Kentucky Board of Nursing Review – May 2018
Reviewed by Sedation Certification – Jan. 7, 2019
State Sedation Policy – Yes
Can RN’s give sedation? – Yes
Can LPN’s give sedation? – No
Can RN’s give Propofol/Ketamine? – Determined by Institutional Policies and Procedures/Protocols
ADVISORY OPINION STATEMENT
PROCEDURAL SEDATION AND ANALGESIA
Rationale for Advisory Opinion
The Board has received multiple inquiries related to the scope of nursing practice as it pertains to the
administration of pharmacological agents for procedural sedation and analgesia. After review of the
statutes governing nursing practice, curricula of prelicensure and continuing education nursing programs,
standards of nursing practice, and study of the issues and concerns regarding the administration of
medications for procedural sedation and analgesia, the Kentucky Board of Nursing issued this advisory
opinion modeled in part from the 2008 Procedural Sedation Consensus Statement.1
1 Procedural Consensus Statement (2008)
The Kentucky Board of Nursing is authorized by Kentucky
Revised Statutes (KRS) Chapter 314 to regulate nurses,
nursing education and practice, promulgate regulations and to
issue advisory opinions on nursing practice, in order to assure
that safe and effective nursing care is provided by nurses to the
citizens of the Commonwealth.
The Kentucky Board of Nursing issues advisory opinions as to
what constitutes safe nursing practice. As such, an opinion is
not a regulation of the Board and does not have the force and
effect of law. It is issued as a guideline to licensees who wish
to engage in safe nursing practice, and to facilitate the delivery
of safe, effective nursing care to the public.
ADMINISTRATION OF MEDICATIONS FOR PROCEDURAL SEDATION AND ANALGESIA BY NURSES
Approved Date: 4/1995
Revised: 6/2003; 8/2004; 2/2005; 4/2007; 2/2009, 12/2014, 12/20015, 12/2017
Editorial Revision: 1/2011; 5/2012; 5/2018
Accountability and Responsibility of Nurses
In accordance with KRS 314.021(2), nurses are responsible and accountable for making decisions that are
based upon the individuals’ educational preparation and current clinical competence in nursing, and requires
licensees to practice nursing with reasonable skill and safety. Nursing practice should be consistent with the
Kentucky Nursing Laws, established standards of practice, and be evidence based.
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This opinion statement does not apply to the advanced practice registered nurse designated as a certified
registered nurse anesthetist (CRNA) functioning within his/her authorized scope of practice.
The Board recognizes that the increased demand for sedation and analgesia in the practice setting
necessitates the provision of procedural sedation and analgesia by registered nurses (RNs) and
Advanced Practice Registered Nurses (APRNs).
Per Kentucky Revised Statute 314.011, the administration of medications is within the scope of practice
of nurses in Kentucky. While the administration of medications is a task performed routinely as a part of
nursing care, many medications have the potential for serious side effects even when ordered and
administered correctly. The Kentucky Board of Nursing expects that nurses will utilize critical thinking and
reasonable clinical nursing judgment prior to each episode of medication administration to discern
whether administering a medication is appropriate.
Rather than focus on a particular medication, the Board advises that it is more appropriate to focus on the
level of sedation. The Board recognizes the four levels of sedation and definitions written by the American
Society of Anesthesiologists and accepted by the Joint Commission2.
A drug-induced state during which patients respond normally to verbal
commands. Although cognitive function and coordination may be impaired,
ventilatory and cardiovascular function is usually maintained.
A drug-induced depression of consciousness sedation during which patients
respond purposefully to verbal commands either alone or accompanied by light
tactile stimulation. No interventions are required to maintain the patient’s airway,
and spontaneous ventilation is adequate. Cardiovascular function usually is
Deep Sedation A drug-induced depression of consciousness sedation during which patients
cannot be aroused easily, but they respond purposefully following repeated or
painful stimulation. The ability to independently maintain ventilatory function
may be impaired. Patients may require assistance in maintaining a patent
airway, and spontaneous ventilation may be inadequate. Cardiovascular
function usually is maintained.
Anesthesia General anesthesia is a drug-induced loss of consciousness during which
patients are not arousable, even with painful stimulation. The ability to
independently maintain ventilator function is often impaired. Patients often
require assistance in maintaining a patent airway and positive pressure
ventilation may be required because of depressed spontaneous ventilation or
drug-induced depression of neuromuscular function. Cardiovascular function
may be impaired.
It is the responsibility of facilities and prescribers to determine specific pharmacologic agents used for
procedural sedation and analgesia. It is not within the authority of the Board to determine how or for what
purpose a specific drug is being administered.
2 American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. (2002). Practice
guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology, 96(4), 1004– 1017.
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The administration of pharmacologic agents for the purpose of procedural sedation requires mastery of
complex nursing knowledge, advanced skills, and the ability to make independent nursing judgments
during an unstable and unpredictable period for the patient.
Licensed Practical Nursing Practice
It is the opinion of the Board that it is NOT within the scope of the licensed practical nurse to administer
intravenous medications via push or bolus for procedural sedation or analgesia or for the purpose of
Registered Nursing Practice
It is within the scope of registered nursing practice for the RN who is educationally prepared and currently
clinically competent to administer medications for procedural sedation and analgesia.
It is NOT within the scope of registered nursing practice to administer medications for the purpose of
The registered nurse has the right and obligation to refuse to administer and/or continue to administer
medication(s) in amounts that may induce anesthesia.
Advanced Practice Registered Nursing Practice
Both the administration of medications for procedural sedation and analgesia and the administration of
medications for regional anesthesia, along with monitoring of the patient responses to such medications,
are within the scope of practice of the APRN (other than those designated as a certified registered nurse
anesthetist) who is educationally prepared and currently clinically competent in the performance of the
Administration, Management and Monitoring of Procedural Sedation and Analgesia
The administration of medications for safe procedural sedation and analgesia requires specific
competencies3 that include:
1. The institution or practice setting has in place written policies, procedures, and signed protocols,
developed in accordance with accepted standards of practice, to guide the RN or APRN (other
than those designated as a certified registered nurse anesthetist) in the administration of
medications and monitoring associated with procedural sedation and analgesia.
2. The institution or practice setting has in place an educational or competency validation
mechanism that includes a process for evaluating and documenting the RN’s or APRN’s (other
than those designated as a certified registered nurse anesthetist) demonstration of the
knowledge, skills, and abilities related to the management of patients receiving procedural
sedation and analgesia. Evaluation and documentation of competence occurs on a periodic
basis according to institutional policy.
3. The RN or APRN (other than those designated as a certified registered nurse anesthetist) directly
providing the care of the patient receiving procedural sedation and analgesia should have no
other responsibilities that would leave the patient unattended or compromise continuous
3 American Association of Nurse Anesthetists (2016). Non-Anesthesia Provider Procedural Sedation and Analgesia: Policy
Considerations. American Association of periOperative Nurses (2016). Recommended Practices for Managing the Patient Receiving
Moderate Sedation/Analgesia. Infusion Nurses Society (2016). Infusion Therapy Standards of Practice.
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4. A valid authorized provider order is required to execute procedural sedation and analgesia.4 In
executing a patient care regimen, the RN or APRN (other than those designated as a certified
registered nurse anesthetist) should monitor, assess, and document the sedated patient’s
physiologic parameters, communicate changes in patient status to the authorized provider
performing the procedure or other appropriate personnel, implement emergency measures as
required, and maintain continuous intravenous access for circulatory support.
5. Provisions are in place for both the appropriate equipment and the immediate presence of
personnel who are competent in airway management, and advanced cardiac life support if
Regardless of practice setting or expected outcome, the Board advises that key components of safe
administration of medications for procedural sedation and analgesia by nurses should include the
educational preparation and demonstrated clinical competence of the nurse.
KRS 314.021(2) imposes individual responsibility and accountability upon nurses. Acts, which are within
the permissible scope of practice for a given licensure level, may be performed only by those licensees
who personally possess the education and clinical competence to perform those acts in a safe, effective
The Board advises the RN or APRN (other than those designated as a certified registered nurse
anesthetist) to use caution, in deciding whether the nurse has the competence to administer the specific
pharmacologic agents ordered.
With regard to this issue, the Board recommends the nurse also take into consideration:
1. Availability of and knowledge regarding the administration of reversal agents for the
pharmacologic agents used; and
2. If reversal agents do not exist for the pharmacologic agents used, then the nurse must consider
his/her individual knowledge, skills, and competence to rescue the patient from unintended deep
sedation/anesthesia using advanced cardiac life support, airway management equipment and
techniques or the immediate presence of another healthcare provider(s) who can meet these
The Board recognizes the position of the Hospice and Palliative Nurses Association that “There may be
situations when conscious patients who are imminently dying may experience intractable symptoms that
are intolerable and are unrelieved by expert palliative care. In these circumstances, palliative sedation
may be utilized to reduce suffering”.5
Thus, it is the Board’s opinion that it is within the scope of nursing practice for a registered nurse or
licensed practical nurse, except as limited by Kentucky Nursing Law, qualified by education and current
clinical competence, to administer medications for sedation as ordered by a qualified provider for the
purposes of palliative care.
4 An authorized provider is an individual who is authorized to practice in this state and is acting within the course of the individual’s
professional practice, which includes, but is not limited to; adherence to the institution’s credentialing requirements for the provider
to perform procedural sedation procedures.
5 Hospice and Palliative Nurses Association Position Statement “Palliative Sedation at End of Life” (2016). Retrieved from
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Determining Scope of Practice
KRS 314.021(2) holds all nurses individually responsible and accountable for the individual’s acts
based upon the nurse’s education and experience. Each nurse must exercise professional and
prudent judgment in determining whether the performance of a given act is within the scope of
practice for which the nurse is both licensed and clinically competent to perform. In addition to this
advisory opinion statement, the Kentucky Board of Nursing issued Advisory Opinion Statement #41
RN/LPN Scope of Practice Determination Guidelines which contains the KBN Decision-Making
Model for Determining Scope of Practice for RNs/LPNs, and published the APRN Scope of Practice
Decision Making Model providing guidance to nurses in determining whether a selected act is within
an individual nurse’s scope of practice now or in the future. A copy of the KBN Decision-Making
Model for Determining Scope of Practice for RNs/LPNs may be downloaded from the Board’s
and a copy of the APRN guidelines may be downloaded from the Board’s website
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Applicable Statutes from the Kentucky Nursing Laws6
KRS 314.021(2) states: All individuals licensed or privileged under provisions of this chapter shall be
responsible and accountable for making decisions that are based upon the individuals’ educational
preparation and experience in nursing and shall practice nursing with reasonable skill and safety.
KRS 314.011 Definitions for chapter (sections 6, 8 & 10).
(6) “Registered nursing practice” means the performance of acts requiring substantial specialized
knowledge, judgment, and nursing skill based upon the principles of psychological, biological, physical,
and social sciences in the application of the nursing process in:
(a) The care, counsel, and health teaching of the ill, injured, or infirm;
(b) The maintenance of health or prevention of illness of others;
(c) The administration of medication and treatment as prescribed by a physician, physician assistant,
dentist, or advanced practice registered nurse and as further authorized or limited by the board, and
which are consistent either with American Nurses’ Association Scope and Standards of Practice or
with standards of practice established by nationally accepted organizations of registered nurses.
Components of medication administration include but are not limited to:
1) Preparing and giving medications in the prescribed dosage, route, and frequency, including
dispensing medications only as defined in subsection (17)(b) of this section;
2) Observing, recording, and reporting desired effects, untoward reactions, and side effects of drug
3) Intervening when emergency care is required as a result of drug therapy;
4) Recognizing accepted prescribing limits and reporting deviations to the prescribing individual;
5) Recognizing drug incompatibilities and reporting interactions or potential interactions to the
prescribing individual; and
6) Instructing an individual regarding medications;
(d) The supervision, teaching of, and delegation to other personnel in the performance of activities
relating to nursing care; and
(e) The performance of other nursing acts which are authorized or limited by the board, and which are
consistent either with American Nurses’ Association Standards of Practice or with Standards of
Practice established by nationally accepted organizations of registered nurses;
(8) “Advanced practice registered nursing” means the performance of additional acts by registered nurses
who have gained advanced clinical knowledge and skills through an accredited education program that
prepares the registered nurse for one (1) of the four (4) APRN roles; who are certified by the American
Nurses’ Association or other nationally established organizations or agencies recognized by the board to
certify registered nurses for advanced practice registered nursing as a certified nurse practitioner,
certified registered nurse anesthetist, certified nurse midwife, or clinical nurse specialist; and who certified
in at least one (1) population focus. The additional acts shall, subject to approval of the board, include but
not be limited to prescribing treatment, drugs, devices, and ordering diagnostic tests. Advanced practice
registered nurses who engage in these additional acts shall be authorized to issue prescriptions for and
dispense nonscheduled legend drugs as defined in KRS 217.905 and to issue prescriptions for but not to
dispense Schedules II through V controlled substances as classified in KRS 218A.020, 218A.060,
218A.080, 218A.100, and 218A.120, under the conditions set forth in KRS 314.042 and regulations
promulgated by the Kentucky Board of Nursing on or before August 15, 2006.
(10)”Licensed practical nursing practice” means the performance of acts requiring knowledge and skill
such as are taught or acquired in approved schools for practical nursing in:
(a) The observing and caring for the ill, injured, or infirm under the direction of a registered nurse,
advanced practice registered nurse, physician assistant, licensed physician, or dentist;
(b) The giving of counsel and applying procedures to safeguard life and health, as defined and authorized
by the board;
6 A copy of the Kentucky Nursing Laws may be downloaded from the Kentucky Board of Nursing website at http://kbn.ky.gov.
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(c) The administration of medication or treatment as authorized by a physician, physician assistant,
dentist, or advanced practice registered nurse and as further authorized or limited by the board which
is consistent with the National Federation of Licensed Practical Nurses or with Standards of Practice
established by nationally accepted organizations of licensed practical nurses;
(d) Teaching, supervising, and delegating except as limited by the board; and
(e) The performance of other nursing acts which are authorized or limited by the board and which are
consistent with the National Federation of Practical Nurses’ Standards of Practice or with Standards of
Practice established by nationally accepted organizations of licensed practical nurses;