Non anesthesia provider providing anesthesia

austin heart, BSN, RN · Apr 10, 2006

HUGE thread regarding this topic over in the GI section. It is MANY pages long and is pretty informative.

MmacFN · Apr 10, 2006

I do this in the ER all the time. Its been a policy for years

gasmn2b · Apr 10, 2006

Definitely something we do all the time around here, probably has a lot to do with the cost and lack of personel to do things like that with anesthesia. But everyone participating should be inseviced on proper techniques and possible outcomes. I know we are.

Just my 2 cents worth though.

fungirl · Apr 10, 2006

I do this in the ER all the time. Its been a policy for years

Do you work in the valley or up north??? Which hospital?? Just curious??

Trauma Columnist · Apr 10, 2006

We do it too! Of course, we have semiannual competencies and if we are the least bit uncomfortable, we have MD inject propofol.

TennRN2004 · Apr 10, 2006

HUGE thread regarding this topic over in the GI section. It is MANY pages long and is pretty informative.

I would think the ER is a safer place for RNs to be dosing it...just because if there is a question of pt not being able to maintain airway, at least you have a MD at the head of the bed that's used to having to tube patients. I bet a GI doc couldn't tell you the last time they intubuated someone.

athomas91 · Apr 10, 2006

read the package inserts.... then decide if it is a good idea.

MmacFN · Apr 10, 2006

hey there

I actually live in Arizona and it is common practice to use diprivan here in the ER both for closed reductions, cardioversions and some docs like to use it to intubate. The state nsg board clearly says that we (RNs) may titrate diprivan on our own but that in order to push it there must be a direct order from a physician who should be standing in the room for some procedure.

Ive also used it when the GI docs come up to sedate patients. I have never had a problem with diprivan as i is a drug im very farmiliar with. The half life alone and how quickly patients come back to baseline makes it much safer than giving massive doses of versed and morphine, as we did in the past.

midwestsrna1 · Apr 10, 2006

read the package inserts.... then decide if it is a good idea.

I agree...after studying anesthesia, I would never agree to push propofol as an RN on a non-intubated patient without an anesthesia provider present. Somehow the "we do it all the time" doesn't seem like it would sound very good in court. The fact of the matter is that patients have died in this situation and propofol can be a very dangerous drug in the wrong hands! Good luck to all of you.

ps. Early in my ICU career, a fellow nurse who did a lot of legal consulting, encouraged me to carry my own malpractice insurance. She said she had seen many situations where the hospital's interests did not allign with the RN's interests. It may be in their best interest to paint you as incompetent, not following official policy (even if it is done frequently), etc. This seems like a perfect example of that to me.

midwestsrna1 · Apr 10, 2006

Aside from my opinion that it is unsafe, RNs who are doing this should push to get an official hosptial/department policy on the practice so at least that would cover you in court.

MmacFN · Apr 10, 2006

Actually, it isnt a concern to me.

Not only are there inservices for new RNs in the ER who are pushing diprivan (i often teach them), but it is backed by hospital policy and state nsg board regulations. There isnt anything to be concerned about. Secondly, there is an ER doc in the room or just outside of it (if its a GI doc in the rm) 100% of the time. There isnt any need for an anesthesia person at all.

Third, the fact of the matter is that Versed and Morphine combo we have typically used in the past are signifigantly more dangerous due to the prolonged effects they have on the patient (most studies citing versed as lasting up to 120 minutes). I dont see where the evidence is for your ascertions at all. Please post the research which proves this.

Please find my research at the bottom of the page proving my point.

Please elighten me as to the reasons you seem to think its so dangerous. Diprivan wears off in minutes and post bolus we bag them, It isnt anymore of a risk for me than it is for a CRNA. I would have absolutely no problem defending myself in court.

As for the legal consulting, i think your friend missed an important piece of information which a RN/JD (lawyer) friend of mine enlightened me to. When a law suit begins, lawyers identify the parties who are negligent. In the case of an RN pushing diprivan in an ER, with a hospital policy and nsg board policy, the order of a physican who is in the room with the RN, the RN would not be negligent and therefore not liable. As for your contention to get 2nd party insurance, he also informed me not to. When an investigation begins the parties whom money can be extracted are identified. The two parties which are prime targets are institutions and physicians due to their large income and large insurance policies. RNs are rarely named or sued (which you can see if you do a search on lawsuits) unless they HAVE insurance as there is little to gain monetairily from them (read: low income).

Research:

This is a study done in a surgery center NOT an ER where a recognized airway expert (ER physician) is always present yet the research clearly shows no issues. There are a number of other studies as well but they dont have the n value (9152) this one does.

http://gidiv.ucsf.edu/course/things/propofolexp.pdf

Summary:

Nurse-Administered Propofol Sedation Without

Anesthesia Specialists in 9152 Endoscopic Cases in

an Ambulatory Surgery Center

CONCLUSION: Nurse-administered propofol sedation in an

ambulatory surgery center was safe and resulted in high

levels of patient satisfaction and rapid postprocedure recovery

and discharge. (Am J Gastroenterol 2003;98:

I agree...after studying anesthesia, I would never agree to push propofol as an RN on a non-intubated patient without an anesthesia provider present. Somehow the "we do it all the time" doesn't seem like it would sound very good in court. The fact of the matter is that patients have died in this situation and propofol can be a very dangerous drug in the wrong hands! Good luck to all of you.
ps. Early in my ICU career, a fellow nurse who did a lot of legal consulting, encouraged me to carry my own malpractice insurance. She said she had seen many situations where the hospital's interests did not allign with the RN's interests. It may be in their best interest to paint you as incompetent, not following official policy (even if it is done frequently), etc. This seems like a perfect example of that to me.