bmarjie1

I work in Washington state in the Tacoma area, and we have a pretty good mix of LPN's and MA's in the offices. I currently work in an independent Family Practice facility with 10 providers and we have 4 RN's, 7 LPN's, and 5 MA's (which is a higher ratio of licensed staff than most FP offices). We utilize the RN's for Care Coordination/Case Management and Triage. Technically LPN's are not supposed to triage in WA, we are only supposed to gather information. In WA, the MA's are not allowed to take verbal orders, administer injections of controlled substances or from a multidose vial, or refill medications based on Standing Orders, so the LPN's allow a greater office flexibility. I have been greatly challenged in my current job as I am now also ACLS certified and Anticoagulant/Coumadin certified as well.

Here is a link for you. MSMA Regulations. Marjie

I cannot speak for the rules in Maryland as I am in Washington State, but our laws are that MA's can give injections with a written order (not verbal) , as long as it is not for a controlled substance (pain meds, testosterone) and it cannot be from a multi-dose vial except for vaccines. In Washington MA's are further broken down by certification and this plays a roll in what duties they can do. The information regarding "authorized duties" in Washington is not found through the board of physicians or nursing commission, but is actually found in the Washington State Legislature website. Perhaps you should look at the Maryland Legislature website and look up MA's, LPN's, RN's there to answer your questions about who can do what? Marjie

There is some debate in my office right now regarding what is needed for an order for recurring injections (i.e. B-12, testosterone, Depo-provera, etc.). I work at a 10 provider, independent, Family Practice office. At this time there is not a routine process for this. The most used way for ordering these injections is to place a prescription on patients med list. The patient then makes a "Nurse Only" appointment to come in for injections? My concern about this is that although the prescription includes medication, dose, route and frequency, it does not state that medication is to be administered in the office or a duration for the order (or a diagnosis/icd-9/10 that we need when administering). My thought process is that if a patient just walked into the clinic and had Lisinopril on his/her medication list, I could not place the Lisinopril in his mouth without an order to administer, so does it count as an order for me to administer an IM injection? I am wondering what the legal/correct answer is for this as I am getting some resistance when stating that I think we need more of an order. Maybe I am just being over cautious? Does the prescription on the med list cover us to administer IM injections in the office or do we need more specific orders to administer in the office and a duration for the order since we are an outpatient, PCP office. I would appreciate any feedback on this since I would like to make sure that our office is being compliant with standards and have not been able to find a clear, defined answer. Sincerely, Marjie

In my past clinic experience we have always made patients wait at least 20 minutes after receiving rocephin or other antibiotic injections. We have a new nurse manger who states that they do not need to wait if they have had thee injection before. My mind remembers that it is not necessarily the first time that you are exposed that you react. Also, it is still an IM injection and will take 20-30 minutes for medication absorption to occur. Just wondering what other peoples experience and protocols are. Perhaps I am just an old nurse and this is a sacred cow? i have been unable to find any research or data to support either so your input would be appreciated.