Sedation nurse acting as tech too...

zerby1470 · May 11, 2007

To me, that seems dangerous. At my facility, we do not do do much RN sedation - most is propofol with a CRNA (whole different debate, not going there), but when we do a sedation, the nurse is never expected to tech the procedure as well. it is considered unsafe for the patient. We average 30 minutes including turn time for procedures, but we are not a free standing SS, so that might make a difference.

Home Health Columnist / Guide · May 11, 2007

when in sedation the nurse is being asked to also do the tech functions too.

this is going against standards..

sorry to say if anything goes wrong, kiss your license good-by.

from: aacn

topic: sedation guideline

monitoring conscious sedation

ccn april 1997 - volume 17 - number 2

q: what is the nurse's role in monitoring a patient who is consciously sedated? how can the joint commission of hospital accreditation requirements be met on a consistent basis throughout the facility,

whether it be an outpatient bronchial unit, a gi lab, or in the recovery room?

a: judy davidson, rn, ms, ccrn, replies:

the role of the nurse in conscious sedation is to monitor the effects of sedatives given for tests and procedures. during this time the nurse should be relieved of other duties. assessment includes monitoring adequate airway and gas exchange, cardiovascular response, level of consciousness, and whether pain and anxiety are controlled to patient satisfaction. literature included on the additional reading list at the end of this section offers recommendations for what to monitor, defines conscious sedation, and provides guidance for stratifying risk factors of patients. issues that remain unclear include what special considerations should be made for monitoring sicker patients (american society of anesthesia [asa] class iii and iv), and when a physician should be available following the test/procedure.

because you cannot predict the response to any given dose or type of sedative, details on how to respond to the transition between conscious and deep sedation of the intubated and nonintubated patient should be developed. the reason why the joint commission of hospital accreditation focuses on conscious sedation is because once sedated, a patient is vulnerable. ....

http://www.aacn.org/aacn/practice.nsf/files/o2s/$file/2002%201%20sedation.doc

GInurse2007 · May 12, 2007

i really appreciate the responses to this post.

i am gathering all the materials i can to support the position of requiring a tech in the room to assist the md, so the reference to aacn was helpful.

the brn for my state says the following: "the registered nurse managing the care of the patient receiving iv conscious sedation shall have no other responsibilities that would leave the patient unattended or compromise continuous monitoring."

i have been basically told that doing the tech functions does not violate this guidline because i can still see the monitor, so the continous monitoring is not compromised. to me though, my attention is split too much when focusing even for a short time on doing the tech functions and i feel that there is a compromise to continous monitoring. also the monitor does not give a complete picture on patient condition. it is an argument that i am willing to have with my employer, and hopefully be able to keep my job. that is why i am trying to get all info i can.

thanks again.

pickledpepperRN · May 12, 2007

From the California Board of Registered Nursing:

http://www.rn.ca.gov/practice/pdf/npr-b-06.pdf

This policy and the AACN position are included in the policies and procedures at my hospital. Some quotes include:

The registered nurse administering agents to render conscious sedation would conduct a nursing assessment to determine that administration of the drug is in the patient's best interest. The RN would also ensure that all safety measures are in force, including back-up personnel skilled and trained in airway management, resuscitation, and emergency intubation, should complications occur.

RNs managing the care of patients receiving conscious sedation shall not leave the patient unattended or engage in tasks that would compromise continuous monitoring of the patient by the registered nurse.

The RN is held accountable for any act of nursing provided to a client.

The RN has the right and obligation to act as the client's advocate by refusing to administer or continue to administer any medication not in the client's best interest

As of 1995, safety considerations for conscious sedation include continuous monitoring of oxygen saturation, cardiac rate and rhythm, blood pressure, respiratory rate, and level of consciousness, as specified in national guidelines or standards.
Immediate availability of an emergency cart which contains resuscitative and antagonist medications, airway and ventilatory adjunct equipment, defibrillator, suction, and a source for administration of 100% oxygen are commonly included in national standards for inducing conscious sedation.

Good for you for advocating in the interest of your patients!

It is NOT in the best interest of a patient undergoing conscious sedation for the RN to be distracted from CONTINUOUS monitoring. This is not simply listening for a monitor alarm.

Home Health Columnist / Guide · May 12, 2007

check your practice act:

pa: 21.413. interpretations regarding the administration of drugs—statement of policy.

(d) as used in this subsection, ‘‘conscious sedation’’ is defined as a minimally depressed level of consciousness in which the patient retains the ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal commands. the registered nurse who is not a certified registered nurse anesthetist may administer intravenous conscious sedation medications, under 21.14, during minor therapeutic and diagnostic procedures, when the following conditions exist:

(1) the specific amount of intravenous conscious sedation medications has been ordered in writing by a licensed physician and a licensed physician is physically present in the room during administration.

(2) written guidelines specifying the intravenous medications that the registered nurse may administer in a particular setting are available to the registered nurse.

(3) electrocardiogram, blood pressure and oximetry equipment are used for both monitoring and emergency resuscitation purposes pursuant to written guidelines which are provided for minimum patient monitoring. additional emergency resuscitation equipment is immediately available.

(4) the patient has a patent intravenous access.

(5) the registered nurse involved in direct patient care is certified in advanced cardiac life support (acls). provisions shall be in place for back-up personnel who are experts in airway management, emergency intubation and advanced life support if complications arise.

(6) the registered nurse possesses the knowledge, skills and abilities related to the management of patients receiving intravenous conscious sedation with evaluation of competence on a periodic basis. this includes, but is not limited to, arrhythmia detection, airway management and pharmacologic action of drugs administered. this includes emergency drugs.

(7) the registered nurse managing the care of the patient receiving intravenous conscious sedation medication may not have other responsibilities during the procedure. the registered nurse may not leave the patient unattended or engage in tasks which would compromise continuous monitoring.

(8) the registered nurse monitors the patient until the patient is discharged by a qualified professional authorized to discharge the patient in accordance with established criteria of the facility.

link to all boards of nursing under links on our top grey toolbar.

salary of a tech vs. lawsuit payout..... know which one i'd choose and which gi doc's name would not cross my lips for recommendation.

boriquarn · Jun 14, 2007

In Florida I worked in a large trauma hosp. and then an outpt. endo center. Both facilities had RN's and Tech's in the rooms.

In South Carolina, the hospitals use RN's and Tech's but the outpt. centers use only RN's-obviously for cost reasons. The physicians who own the center are looking at maximum profit much to the stress of their nurses.

The overhead costs for staff and supplies are high and they want to be assured a profit- so they dwindle down the staff to the bare minimum.

Unfortunately, the policies of the facility and practice acts can be interpreted either way but SGNA does advise tech assistance during procedures inorder to assure the RN is able to focus on sedation.

maxm · Jul 25, 2007

i think this is a problem, in my institution, the sedating nurse is to be watching the patient and monitoring vital sign. this is what the policy says. we have 2 people in the room for all procedures. what soes your conscious sedation policy say.

kstec, LPN · Jul 28, 2007

I was just reading this and wondering how do I find out if it is within a LPN's scope of practice to do conscious sedation? I wrote a post earlier and received no responses. I have interview on Monday to do pre-op, conscious sedation and recovery in a GI facility. Are they asking me to work out of my scope or am I in my scope but just cheaper labor than a RN? By the way, I live in Illinois. Thanks for any responses.

EndoRN · Aug 26, 2007

I'm not sure what IL law is re: LPN's giving conscious sedation. I know in our GI lab they do not.

In regards to the first post, SGNA states if the nurse is doing the sedating (vs. a CRNA) then that should be their ONLY responsibility in the room, to sedate/monitor the pt.

I have worked places where it's like you said, we are sedating AND teching. But it's pretty bad practice.

queenb091 · Sep 23, 2007

I had an issue with this a few months ago. A physician scheduled a scope on a Saturday( a whole other issue in itself). I notified my CNO, so she would know why we were there on the weekend. I received a call from "upper management" saying that only 1 nurse needed to come in. I stood my ground and told them "absolutely not," that it was not safe. I did find my hospital's policy re: GI procedures and it states the RNs sole duty is to monitor the patient and the LPN/tech assists the physician. Hope that answered your question.