PMHNP's with ketamine experience??

[caleyannwek]

Hello! I am considering taking a job in Colorado at an integrative psychiatry clinic, which is my niche. My concern is that there will be times that I will be the only on site provider in this clinic that does ketamine assisted psychotherapy. The ketamine is administered IV by a RN. During the procedure the patient is monitored by the RN and is in session with the therapist. I am the only PMHNP at this practice, there are 3 other psychiatrists. They would like me to be able to "cover" as the on site provider should there be a reason that a provider needs to be consulted during the procedure. They monitor SpO2 levels during and take VS before and after procedure.

I spoke with the Colorado board of nursing who said there are no rules, regulations, or opinions that the state has regarding APRN's and there ability to utilize ketamine. I come from NYS which is incredibly restrictive. It seems Colorado has embraced ketamine much more readily than other areas of the country. The only guidance that the board was able to give was that they recommend I act with ANA and APNA scope. It seems NP's own and run their own ketamine clinics in Colorado, so I am a bit lost here. Any PMHNP's with ketamine experience??

[stephkneew, ASN, BSN]

This is my dream job! Curious if you figured out the answer to your question. Also would love to pick your brain on integrative PMHNP & psychedelic assisted therapy if you have the time! I’m an RN and want to do integrative PMHNP but haven’t picked a school yet. What school did you attend? Feel free to email me your experience at [email protected]. Thank you!

[PMHNPgomez]

Hey there. First time ever responding to a post but I felt compelled to share my experience. I did clinical rotations at a ketamine clinic in Washington where (like CO) rules are not defined and there are several clinics popping up. To be honest (in my specific experience) - it was a very unsafe environment and I ended up quitting clinicals due to fear of eventual repercussions. To outline my experience - the shipments of ketamine (they did IM injections based off of weight) - were stored in a closet with no real “count”, the patients had VS taken but there were frequent episodes of apnea which the other providers called “holding their breath in the ketamine experience”, the ketamine was prescribed for at home use in the form of sublingual tabs with zero education on the potential addictive nature, and any questions I had regarding safety were thought of as a naysayer. I’m all for integrative psychiatry - but let’s just be real here for a a moment regarding our education, our practice role, and our knowledge of ethical research - ketamine in the context of psychedelic medicine for the treatment of psychiatric illness has almost no scientific emperical evidence, ketamine as a treatment for treatment resistant depression in the form of es ketamine and some IV use has evidence but only in that context, and really the safe use and integration of these medications should on those with specific training on using anesthetics - which is not a PMHNP scope of practice. Sure, we can risk it - but if someone stops breathing in an outpatient clinic and you’re the only one around - who’s neck is on the line. Again, I’m all for integrative psychiatry and psychedelic science - but doing it in an informed and safe way - which I don’t think we are there yet with ketamine. There’s not enough research or evidence and ultimately I think the ketamine clínics of today (from what I’ve seen in WA) fall short of the great responsibility we have to our patients when entrusted with their care and their lives. 

[stephkneew, ASN, BSN]

I agree in some ways, I think SO many clinics are doing it wrong and short-cutting to make money! I want to be one of the few doing it right in a safe environment with therapy assisted integration as well…that may mean opening my own clinic if I can’t find an environment I’m comfortable with but I’m OK with that. 

[umbdude, MSN, APRN]

I don't see how administering and monitoring ketamine and esketamine tx are in PMHNP's wheelhouse. I absolutely would not feel comfortable being the  one monitoring patients undergoing this type of anesthetic unless I have some years of doing cardiac resuscitations. For this reason, the ketamine clinics I see that are owned by non-physicians are owned by CRNAs. I had seen several jobs posted by ketamine clinics doing these "monitoring," and they were hiring ACNP.

Where I see PMHNPs come into play is doing screening, referring, and following up to assess efficacy. I would be cautious and thoroughly learn the protocols when deciding whether it is an appropriate role for PMHNP.

[Alison Kirkpatrick RN]

So are there any scoring systems to meet criterion for discharge as you have with Aldrete or PAS in the PACU following surgery? 

 

[ICUPMHNP]

How different is this ketamine IV infusion than what we give in the ICU? I don't see the big concern? Patient goes apneic stop infusion? if its truly bad give reversal? This is the perspective on someone on the outside looking in. Please feel free to educate. ty!

[Laulea Marie]

In the ICU you have a team of people that can come in and help resus a patient who has been given an anesthesia and has a poor or adverse reaction.  My concern would he the liability of 1. Administering anesthesia when im not a CRNA and 2. Admin a drug that is not FDA approved for depression.  
Now using Spravato in REMS approved clinic I wouldn't have a problem with.