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Propofol administration by ER RN

Emergency   (391 Views 7 Comments)
by diane e diane e (New Member) New Member

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Hi, In the state of California what is the scope of practice for propofol administration for sedation in ER by RN.  Also can a patient be in 4 point hard restraints on a stretcher vs a regular hospital bed.  Any replies would be appreciated. I think this hospital is cutting corners, with unsafe practices. And putting nurses license in jeopardy .  Thank you

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Pixie.RN has 18 years experience as a MSN, RN, EMT-P and specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN.

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Regarding your first question, did you search the California Nurse Practice Act? https://www.rn.ca.gov/practice/npa.shtml

A simple search on "sedation" will answer your question. 

In regards to restraints, I have used them in ERs (not in California but elsewhere) where there are no hospital beds in the first place; however, we stopped using hard restraints (leathers) a long time ago. What is your facility policy? It is usually more important to have a valid order with the proper checks. 

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NurseVoldemort has 12 years experience as a BSN, RN and specializes in ED.

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I've worked in Washington, NY and Oregon. Never in Cali, but we have never had a regular hospital bed to even think about using locking/hard restraints on. We only have every used them on the stretchers. The biggest thing is to ensure you have proper charting and orders for said restraints.

I've been legally allowed to give propofol IV push for sedation in every state I work with in the prescence of the MD for moderate sedation procedures. The hospital I currently work in only allows ED RN's to perform this and when our house float comes to help (from the ICU) they can't do it since it is against hospital policy; only ED nurses can do it and only when the MD is present. 

For sedation for intubated patients though we also can do boluses in prescence of MD and then titrate drips without MD being in the room once the pt is tubed.

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Propofol- a quick Google search indicates it is legal.  The idea that it is illegal is one of those persistent nursing myths. (Though maybe it is illegal in some states.)  Nurses will tell you with absolute authority that it is legal to maintain a drip and titrate, but illegal to bolus.  I curious where this is actually true.

As far as 4 points on an ER cot- common practice.

 

 

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1,580 Posts; 17,062 Profile Views

Propofol- a quick Google search indicates it is legal.  The idea that it is illegal is one of those persistent nursing myths. (Though maybe it is illegal in some states.)  Nurses will tell you with absolute authority that it is legal to maintain a drip and titrate, but illegal to bolus.  I curious where this is actually true.

As far as 4 points on an ER cot- common practice.

Also- check with the Cali BON.

Have you ever heard of a nurse losing a license for applying 4 points on an ER cot as ordered, or administering a drug as ordered?

Curious- what kind of nursing do you do?  Are you a new hire in an ER?

 

 

 

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Hi. I have been an ER nurse for 33 years.( yikes that seems like a life time). I used to work in a big county hospital in Los Angeles for 19 years in a level 1 trauma centerThen in 2002 moved to Kodiak Alaska. Still in Er. But went from 44 beds to 6 beds. My daughter is a new grad and got hired here in Southern California. I was actually inquiring for her. The ER she got hired at, hires new grads, but the orientation they gave was all about speed, and getting patients in and out fast. So she had those questions for me. I honestly appreciate the replies. Nursing has changed over the years.  So much I used to know, and now not sure what I know,, Thank you for the information

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On 9/13/2019 at 12:00 AM, diane e said:

The ER she got hired at, hires new grads, but the orientation they gave was all about speed, and getting patients in and out fast. So she had those questions for me. I honestly appreciate the replies.

Kudos to you on your long ED career. 🏆

Unfortunately I would say your daughter's take on the orientation is probably spot on.

Good nursing judgment might be more important than ever. You can help her learn how best to verify what she is being taught, through policies, regulatory agency websites, information from professional bodies, etc., etc. A good ED reference manual can help fill in the gaps of knowledge about actual patient care. I think a close review of the ESI triage manual can help new people too, because it helps lay out a good foundation and sequence for deciding who is sick/high risk and who isn't. She needs to try to get up to speed about patient conditions and who is at risk for what ASAP so she can use good judgment despite all the competing foci.

Take care ~

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