medications for conscience sedation that RN's are able to push

BigDave · Jun 10, 2005

I not sure if such a list exists. For endoscopy and such, either Demerol/Fentanyl with Versed are the things I've used. I've done some ketamine for a burn dude.

There are a lot of places that use propofol, but there are some folks (the ASA and AANA) that do not feel it is safe for this purpose (by an RN)--related to no reversal agents and resp/hemo depression.

http://www.asahq.org/news/asaaanajointstmnt.htm

jwk · Jun 10, 2005

Does anyone know where I could find a list of medications for conscience sedation that RN's are able to push? I work for a small ASC in Pennsylvania and there has been some question on what an RN can and cannot push under the direction of an MD when a CRNA is not available. Thank you for any imput.
siobhan :)

Although there is no official list of CONSCIOUS sedation drugs that RN's can push, some states specifically prohibit RN's from using propofol for sedation, except on mechanically ventilated patients.

Although GI nurses might disagree, propofol is NOT a suitable drug for non-anesthesia personnel to be using for conscious sedation. This topic has been discussed ad nauseum in the GI nurses forum.

WAREAGLE · Jun 10, 2005

Does anyone know where I could find a list of medications for conscience sedation that RN's are able to push? I work for a small ASC in Pennsylvania and there has been some question on what an RN can and cannot push under the direction of an MD when a CRNA is not available. Thank you for any imput.
siobhan :)

You need to read the policies set forth by the board of nursing in your state & also your individual hospital policy. Remember, even if for some reason your hospital allows you to push/use something you still need to check with the BON in your state. CYA always!!!!!!

yoga crna · Jun 11, 2005

The operative word is CONSCIOUS. In other words, the patient must always be responsive to verbal command. That is very tricky if you are mixing types of drugs or if the surgeon does not inject an adequate local anesthetic. Also, know the pharmacology of the drugs and the synergistic or additive effects with other drugs. In the surgery center that I run, RNs may only administer midazolam, benadryl or narcotics. They must be ACLS certified, prove to me that they can adequately maintain an airway and ventilate an unconscious patient. We also provide CE on the oxygen-hemoglobin dissociation curve and what the numbers mean on the pulse oximeter. Also, there must be a dedicated nurse for this function and they must not have any other duties, such as circulating.

When the surgeons saw my policy, they decided to always use a CRNA. The only times there is not a CRNA is for local cases that require no meds more than po valium.

Everyone is happy, the patients are safe, get less meds and the nurses are not required to practice beyond their education and scope.

Yoga

chansonsrna · Jun 11, 2005

Struggling...did you post this the other day? The reason I mention was because your original question had been about anesthesia meds pushed by RNs. To answer this thread our institution uses versed and fentanyll. Both one can consider anesthesia meds. I imagine that from state to state policies may vary, I can only answer for my institution, and I assume my state. (Just because a state allows, institutional policies may vary so to ask how one practices in their hospital may not actually reflect policy in their state) Clear as mud I hope. :uhoh3: Hope that helps.

Home Health Columnist / Guide · Jun 11, 2005

most states do not have a list of medications nurses are permitted to administer. that decision is left up to each institution's administration to decide.

following are pertinent regs from pa nurse practice act, i highlighted areas most impacting a non crna administering conscious sedation.

interpretations ... 21.401

interpretations regarding the administration of drugs--statement of policy.

(d) as used in this subsection, ''conscious sedation'' is defined as a minimally depressed level of consciousness in which the patient retains the ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal commands. the registered nurse who is not a certified registered nurse anesthetist may administer intravenous conscious sedation medications, under 21.14, during minor therapeutic and diagnostic procedures, when the following conditions exist:

(1) the specific amount of intravenous conscious sedation medications has been ordered in writing by a licensed physician and a licensed physician is physically present in the room during administration.

(2) written guidelines specifying the intravenous medications that the registered nurse may administer in a particular setting are available to the registered nurse.

(3) electrocardiogram, blood pressure and oximetry equipment are used for both monitoring and emergency resuscitation purposes pursuant to written guidelines which are provided for minimum patient monitoring. additional emergency resuscitation equipment is immediately available.

(4) the patient has a patent intravenous access.

(5) the registered nurse involved in direct patient care is certified in advanced cardiac life support (acls). provisions shall be in place for back-up personnel who are experts in airway management, emergency intubation and advanced life support if complications arise.

(6) the registered nurse possesses the knowledge, skills and abilities related to the management of patients receiving intravenous conscious sedation with evaluation of competence on a periodic basis. this includes, but is not limited to, arrhythmia detection, airway management and pharmacologic action of drugs administered. this includes emergency drugs.

(7) the registered nurse managing the care of the patient receiving intravenous conscious sedation medication may not have other responsibilities during the procedure. the registered nurse may not leave the patient unattended or engage in tasks which would compromise continuous monitoring. (8) the registered nurse monitors the patient until the patient is discharged by a qualified professional authorized to discharge the patient in accordance with established criteria of the facility.

( 21.12. venipuncture; intravenous fluids.

performing of venipuncture and administering and withdrawing intravenous fluids are functions regulated by this section, and these functions may not be performed unless:

(1) the procedure has been ordered in writing for the patient by a licensed doctor of the healing arts.

(2) the registered nurse who performs venipunctures has had instruction and supervised practice in performing venipunctures.

(3) the registered nurse who administers parenteral fluids, drugs or blood has had instruction and supervised practice in administering parenteral fluids, blood or medications into the vein.

(4) a list of medications which may be administered by the registered nurse is established and maintained by a committee of physicians, pharmacists and nurses from the employing agency or the agency within whose jurisdiction the procedure is being performed if no employing agency is involved.

(5) the intravenous fluid or medication to be administered is the fluid or medication specified in the written order.

(6) the blood is identified as the blood ordered for the patient.

(7) an accurate record is made concerning the following:

(i) the time of the injection.

(ii) the medication or fluid injected.

(iii) the amount of medication or fluid injected. (iv) reactions to the fluid.

http://www.pacode.com/secure/data/049/chapter21/chap21toc.html#21.11.

21.14. administration of drugs.

(a) a licensed registered nurse may administer a drug ordered for a patient in the dosage and manner prescribed

21.18. standards of nursing conduct.

(a) a registered nurse shall: (1) undertake a specific practice only if the registered nurse has the necessary knowledge, preparation, experience and competency to properly execute the practice

-------------------

after reading these regs most saliant point is

provisions shall be in place for back-up personnel who are experts in airway management, emergency intubation and advanced life support if complications arise

who is considered "back-up expert in airway management, emergency intubation and advanced life support" in your facility and needs to be expressly written into your facilites policys and procedures and available on-site during clinic hours. pa practice act is making you responsible for having this support.

in a court of law, you will be held to sbon regs and professional practice standards.

from these recognized professional groups in pa:

pana and psa release joint statement on propofol administration

to insure patient safety, propofol should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure

considerations for policy guidelines for registered nurses engaged in the administration of sedation and analgesia

www.aana.com/practice/conscious.asp

Home Health Columnist / Guide · Jun 11, 2005

conscious sedation

identify medications frequently used for conscious sedation, ... physician or

nurse, administering conscious sedation is to prepare and monitor the patient ...

www.gasnet.org/protocols/sedation

nursing: resting easy: how to care for patients receiving iv ...

the medications used for conscious sedation are central nervous system (cns)

depressants that can be categorized into four groups: opioids, benzodiazepines, ...

www.findarticles.com/p/articles/ mi_qa3689/is_199606/ai_n8754716

ce159d |[color=maroon]1.0 hr

administration of conscious sedation/analgesia

identify medications used to achieve conscious sedation/analgesia. ...

and postprocedural nursing care of patients who receive conscious sedation/analgesia...

www2.nursingspectrum.com/ ce/self-study_modules/course.html?id=265