ExperiencedCRNA

Propofol can be administered ONLY by a person specially training in anesthesia: including anesthesiologists, anesthesia residents, dentists that completed an anesthesia residency, nurse anesthetists and student registered nurse anesthetists. You can find this information in the manufacturer's package insert for propofol. The only exception is when a patient is intubated and has a secure airway. ICU nurses can titrate an infusion in this scenario and I believe they can bolus through the pump. I'm not sure if ED nurses can administer it by infusion with a secure airway but I am certain that an ED nurse, or any other nurse not trainied in anesthesia, SHOULD not administer freehand propofol. I don't know where you would find this information in the nurse practice act or if it specifically stated. Conscious and moderate sedation refers to midazolam and fentanyl only. Propofol provides deep sedation. If your hospital is asking you to bolus propofol freehand I would immediately consult your supervisor to determine that this is in fact the policy and ask where you can review it in writing. Also, if it is true that this is the hospital policy I would urge you to go to administration and ask that they review the policy. I can tell you from personal experience that propofol is extremely unpredictable. I have seen people go completely apneic and require bag-mask ventilation from 1-2cc boluses. I have seen extreme hypotension and bradycardia from "normal" amounts. The ASA strongly recommends that the person giving propofol be a trained anesthesia professional not involved in the procedure. I know an ED physician should be able to rescue an airway but sometimes the effects of propofol happen so quickly that IMMEDIATE intervention is necessary to prevent cardiac or respiratory arrest; including specialized airway maneuvers and boluses of heavy duty vasopressors. Regardless of whether or not it is legal/illegal, or written in hospital policy, I would not recommend doing it from a patient safety standpoint.

I recommend this book for you. It is true that medical error is very common and often goes unreported and not admitted. I believe a lot of providers are suffering because of this. You are one of them and you are not alone. It doesn't matter that that the error was a long time ago or how significant it may have been. For the record, this does not come close to some of the horror stories I have heard, witnessed or personally been involved in. But when it happens to you it feels like the worst thing in the world. I understand. And I understand why you can't just "forget about it and move on". The reason you are obsessed with the error and with tracking down the patient to see how they are doing is because you are a good person, a caring person, a good nurse and one committed to doing the best for her patients.

Why is contacting the patient a huge mistake? Most providers dealing with this second victim syndrome want to apologize and it helps to move on. Doesn't the patient have a right to know what happened? I believe most people are forgiving and understanding when someone is honest and sincere.