Rad Tech's pushing IV Narcotics for sedation

[GeanineRN]

I have worked in an interventional radiology department for the last 4 1/2 years. We have 2 rooms, 4 rad techs, and 2 RN's. Our techs do conscious sedations and push IV narcotics. I was told that this is ok, because they are doing it under "direct supervision of the physician". The RN is in another case, or off for the day. But there is always a RN on duty. Never are we off the same day.

We also have a narcotic sign out sheet, and our techs also sign out these narcotics. Is this a practice at other hospitals?

I don't have a nurse manager, and my supervisor is a Rad Tech. She does not know my licensure. Our techs for our state, are not licensed. They are registered with their national registry. But not licensed to practice by our state.

[kckcgussyy]

I would check with your state board.You are still liable,you have a licence to lose,they don't.

kc

[Marie_LPN, RN, LPN, RN]

I checked our hospital's policy, no where does it grant permission for rad techs to push narcs.

[BSS25]

I recently started to work in IR. I am an LVN and I know for sure that I am not able to push anything IV and the tecs are not also.

[Gompers, BSN, RN]

Just talked to my dad - he's a former radiology/nuclear medicine tech who now manages a radiology department. He said that techs are able to start IVs, push saline to flush, and to administer contrast via IV. NOTHING ELSE. If a patient is getting IV sedation, he said, a nurse must be present to monitor the patient during the procedure and to administer the medication.

I know, myself, from having a CT done where I had a slight reaction to the contrast - the tech was able to give me the contrast but the radiologist himself had to come in and administer IV Benadryl.

[ZASHAGALKA, RN]

I doubt seriously that this practice is legal, in any state.

Whether you are working 'under supervision of a physician' or not, the job you are doing must still fall within your scope of practice. Unless the rad tech was certified by state examination to deliver narcotics, that is a scope of practice issue limited to docs and nurses.

And if the doc didn't write it as an order, or you don't have a standing protocol (I doubt you do, since it's illegal), then it's going to come down to an issue of RN delegation. And in this case, it's an illegal delegation.

Heads will roll and licenses will be endangered if, God forbid, a patient were mismanaged or a narc was diverted, or even if the DEA audits and asks who all these non-licenses signing off narcs are. . .

And besides, who is doing the IV CONSCIOUS SEDATION forms for these pts? Not to mention the NURSING monitoring that those forms require . . .

I wouldn't sign out a narc for a non-nurse to give (except rarely, I have signed out morphine for RT to give as nebs, under my direct supervision). And if the techs have access to the narcs independent of you, woe be to your hospital if DEA or JCAHO ever finds out.

~faith,

Timothy.

[sunnymqt]

In the cardiac cath lab the Imaging techs give sedation, many of these are LPNs. but in the radiology department only RNs give sedation.

we dom use a conscious sedation record with LOC and level of sedation.

[ZASHAGALKA, RN]

In the cardiac cath lab the Imaging techs give sedation, many of these are LPNs. but in the radiology department only RNs give sedation.

we dom use a conscious sedation record with LOC and level of sedation.

But the point is that those IV conscious sedation records require NURSING ASSESSMENTS. It's beyond the scope of practice for a non-nurse to make those assessments.

Whether that be cath lab or radiology. The sedation and its effects must be given and monitored by a nurse or physician.

~faith,

Timothy.

[Marie_LPN, RN, LPN, RN]

A tech has no business giving sedation. They are not a licensed nurse.

[GeanineRN]

I live in Michigan, and it is my understanding that the Rad Techs are not licensed by the state of Michigan for anything. They are nationally registered. The director of the Radiology Tech Student program has her masters degree, and she swears that it is legal for them to give narcotics IVP under the direct supervision of the Radiologist.

I have a problem with this issue since they are not licensed by the state of Michigan to dispense and administer narcotics. I have alot of questons and no where to go for answers. NO nurse managers, only a rad tech supervisor.:stone

I really appreciate all of your inputs. Thanks!

[dianah, ASN]

You might poll the area hospitals and see what they're doing, and if it's different, ask if they have any reference material (articles, national technologist bylaws/guidelines/standards) to support their practice. If all else fails, you may contact the tech licensing organization and let them fill you in. It sounds like it's a touchy area (a little territory-ism going on??). I agree that it's a NURSING duty. Years ago they did push narcs (I'm talking 25 yr ago ), but at the facilities I've worked, the pendulum has swung (and rightly so) and it IS a nursing duty. Assessments, monitoring and all. Hmmm, maybe JCAHO has something to say about this, you might check their website and do a search. -- D

[DusktilDawn]

I work in a Michigan facility. IV starts, IV sedation, conscious sedation are all done by RNs. Have you contacted risk management at this facility?

The director of the Radiology Tech Student program has her masters degree, and she swears that it is legal for them to give narcotics IVP under the direct supervision of the Radiologist.

I would ask her under what legislative guidelines that they are allowed to perform what is clearly within a NURSES scope of practice. In fact I would have to see this in black and white to actually believe this one.