to someone having an allergic reaction? Does that also always have to be ordered by an MD?

[Mandychelle79, ASN, RN]

When I went through my EMT training, we were taught to make sure the patients hand was on the epi-pen and "assit" them in giving it.

[elkpark]

AFAIK, if someone is carrying an epi pen, that means it was ordered for her/him by a physician (they are available by Rx only).

[BellsRNBSN]

Sorry, I don't think I was clear. I meant administering epinephrine to someone who doesn't already have a prescription for it. When I mentioned the epi-pen, I meant using an epi-pen from the hospital in a situation in which a new med is being administered to a patient and a severe allergic reaction may occur.

For example, say you have a doctor's order to administer a cephalosporin to a patient who has had an anaphylactic allergic reaction to penicillin in the past and who has never taken a cephalosporin before (my pharm teacher says this is a plausible situation, as it was in one of our test questions). Knowing that there is a cross-sensitivity between penicillin and cephalosporin, would you maybe want to have an epi-pen ready in case the patient has a severe allergic reaction to the cephalosporin? And if the patient does suddenly go into anaphylactic shock, does the nurse have the right to administer epinephrine without a doctor's order?

Thanks for your help!

[Mandychelle79, ASN, RN]

Sorry, I don't think I was clear. I meant administering epinephrine to someone who doesn't already have a prescription for it. When I mentioned the epi-pen, I meant using an epi-pen from the hospital in a situation in which a new med is being administered to a patient and a severe allergic reaction may occur.

For example, say you have a doctor's order to administer a cephalosporin to a patient who has had an anaphylactic allergic reaction to penicillin in the past and who has never taken a cephalosporin before (my pharm teacher says this is a plausible situation, as it was in one of our test questions). Knowing that there is a cross-sensitivity between penicillin and cephalosporin, would you maybe want to have an epi-pen ready in case the patient has a severe allergic reaction to the cephalosporin? And if the patient does suddenly go into anaphylactic shock, does the nurse have the right to administer epinephrine without a doctor's order?

Thanks for your help!

Not that Im aware of, unless it was part of a protocol. In that circumstance, id be calling a condition r ( rapid response team, one stage below a code blue) and a dr can order it verbally.

[elkpark]

For example, say you have a doctor's order to administer a cephalosporin to a patient who has had an anaphylactic allergic reaction to penicillin in the past and who has never taken a cephalosporin before (my pharm teacher says this is a plausible situation, as it was in one of our test questions). Knowing that there is a cross-sensitivity between penicillin and cephalosporin, would you maybe want to have an epi-pen ready in case the patient has a severe allergic reaction to the cephalosporin? And if the patient does suddenly go into anaphylactic shock, does the nurse have the right to administer epinephrine without a doctor's order?

Thanks for your help!

An RN (without Rx authority) cannot legally administer epinephrine to someone without a legitimate, valid order. In your scenario, IMO, the smart, prudent nursing action would be to review the order with the physician and make sure the physician is aware of the previous anaphylaxis, before giving the cephalosporin. If the physician wants to proceed with the order, that would be a good opportunity to ask about an order for something to have on hand in case there is an anaphylactic reaction.