Can RNs in CA give Propofol??

I am new to California and looked up the policy for sedation meds that RNs can give and it is very vague. It states that a RN can give any medication as long as it a appropriately prescribed. I know in most states, RNs CANNOT give Propofol and just wanted to know if there is some other information I am missing?? I interviewed for a job today and the nurse manager told me that they give Propofol. I need to clarify with her if the RNs do, but from what it sounded like, they do.

[dianah, ASN]

If the level of sedation required is deeper than moderate sedation, then no matter what the RN is injecting, THAT is deep sedation and thus outside the scope of RN practice, unless a CRNA.

[OhioCCRN, MSN, NP]

I work in a high acuity SICU and I push propofol. During RSI the RN usually pushes the medication (prop/Roc). the only caveat is that anesthesiology is ready to establish an airway during RSI. If the airway is already established, we are allowed to bolus propofol.

[Boomer MS, RN]

I work in a high acuity SICU and I push propofol. During RSI the RN usually pushes the medication (prop/Roc). the only caveat is that anesthesiology is ready to establish an airway during RSI. If the airway is already established, we are allowed to bolus propofol.

This makes sense to me. The original OP's question was regarding propofol for sedation in the state of CA. It doesn't matter which state though, does it? RSI is a whole different ball of wax from procedural sedation. As someone else said, I would proceed with extreme caution and not push propofol without strict policies and procedures in place for procedural sedation with appropriate personnel at the bedside. And as I said in a previous post, the drugs allowed differ from hospital to hospital. I think original OP's post stated it was not in a hospital.

[SquishyRN, BSN, RN]

At my facility we do use propofol for procedural sedation, but only MDs can push. RNs can titrate and bolus only on intubated patients. While I'm in CA, this is in ER, so not exactly the same circumstances OP was inquiring about.

[William2]

Our practice acts forbid us to push propofol here, but we do it anyway. Everyone knows it and you're gonna catch a lot of hell if you stand up to a physician by refusing to do it. Its an integral part of RSI for us so its not something we debate.

[Buyer beware, BSN]

Only illegal for the nurse to give propofol in Calfornia if the Cardiologist with no experience whatsoever with this drug orders it for a entrenched sleep disorder and the patient's name is Michael Jackson. WOO HOO!

[CRNA, DNSc]

RNlmbhb said:

I am new to California and looked up the policy for sedation meds that RNs can give and it is very vague. It states that a RN can give any medication as long as it a appropriately prescribed. I know in most states, RNs CANNOT give Propofol and just wanted to know if there is some other information I am missing?? I interviewed for a job today and the nurse manager told me that they give Propofol. I need to clarify with her if the RNs do, but from what it sounded like, they do.

You are right to be concerned- This is directly from the package insert for Diprivan (Propofol)...

Quote

For general anesthesia or monitored anesthesia care (MAC) sedation, DIPRIVAN Injectable Emulsion should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure. Patients should be continuously monitored, and facilities for maintenance of a patent airway, artificial ventilation, and oxygen enrichment and circulatory resuscitation must be immediately available.

For sedation of intubated, mechanically ventilated adult patients in the Intensive Care Unit (ICU), DIPRIVAN Injectable Emulsion should be administered only by persons skilled in the management of critically ill patients and trained in cardiovascular resuscitation and airway management.

Package insert material can and will be used in any court of law in any case that does not go well. If these conditions are not met the brunt of the axe will fall on the person who administered the drug.

[BeenThere2012, ASN, RN]

When I type in "Propofol" under state board of nursing...it comes up 1.5 pages on CONSCIOUS SEDATION; the first paragraph states:

"It is within the scope of practice of registered nurses to administer medications for the purpose of induction of conscious sedation for short-term therapeutic, diagnostic or surgical procedures.Authority for RNs to administer medication derives from Section 2725(b)(2) of the Nursing Practice Act(NPA).

This section places no limits on the type of medication or route of administration; there is only a requirement that the drug be ordered by one lawfully authorized to prescribe. Other relevant sections of the NPA do impose additional requirements. Specifically, the registered nurse must be competent to perform the function, and the function must be performed in a manner consistent with the standard of practice. [business and Professions Code 2761(a)(1); California Code of Regulations 1442, 1443,1443.5.]

In administering medications to induce conscious sedation, the RN is required to have the same knowledge and skills as for any other medication the nurse administers. This knowledge base includes but is not limited to: effects of medication; potential side effects of the medication; contraindications for the administration of the medication; the amount of the medication to be administered. The requisite skills include the ability to: competently and safely administer the medication by the specified route;anticipate and recognize potential complications of the medication; recognize emergency situations and institute emergency procedures. Thus the RN would be held accountable for knowledge of the medication and for ensuring that the proper safety measures are followed. National guidelines for administering conscious sedation should be consulted in establishing agency policies and procedures."

From reading this, sounds like it is legal for RN's to give Propofol in CA. I wouldn't do this unless I had proper training and there was an anesthesiologist on site all the time and if the airway is secure.

If anyone else has found any other information for the BON for California, please let me know! Thanks.

I agree, the CA BRN isn't as clear in explaining nurses giving Propofol. I have worked in ICU settings that allow the nurse to administer Propofol WHILE THE DOCTOR WAS AT THE BEDSIDE, during a procedure and while intubated. But, he was our Attending intensivist, not an anesthesiologist. However, there were anesthesiologists in house at the time. Not sure if that qualifies, but that is what we were taught and was the policy we all worked under. We do give Propofol as a continuous drip in ICu's.

[Gina-RNBSN]

I am in the ED in Southern California ….post intubation or conscious sedation propofol cannot be IV push by a RN. We can run the drip but not push the initial bolus. I don’t mind, rather not have the responsibility! But, I do think it’s an excellent drug. I’d rather be safe than sorry and not push it. 10 or 15 years ago one of our nurses was reported to the state board for pushing it under verbal orders from a Doctor (Who of course later says he didn’t give the verbal order to cover his own rear end.) Lesson learned, everybody is looking out for themselves!(I do not think that lying to do this is any way professional, but it happens all the time!) The other lesson I learned  is to do my own homework and not believe what some doctor thinks is OK. However, the good thing is that you can still do RSI using other drugs first while setting up a propofol drip and in those cases you can avoid a bolus all together.

[RNlmbhb]

Correct. They would train me and I would make sure I am comfortable with it before doing it. It is for an endoscopy job doing pre op, sedation and recovery. It's a small center (not in a hospital). So I'm a little skeptical, may ask her to clarify.

[RNlmbhb]

Thanks! This is very helpful. I'm from Texas and knew it isn't legal in TX, but CA board of nursing does not go into detail like TX does. I will try to find out more what Ca board says. I know the place has an anathesiaologist on site, but not sure if he is there all the time. It sounded like he was just for cases that needed general anethesia. Not sure. I'll have to have her clarify. Thank you!

[RNlmbhb]

When I type in "Propofol" under state board of nursing...it comes up 1.5 pages on CONSCIOUS SEDATION; the first paragraph states:

"It is within the scope of practice of registered nurses to administer medications for the purpose of induction of conscious sedation for short-term therapeutic, diagnostic or surgical procedures.Authority for RNs to administer medication derives from Section 2725(b)(2) of the Nursing Practice Act(NPA).

This section places no limits on the type of medication or route of administration; there is only a requirement that the drug be ordered by one lawfully authorized to prescribe. Other relevant sections of the NPA do impose additional requirements. Specifically, the registered nurse must be competent to perform the function, and the function must be performed in a manner consistent with the standard of practice. [business and Professions Code 2761(a)(1); California Code of Regulations 1442, 1443,1443.5.]

In administering medications to induce conscious sedation, the RN is required to have the same knowledge and skills as for any other medication the nurse administers. This knowledge base includes but is not limited to: effects of medication; potential side effects of the medication; contraindications for the administration of the medication; the amount of the medication to be administered. The requisite skills include the ability to: competently and safely administer the medication by the specified route;anticipate and recognize potential complications of the medication; recognize emergency situations and institute emergency procedures. Thus the RN would be held accountable for knowledge of the medication and for ensuring that the proper safety measures are followed. National guidelines for administering conscious sedation should be consulted in establishing agency policies and procedures."

From reading this, sounds like it is legal for RN's to give Propofol in CA. I wouldn't do this unless I had proper training and there was an anesthesiologist on site all the time and if the airway is secure.

If anyone else has found any other information for the BON for California, please let me know! Thanks.