Along similar lines as the recent discussion about RNs pushing certain drugs for sedation, how do you feel about the rules which allow non-anesthesia physicians to push these drugs if RNs can't?
For example, in an Emergency Room where I used to work, sometimes the ER MD would want to do some sort of sedation for a procedure and would want to use propofol. RNs there were not allowed to push propofol (they could only administer a drip for mech vent.) so the MD would push it while the RN monitored the pt. Often times, the same MD doing the procedure would also push the drug. Now, to me, that seems like a loophole around adequate monitoring. The RN is still the one monitoring the patient, it's just the MDs hand actually depressing the plunger.
What's the difference here between this situation and the RN doing it and the MD saying, "OK, give another ml."?
Am I missing something? Should an anesthesia provider of some sort (MDA or CRNA) be required to do this? If I'm not understanding something, educate me. :)
I am not a CRNA. As an experienced critical care nurse CCRN 20+ years) working nights we often administer conscious sedation for emergency cardioversions and bedside endoscopy. I do NOT push propofol, pentothal, brevital, or ketamine.
The practice committee at my hospital solved the problem of an ER doc wanting the same RN who had four patients to administer propofol for orthopedic procedures by asking for the written policy and procedure. This must be approved and signed by pharmacy, medicine, nursing, and administration.
Our BRN advisory was helpful The RN responsible for monitoring the patient must not be distracted with assisting the physician.
Some states specifically prohibit RN's from administering propofol, and wisely so. Check out the package insert on propofol - again, it's an ANESTHESIA DRUG. Trust me - the attorneys know this and will hang you out to dry if you ever have a problem with it.
NO ONE uses propofol for "conscious sedation". That's why it's used so much by gastroenterologists and ER types and the nurses that work there. There are plenty of drugs and combinations of drugs to use for conscious sedation. Propofol is used, by and large, inappropriately, to get people to a deeper level of sedation, even though that is totally inappropriate for non-anesthesia professionals to be doing. The key word is CONSCIOUS sedation.
I was not clear. We had two issues.
One was ordering an RN to push propofol. We do not do this!
Two was asking an RN with 2 or 3 other patients to administer conscious sedation and assist with positioning the patient, handing instruments, and so on.
The request for a written policy and procedure solved both.
The RN does NOT administer anesthesia meds, the RN responsible for monitoring the patient has no other assignment until the assessment determines the patient is no longer in need of constant assessment.
If a Doc wants propofol given we offer to call anesthesia.
pickledpepperRN
4,491 Posts
I was not clear. We had two issues.
One was ordering an RN to push propofol. We do not do this!
Two was asking an RN with 2 or 3 other patients to administer conscious sedation and assist with positioning the patient, handing instruments, and so on.
The request for a written policy and procedure solved both.
The RN does NOT administer anesthesia meds, the RN responsible for monitoring the patient has no other assignment until the assessment determines the patient is no longer in need of constant assessment.
If a Doc wants propofol given we offer to call anesthesia.