Arizona Board of Nursing Review – May 23, 2018
Reviewed by Sedation Certification – March 20, 2019
State Sedation Policy – Yes
Can RN’s give sedation? – Yes
Can RNs give anesthetic medications? –  No

 

https://www.azbn.gov/media/2223/ao-moderate-sedation_analgesia-for-diagnostic-therapeutic-procedures.pdf

https://www.azbn.gov/faqs/advisory-opinions/pain-management-faq/

Doug Ducey Joey Ridenour
Governor Executive Director
Arizona State Board of Nursing
4747 North 7th Street, Suite 200
Phoenix, AZ 85014-3655
Phone (602) 771-7800 Fax (602) 771-7888
E-Mail: arizona@azbn.gov
Home Page: www.azbn.gov

OPINION: MODERATE SEDATION/ANALGESIA FOR DIAGNOSTIC AND THERAPEUTIC PROCEDURES
APPROVED DATE: 7/90
REVISED DATE: 7/91, 4/96, 10/97, 2/01, 3/01, 6/01, 1/03, 6/03, 5/08, 3/12, 1/16
ORIGINATING COMMITTEE:  Within the Scope of Practice of X RN (Not LPN–Ed. note) LPN

SCOPE OF PRACTICE COMMITTEE

ADVISORY OPINION
MODERATE SEDATION/ANALGESIA

It is within the Scope of Practice of a Registered Nurse (RN) to administer medications to provide
moderate sedation/analgesia for the purposes of diagnostic or therapeutic procedures.

Moderate Sedation/Analgesia (“conscious sedation”) is defined as “a drug-induced depression of
consciousness during which patients respond purposefully to verbal commands, either alone or
accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and
spontaneous ventilation is adequate. Cardiovascular function is usually maintained. Centers for Medicare
and Medicaid Services (CMS) consistent with American Society of Anesthesiologist (ASA) guidelines,
does not define moderate or conscious sedation as anesthesia” (CMS, 2011).
It should be noted that sedation exists along a continuum, and RNs who administer moderate
sedation/analgesia must be qualified to provide rescue support to patients who proceed to a deeper
level of sedation.

I. GENERAL REQUIREMENT
A. A written policy and procedure is maintained by the employer. The following general
requirements should be addressed in the policy and procedure
1. The healthcare facility shall have in place an educational mechanism which includes a
process for evaluating and documenting the individual’s competence relating to the
management of patients receiving sedation and analgesia. Evaluation and documentation
should occur on a periodic basis and must be maintained on file with the employer.
2. Guidelines for patient monitoring and drug administration and protocols for managing
potential complications or emergency situations, developed in accordance with accepted
standards of sedation practice, are available.
3. The employer has convened an interdisciplinary team, which includes nurses, to identify
and approve medications to be used for moderate sedation, based on the age of the patient.
4. A pre-sedation assessment and collaborative sedation plan must be performed for each
patient by a licensed provider and the administering RN to determine that the patient is an
appropriate candidate.

An advisory opinion adopted by AZBN 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 AZBN
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.

5. A qualified anesthesia professional or licensed independent provider selects and orders the
agents to achieve sedation and analgesia.
6. The licensed independent provider, properly credentialed to order moderate sedation, must
be present in the department from the time the medication is initiated through the
completion of the procedure. A qualified professional capable of managing complications
must be readily available in the facility during the post-procedure period and must remain in
the facility until the patient is stable.
7. The registered nurse administering medications and monitoring the patient receiving
sedation and analgesia shall have no other responsibilities during the procedure.
8. Venous access shall be maintained for all patients having moderate sedation/analgesia.
9. Supplemental oxygen shall be available for any patient receiving sedation and analgesia,
and when appropriate in the post-procedure period.
10. Documentation and monitoring of physiologic measurements including but not limited to
blood pressure, respiratory rate, oxygen saturation, cardiac rate and rhythm, and level of
consciousness should be recorded at least every five minutes.
11. Documentation and monitoring of adequate ventilation using continuous capnography is
highly recommended, if available. Values should be recorded at least every five minutes.
12. Emergency equipment necessary to perform advanced cardiopulmonary resuscitation
specific to the population served must be immediately accessible in every location where
moderate sedation/analgesia is administered and staff caring for the patient are certified in
advanced cardiopulmonary resuscitation specific to the age of the patient.
13. A qualified professional authorized under facility guidelines to discharge the patient
remains in the facility to discharge the patient in accordance with established criteria of the
facility.
14. The RN has the right and obligation to refuse to administer and/or continue to administer
medication(s) in amounts/frequency that may induce deep sedation or anesthesia.
Adapted from: American Association of Nurse Anesthetists (2013).

II. COURSE OF INSTRUCTION
1. Indications for and contraindications to the use of moderate sedation.
2. The four levels of sedation: minimal sedation, moderate sedation/analgesia, deep
sedation/analgesia, and anesthesia.
3. Anatomy, physiology, pharmacology, cardiac arrhythmia recognition, and complications
related to sedation and analgesia medications.
4. Patient care requirements before and during the administration of moderate
sedation/analgesia, including the recovery phase.
5. Principles of oxygen delivery, transport and uptake, and respiratory physiology, as well as
the use of oxygen delivery devices and continuous capnography monitoring, if available.
6. Complications of moderate sedation/analgesia for each type of agent being administered,
and administration of reversal agents.
7. Intervention in the event of complications and institution of appropriate interventions in
compliance with orders or facility protocols.
8. Sedation monitoring using a valid sedation scale (e.g. Richmond Agitation Sedation Scale).
9. Certification in advanced cardiopulmonary resuscitation specific to the population served
i.e. ACLS/PALS.
10. Assessment of recovery progress prior to discharge from recovery area.
11. Moderate sedation/analgesia education to patients and families.
Adapted from: American Association of Nurse Anesthetists (2013).

III. RATIONALE
The intent of this advisory opinion is to define moderate sedation/analgesia and the RN role in
administering pharmacological agents to produce moderate sedation during diagnostic or
therapeutic procedures. The advisory opinion is provided to assist the RN in understanding the
necessary facility, monitoring, knowledge, and clinical competency requirements to safely
perform moderate sedation/analgesia.

IV. REFERENCES
Adams, L., Butas, S., & Spurlock, D. (2015). Capnography (ETCO2), respiratory depression, and
nursing interventions in moderately sedated adults undergoing transesophageal
echocardiography (TEE). Journal of PeriAnesthesia Nursing 30(1), 14-22.
Alaska Board of Nursing. (2013). Registered nurse administration of sedating and anesthetic
agents. Retrieved from http://commerce.state.ak.us/dnn/portals/5/pub/nur1809.pdf
American Association of Moderate Sedation Nurses. (2014). Certified sedation registered nurse
(CSRN) scope of practice. Retrieved from http://aamsn.org/resources/pdfs/sedation-relatedpdfs/registered-nurse-csrn-scope-of-practice
American Association of Nurse Anesthetists. (2013). Registered nurses engaged in the
administrationof sedation and analgesia. Retrieved from http://www.aana.com/resources
2/professionalpractice/Pages/Registered-Nurses-Engaged-in-the-Administration-of-Sedationand-Analgesia.aspx
American Society of Anesthesiologists. (2011). Standards for basic anesthetic monitoring.
Retrieved from https://www.asahq.org/resources/standards-andguidelines/search?q=capnography
Centers for Medicare & Medicaid Services. (2011). Revised appendix A. Interpretive guidelines
for
hospitals. Retrieved from https://www.cms.gov/Regulations-and-Guidance/Guidance
/Transmittals/downloads/R74SOMA.pdf
Conway, A. Rolley, J., Page, K., & Fullbrook, P. (2013). Clinical practice guidelines for nurseadministered procedural sedation and analgesia in the cardiac catheterizationlaboratory: a
modified Delphi study. Journal of Advanced Nursing, 70(5), 1040-1053.
Department of Health and Human Services. Nebraska Board of Nursing Advisory Opionion.
(2013). Analgesia & moderate sedation. Retrieved from http://dhhs.ne.gov/publichealth
/Licensure/Documents/AnalgesiaAndModerateSedation.pdf
O’Malley, P. & Polling, L. (2015). Finding a way through the sedation labyrinth: is it conscious,
moderate, deep, or procedural sedation? Emerging evidence for CNS practice. Clinical Nurse
Specialist, 29(1), 12-18.
Society of Gastroenterology Nurses. (2013). Position statement: statement on the use of sedation
and analgesia in the gastrointestinal endoscopy setting. Retrieved from http://www.sgna.org/
Portals/0/Sedation_2013%20-FINAL.pdf