Wyoming Board of Nursing Review – April 13, 2022
Reviewed by Sedation Certification – January 10, 2024
State Sedation Policy – Yes
Can RN’s give sedation? – Yes
Can RN’s give Propofol? – Under Certain Circumstances
Can RN’s give Ketamine? – Yes
Excerpts for each document are posted below. Click the link for the full opinion.
Pre & Post Anesthesia Nursing Practice
ADVISORY OPINION
MODERATE SEDATION
In accordance with Wyo. Stat. Ann. § 33-21-122(c)(iii) of the Wyoming Nursing Practice Act (NPA), the Wyoming State Board of Nursing (WSBN) has approved the following Advisory Opinion on Moderate Sedation.
The intent of this advisory opinion is to provide clarification for RNs who may be asked to administer sedating agents to provide comfort and pain control for patients undergoing potentially painful or uncomfortable diagnostic and therapeutic procedures.
For the purposes of this advisory opinion, moderate sedation/analgesia is defined as follows:
Moderate Sedation/Analgesia (aka “conscious sedation”) means: a medically controlled state of depressed consciousness, induced to allow the patient to tolerate procedures, that:
1. Allows protective reflexes and cardiovascular function to be maintained;
2. Retains the patient’s ability to maintain a patent airway independently and continuously; and
3. Permits appropriate response by the patient to tactile stimulation or verbal command, e.g., “open your eyes.”
It is within the scope of practice of an appropriately trained and competent RN to administer moderate sedation during diagnostic or therapeutic procedures as ordered by and in the presence of the physician, APRN or PA if the following criteria are met:
1. There are institutional policies and procedures to guide this practice;
2. The nurse has completed training and demonstrated continuing competency as well as current certification appropriate to patient population (e.g. ACLS, PALS);
3. The agency/facility maintains documentation on competency and training for each nurse;
4. The care is provided under the direction of a physician, APRN, or PA who is on-site;
5. The patient’s condition is assessed prior to, during, and after the procedure to current standard of practice;
6. The nurse managing and monitoring the care of the patient receiving moderate sedation shall have no other responsibilities that would leave the patient unattended or compromise continuous monitoring during the procedure; and
7. Assure that emergency support strategies appropriate for the setting and individual patient are available. These are to include, but not limited to:
a. The presence of pharmacologic antagonists;
b. The presence of appropriately sized emergency airway equipment;
c. The presence of an individual capable of establishing a patent airway and providing positive pressure ventilation and resuscitation;
d. The presence of an individual to establish intravenous access; and
e. The availability of rescue support.
It is not considered appropriate for an RN to administer drugs labeled by the Food and Drug Administration as Anesthetic Agents (including, but not limited to: Propofol, Etomidate, Pentothal, or Brevital by any route) for the purpose of moderate sedation with the exception of Ketamine.
The WSBN acknowledges it is within the scope of practice of the appropriately trained and competent RN and APRN to administer Ketamine for moderate sedation as outlined in this Advisory Opinion.
ADVISORY OPINION
Pre & Post Anesthesia Nursing Practice
An advisory opinion adopted by WSBN is an interpretation of what the law requires. While an advisory opinion is not law, it is more than a recommendation. In other words, an advisory opinion is an official opinion of WSBN regarding the practice of nursing as it relates to the functions of nursing. Facility policies may restrict practice further in their setting and/or require additional expectations related to competency, validation, training and supervision to assure the safety of their patient population and/or decrease risk.
Within the Scope of Practice/Role of APRNs & RNs.
The Wyoming State Board of Nursing (WSBN) relies on the evidence-based practice guidelines supported by national associations whose goals include determining standards of practice and safe protocols. Nursing practice is increasingly more complex and technical. It is the responsibility of the individual nurse and the facility (or system) to provide opportunities to ensure nurse competency and an environment conducive to providing safe care.
WSBN endorses the following positions statements in support of this advisory opinion;
● Perianesthesia Nursing Standards, Practice Recommendations and Interpretive Statements. American Society of PeriAnesthesia Nurses
● 2017 Position Statement by the American Association of Nurse Anesthetists (AANA): Care of Patients Receiving Analgesia by Catheter Techniques
● 2020 Position Statement by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN): Role of the Registered Nurse in the Care of the Pregnant Woman receiving Analgesia and Anesthesia by Catheter Techniques
● Guidelines for sedation and anesthesia in GI endoscopy Gastrointest Endosc 2018 Feb, Volume 87, Issue 2, Pages 327–337 / DOI: http://dx.doi.org/10.1016/j.gie.2008.09.029
● Position statement: non anesthesiologist administration of propofol for GI endoscopy Gastrointest Endosc 2009;70:1053-1059 / DOI: http://dx.doi.org/10.1016/j.gie.2009.07.020
The Role of the Certified Registered Nurse Anesthetist (CRNA)
WSBN supports advanced practice role of the CRNA in all settings requiring anesthesia or pain management, which includes administering and adjusting doses of intermittent and continuous-infusion regional anesthetic and analgesic agents (American Association of Nurse Anesthetists, 2007). CRNAs are independent, primary providers of care, as defined under the 2008 Consensus Model of APRN Regulation, and do not require physician oversight. Direct management (vs. monitoring) of regional analgesia and anesthesia is beyond the scope of practice for RNs.
Role of the Registered Nurse
The RN is responsible for coordinating and documenting the care of the patient which includes providing direct physical care and family support. This responsibility includes implementing, monitoring, and evaluating the effectiveness of nonpharmacologic, oral, and parenteral pharmacologic pain relief measures and managing high-alert and high risk medications administered via one or more infusion pumps. The RN participates in educating patients about their options for pain relief and provides information about benefits and risks associated with various types of analgesia and anesthesia.
The RN has the right and responsibility to refuse to administer any medication that may induce procedural sedation when in the professional judgment of the RN, the medication or combination of medications, the dosages prescribed, or frequency of administration may produce a state of deep sedation or place the patient at risk for complications.
It is within the scope of practice of an appropriately trained and competent RN to assist a physician, APRN or PA by administering anesthetic and/or neuromuscular agents in situations where the physician, APRN or PA is delegating direct critical tasks to the RN.
This action is permissible if the following criteria are met:
A. There are institutional policies and procedures to guide this practice, and the action follows safe medication administration protocols;
B. The nurse has completed training and demonstrated continuing competency as well as current certification appropriate to patient population (i.e. ACLS, PALS);
C. The facility maintains documentation on training and competency for each nurse;
D. The care is provided under the direct supervision of a physician, APRN or PA; and
E. The patient’s condition is assessed prior to, during, and after the procedure to current standard of practice.
Click Link above for references.
Excerpt from Ketamine Guidelines:
The WSBN acknowledges that it is within the scope of practice of the appropriately trained and competent RN and APRN to administer Ketamine.
The WSBN recommends the following to ensure competency:
A. There are institutional policies and procedures to guide this practice;
B. The nurse has completed training and demonstrated competency;
C. The agency/facility maintains documentation on training and competency for each nurse;
D. The care is provided under the direction of a provider, and
E. The patient’s condition is assessed prior to, during, and after the procedure to current standard of practice.
Excerpt from Nitrous Oxide Administration Guide
It is within the Scope of Practice of a Registered Nurse (RN) to administer nitrous oxide as a single agent, not to be administered concurrently with any other sedative or depressant agents.
It is within the Scope of Practice of an RN to monitor maternal self-administration of nitrous oxide during labor for purposes of anxiolysis/analgesia.
The intent of administering nitrous oxide is to achieve minimal sedation (anxiolysis). This procedure is performed by Registered Nurses (RNs) with additional education, skills, and demonstrated competency. This advisory opinion CANNOT be construed as approval for the RN to administer an anesthetic agent
for the purposes of anesthesia.
WSBN acknowledges that it is within the scope of practice of the appropriately trained and competent RN to administer nitrous oxide as ordered by the physician, APRN or PA if the following criteria are met:
A. There are institutional policies and procedures to guide this practice;
B. The nurse has completed training and demonstrated continuing competency;
C. The agency/facility maintains documentation on training and competency for each nurse;
D. The care is provided under the direction of a physician, APRN or PA; and
E. The patient’s condition is assessed prior to, during, and after the procedure to current standard of practice.