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Amiodarone Drip

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Just wondering what the protocol is concerning amiodarone drips once the patient converts as I haven't noticed consistency on how this is handled by nurses.  The amio is to infuse at 33 ml/hr x 6 hrs then 16.7ml/hr for 18 hours.  If the patient converts from Afib to NSR while on the drip, which of the following do you do?

1.  Notify the doctor that the patient has converted and ask if he wants the drip to continue and/or change the amio to tablet form.

2. Don't notify the doctor, keep the amio infusing for the full course.

I ask because I've seen nurses do either of these.

LC0929, ASN, RN, EMT-B

Specializes in Critical Care. Has 17 years experience.

You know the answer to this question, the problem is that you’ve worked with nurses who like to be “cowboys” and make decisions that aren’t in their scope of practice.  Even though we, as nurses, sometimes know or even know BETTER what to do in a certain situation, we are not licensed to diagnose.  We can relay current status, status updates, as well as our thoughts/suggestions/assessment of the patient to the DOC, but we cannot diagnose.  In some cases, as I did, you build up trust and a rapport with the CICU docs.  You may have conversations about things that are allowable, or they may give you parameters because they trust your assessment skills, etc, but we still don’t diagnose.  The patient may have converted right in front of you, but until a doc reads the strip themselves and diagnoses that, it, in essence,hasn’t happened.  Nurse Jane may be foolish enough to take it upon herself to manage that patient without notifying the doc, but do not follow her lead.  If you do and it goes in the toilet, I guarantee that giving an answer of “but Nurse Jane does it” is gonna be a problem and as far as support from Nurse Jane, there won’t be any.  The only thing you’ll see is her taillights leaving the hospital.  Cover your ***. 

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

On 1/25/2021 at 4:41 AM, LC0929 said:

You know the answer to this question, the problem is that you’ve worked with nurses who like to be “cowboys” and make decisions that aren’t in their scope of practice.  Even though we, as nurses, sometimes know or even know BETTER what to do in a certain situation, we are not licensed to diagnose.  We can relay current status, status updates, as well as our thoughts/suggestions/assessment of the patient to the DOC, but we cannot diagnose.  In some cases, as I did, you build up trust and a rapport with the CICU docs.  You may have conversations about things that are allowable, or they may give you parameters because they trust your assessment skills, etc, but we still don’t diagnose.  The patient may have converted right in front of you, but until a doc reads the strip themselves and diagnoses that, it, in essence,hasn’t happened.  Nurse Jane may be foolish enough to take it upon herself to manage that patient without notifying the doc, but do not follow her lead.  If you do and it goes in the toilet, I guarantee that giving an answer of “but Nurse Jane does it” is gonna be a problem and as far as support from Nurse Jane, there won’t be any.  The only thing you’ll see is her taillights leaving the hospital.  Cover your ***. 

I sort of get the confusion, "atrial fibrillation" is both a billable DSM diagnosis as well as a cardiac rhythm that is within the scope of a properly trained RN to identify and document.

I worked in an ICU where the compliance officers for the state nursing board went out their way to make themselves available to take part in discussions related to scope of practice issues at hospitals, this was one of the first questions I heard them speak on.

The idea that nurses don't "diagnose" is a bit of a misnomer, recognizing and identifying various symptoms is not allowed in nursing, it's a requirement of our license.

One compliance officer starting by bringing up ACLS, which is a medical protocol which is within the scope of an RN with ACLS certification to initiate, part of ACLS includes identifying a shockable rhythm, the compliance officer pointed out that if an RN with ACLS certification refused to follow ACLS protocols because that would involve identifying a rhythm and didn't take the appropriate action that they would not only take action against their license but refer them for criminal charges.

In order to ensure prompt and effective treatment of arrhythmias like A-fib, it's not unusual for facilities to have protocols in place that utilize assessments that are within the scope of an RN, such as rhythm identification, according to the compliance officers, if an RN refused to initiate interventions within these protocols not because they lacked the competency but because they insisted on practicing below the scope of their license that this would result in action against their license.

LC0929, ASN, RN, EMT-B

Specializes in Critical Care. Has 17 years experience.

6 hours ago, MunoRN said:

I sort of get the confusion, "atrial fibrillation" is both a billable DSM diagnosis as well as a cardiac rhythm that is within the scope of a properly trained RN to identify and document.

I worked in an ICU where the compliance officers for the state nursing board went out their way to make themselves available to take part in discussions related to scope of practice issues at hospitals, this was one of the first questions I heard them speak on.

The idea that nurses don't "diagnose" is a bit of a misnomer, recognizing and identifying various symptoms is not allowed in nursing, it's a requirement of our license.

One compliance officer starting by bringing up ACLS, which is a medical protocol which is within the scope of an RN with ACLS certification to initiate, part of ACLS includes identifying a shockable rhythm, the compliance officer pointed out that if an RN with ACLS certification refused to follow ACLS protocols because that would involve identifying a rhythm and didn't take the appropriate action that they would not only take action against their license but refer them for criminal charges.

In order to ensure prompt and effective treatment of arrhythmias like A-fib, it's not unusual for facilities to have protocols in place that utilize assessments that are within the scope of an RN, such as rhythm identification, according to the compliance officers, if an RN refused to initiate interventions within these protocols not because they lacked the competency but because they insisted on practicing below the scope of their license that this would result in action against their license.

I appreciate the feedback, but I’m not sure that you read and understood what I wrote.  Registered Nurses, unless something has changed in the past 6 months, cannot “diagnose” patients.  I also have worked in Critical Care, CICU, ER, Telemetry, etc, for 17 years and I’ve have never heard or seen anything written that states, “The patient was diagnosed by M. Blank, RN and treated as follows”.  We are certainly expected to respond accordingly to Codes, Trauma, etc, and administer medications, including titrations, but we do not diagnose and prescribe medications.  Any hospital that I’ve worked at, even as a travel RN, has always had either standing orders or protocols, which are written by either and APRN or MD.  It’s our job to assess the patient properly and quickly and inform the physician, but we don’t make a diagnosis for the physician.  We can make suggestions, obviously, as we are the front line, and if we are good at assessing and have built a rapport with a physician, they may give an order for something that requires our discretion and critical thinking, but we don’t “diagnose”.  Maybe this will clear up any confusion.