As usual, it took a patient death to effect change to a dangerous practice. This is why I, an operating room nurse, am so adament about getting the practice of RNs giving conscious sedation stopped, and the reason for my thread about OR nurses--and endoscopy nurses-- giving conscious sedation. This dangerous practice simply needs to stop. As evidenced by an ongoing thread in the gastroenterology nursing section, apparently--at least in some facilities-- endo RNs administer propofol as part of "conscious sedation."
FYI on Propofol Administration by RNs
Saying that it has received several reports of adverse events, including
the death of a cosmetic surgery patient, after RNs improperly
administered propofol, the American Association for Accreditation of
Ambulatory Surgery Facilities (AAAASF) is rushing to ensure that only
those trained to give general anesthesia or rescue from general
anesthesia administer propofol in its 1,100 or so accredited facilities.
The AAAASF announced last week that facilities that want to continue to
use propofol -- even if only for "conscious sedation" -- must either
upgrade to a Class C facility (where all anesthesia must be administered
by an anesthesiologist or CRNA) or promise to always use an anesthesia
professional to administer the drug. Facilities must comply by May 1.
"We decided that we need to get our standards in line with the
manufacturer's recommendations," says Jeff Pearcy, executive director of
the AAAASF. "The easiest way to do that was to require those facilities
that want to continue to use propofol to become Class C facilities."
For Class B facilities that would like to continue to use propofol but
won't use other types of general anesthesia, complying with the new
standard is simple. These facilities must fill out a form certifying
that they have a dedicated anesthesiologist or CRNA administering the
sedative-hypnotic. They also must have neuromuscular blocking agents
available in the facility. No on-site inspection is necessary. There
will be no additional charge, says AAAASF.
Those facilities that are upgrading to a C and plan to use general
anesthesia (inhalational) in addition to using propofol must comply with
all Class C criteria, says AAAASF.
AAAASF President Michael F. McGuire, MD, a board-certified plastic
surgeon, says the major motivation for making the change was that
"administration of propofol by a non-anesthesia provider is really not
appropriate."
Dr. McGuire adds that the new standard has caused quite a bit of
confusion and concern, mostly among Class B facilities that don't give
inhalational anesthesia and misread the standard to mean they couldn't
administer propofol unless they bought an anesthesia machine and CO2
monitor. Part of the confusion, he says, lies in the nature of the
propofol.
"Is propofol a general anesthetic or a sedation agent? It's both.
Really, truly, it is both," says Dr. McGuire. "At a certain level and in
a certain individual, it is a sedation agent. In other individuals or at
higher does, it becomes a general anesthetic agent. It's so
unpredictable, which is not a problem if you're an anesthesiologist but
can be if you're a surgeon trying to do surgery and supervise a nurse
giving the medication."
NurseasPatient
10 Posts
First let me say thanks for the info. I am aware that OPEN MRIs are available in some areas. I had traveled 12 hours from my home to see this specialist & to have the tests he ordered in the facility it was ordered in.
I would imagine if they had an open MRI they would of offered it as I'm sure (very sure now) that it is certainly a safer alternative to anesthesia.
The oncologist suggested sedation- due to my anxiety over both being diagnosed with malignant cancer (that has killed nearly ever ancestor of one side of my family) & the many tests & tortuous procedures I have endured this year. I as an LPN (not claiming any great knowledge of medicine) am aware of the dangers of anesthesia but sure did not think that anyone who is supposed to know alot more about it than me would be so RETARDED as to give me a med that would cause me to stop breathing while in a tube not intubated. I guess in the future I will ask more questions before letting them use just anything. One of my greatest lessons this year? If you don't know a little bit about medicine you are pretty much screwed & sometimes even if you do you still are. I don't mean to come off as sarcastic - honestly I don't- but sometimes things are not as simple as "have an open MRI" I felt safe in having it there under anesthesia & it was necessary that it be done there so the Dr. could quickly review the results with the me.
My insurance pays for MRI wherever I chose to have one. Thankfully it is excellent insurance & in the future before having an MRI I will be sure to discuss all avenues of anesthesia/sedation/open MRI etc so this never happens again. I've certainly got enough trying to kill me without anesthesia helping.
Thanks again.