RN without ACLS pushing Versed?

[NoAverageLPN]

Howdy! I am an LPN and am currently working for a company as a Quality coordinator for an outpatient surgery center that deals mostly with pain management.

My question is this: We have RN's in pre-op who administer 2mg Versed prior to epidural steriod injections and I am getting conflicting opinions on whether this dose qualifies as moderate anesthesia in conjunction with wanting to evaluate competency for the nurses pushing the Versed. According to the ASA, 2mg would be minimal not moderate sedation however I know a surveyor for AAAHC and he states that because Versed is on the 'list' we have prove competency to push this med as a moderate sedation? Thoughts?

[P_RN, ADN, RN]

Don't believe so.

[Biffbradford]

Honestly, I wouldn't touch this question with a 10 ft pole, but let me just comment that a 2mg dose would have different effects on different people. Let me use myself as an example. A few years ago, I had an unfortunate accident, and while in the hospital they wanted to do a bedside endoscopic echo. I was told that they gave me up to 15mg of Versed to sedate me enough to shove that probe down my throat, but I was still fighting it. Obviously, it was a good enough dose that I don't remember the procedure, but not enough to sedate me. (you know they were probably holding me down too!) I eventually had to go into the cath lab with an anesthesiologist and a bottle of Propofol to get the job done. I'm 6'5" 200+ lbs. Give 15mg of Versed to a 100 lb person and you'd have a different outcome.

[NoAverageLPN]

So therefore, making them take a Moderate Sedation Competency exam and changing all of our policies (also part of my job) would be useless, right?

[NoAverageLPN]

Honestly, I wouldn't touch this question with a 10 ft pole, but let me just comment that a 2mg dose would have different effects on different people. Let me use myself as an example. A few years ago, I had an unfortunate accident, and while in the hospital they wanted to do a bedside endoscopic echo. I was told that they gave me up to 15mg of Versed to sedate me enough to shove that probe down my throat, but I was still fighting it. Obviously, it was a good enough dose that I don't remember the procedure, but not enough to sedate me. (you know they were probably holding me down too!) I eventually had to go into the cath lab with an anesthesiologist and a bottle of Propofol to get the job done. I'm 6'5" 200+ lbs. Give 15mg of Versed to a 100 lb person and you'd have a different outcome.

The doc ONLY gives 2 mg of Versed, never anymore or less. It is his weird standing order, other physicians will use a propofol/fentanyl MAC with an MDA or CRNA...not this guy. There is no dose calculation based on age, weight, health history, etc. Versed 2mg IV for all....

[kessadawn, BSN, RN]

RNs at my hospital, myself included, must pass yearly sedation competencies, regardless if they are giving minimal or moderate sedation. There's more to it than just pushing the med, you must also have education on what to do in various outcomes, and rarely is it anything like ACLS, which we are all certifed in as well (I work ICU).

[RNChristy]

I worked many years in a hospital and Versed has always been considered Conscious/Moderate Sedation there. I worked in the ICU and eventually in Interventional Radiology where I gave Versed regularly for procedures and any nurse, always an RN, had to have yearly competencies and ACLS. There are too many side effects or reactions that could happen and the nurse would need to be educated/prepared for this. I would think this would not be any different for another hospital or facility but this would be based on policies and procedures.

[meandragonbrett]

ACLS nowadays is nothing more than a joke and a hoop that one must jump through in order to continue to work.

[silentRN]

We push Versed all the time on our unit. Even have Versed drips if we need them.

[GilaRRT]

What exactly would having ACLS change?

[NoAverageLPN]

In one of the many, many articles I have been reading it stated that when used as Moderate Sedation the nurse should be ACLS certified. However, it is not being used as moderate, but anxiolysis. Like I said, we usually have a MDA or CRNA doing the anesthesia but this particular doctor uses only 2 mg preop. I just want to make sure that our policies are correct and we are not missing anything. The nurse director stated that if we test the competency we are opening ourselves up for liability saying that we have nurses pushing Versed and quote "especially since not all of the nurses have ACLS".

[NoAverageLPN]

Oh and THANK YOU all for your responses!! I am going to talk to the administrator and we are more than likely going to implement yearly competency. Everyone could use a little refresher...right!?!?

My main goal is to make sure that they know what the side effects are and how to respond appropriately. We have had some transfers out to inpatient lately, as well as a survey coming up so I am just a little on edge.

Thanks again!!