Bolus function on the IV Pumps

[Bluebolt]

So I've worked in probably 7 different ICU's across the east coast, Texas and now expanding to the West coast. Something I've noticed different from one hospital to the next is the bolus function being used on the IV pump. As in when a patient starts to buck the vent, pull on restraints, etc people will program a bolus of the Versed, Propofol.

When I was a staff nurse and first learning as a new grad this was done often. I learned it as normal and necessary to protect the patient, within reason. Meaning you used your critical care judgement to determine the dose. As I traveled I realized this is considered practicing medicine unless there is a protocol determining the amount you give, documenting the bolus amount, etc. As I got more experience in the various ICU's across the nation I realized that our "protocols" are what protect us ICU RN's from being accused of practicing medicine.

My current problem is when I arrive at a facility where they practice the bolus method without a clear defined protocol or documentation method.

Do you fellow ICU RN's have any experience in this and what do you do at your facility?

[april_tomorrow]

In my hospital system, giving a bolus of propofol, ketamine etc is considered practicing anesthesia and cannot be done by a RN. Its outside of our scope of practice = illegal in FL. Only a physician can give an iv push of those.

Ive seen it done under the table, of course.

[chare]

Do you fellow ICU RN's have any experience in this and what do you do at your facility?

Where I currently work, if we have a patient on a continuous infusion of any sedation or analgesia, we always have an order for a PRN bolus equal to the hourly infusion. Typically, these infusions are ordered with a dosing range, and are titrated up, or down, by the bedside nurse based on either FLACC or RASS scores. If the rate is adjusted, the PRN dose is adjusted accordingly.

What you are describing was previously referred to as a nursing dose,” and depending upon where you were was a somewhat common, although unsanctioned or unapproved process. I think even then most state boards of nursing would have considered this practicing medicine. There was a previous thread (Nursing Dose) earlier this year in which this topic was discussed.

In my hospital system, giving a bolus of propofol, ketamine etc is considered practicing anesthesia and cannot be done by a RN…

You'll find this varies from state to state. In NC, an RN typically cannot administer a bolus dose of propofol to a non-intubated patient. However, if the ordering physician is in the room/at the bedside the RN can administer it as he or she is considered an extension” of the ordering physician.

[Bluebolt]

As a new grad I learned what a "nursing dose" meant. Sometimes I would hear the term a "baptist dose" which in the Southeast meant, I gave double the Ativan. lol