Maine Board of Nursing Review August 10, 2017

Reviewed by Sedation Certification – March 20, 2019

State Sedation Policy – Yes

Can RN’s give sedation? – Yes

Can RN’s give Propofol? – Under Certain Circumstances – Intubated/Ventilated, Palliative Care, Rapid Sequence Induction (See circumstances below.)

 

http://www.maine.gov/boardofnursing/practice/rpn-questions.html#anesthetic

 

Anesthetic Agents

At its April 10-11, 2002 meeting the Board reiterated that a registered professional nurse may not administer anesthetic medications for the purpose of anesthesia unless the nurse is a certified registered nurse anesthetist. However, a registered professional nurse may administer anesthetic agents, such as Diprivan, for the purpose of analgesia, muscle relaxation, or sedation provided that the nurse has received the appropriate documented training based on the facility’s established policies and procedures.

Reviewed March 2, 2006.

The Board rescinded a portion of its previous position that “a registered professional nurse may, after appropriate documented training based on the facility’s established policies and procedures, administer Propofol (Diprivan) for the purpose of analgesia, muscle relaxation, or sedation.”

Other agents used for the purpose of analgesia, muscle relaxation or sedation may continue to be administered by the registered professional nurse.

The Board supports safe practice to include Propofol (Diprivan) administration by registered professional nurses only in the following circumstances: to intubate; to maintain sedation for mechanically ventilated patients; and, to sedate or those patients undergoing emergency intubation.  The Board recognizes that Propofol administration for analgesia, muscle relaxation, or sedation may rapidly lead to deep sedation and or short duration general anesthesia requiring intubation.  Therefore, effective June 4, 2010, administration of Propofol for non-ventilated patients is restricted to certified registered nurse anesthetists.

Reviewed March 3-4, 2010

At its September 16-17, 2015 meeting, the Board revisited its previous position on the administration of Propofol (Diprivan) by registered professional nurses and has included administration of Propofol (Diprivan) for the purpose of palliative sedation under the following circumstances:

      1. The patient has a do not resuscitate order (DNR) and has been placed on comfort care measures only.
      2. The registered professional nurse has completed a competency based education and training program on the administration and monitoring of palliative care sedation based on the facility/organization’s policies and procedures.
      3. The first dose of palliative care sedation is administered by a physician, nurse practitioner, or nurse anesthetist.

August 10, 2017, the Board reviewed its March 2, 2006 practice statement on the administration of Propofol (Diprivan) by registered professional nurses during rapid sequence intubation and provided the following clarification:

A registered professional nurse (RN) may assist a licensed provider by administering Propofol in situations where the provider is present at the bedside, but unable to personally inject the agents because the provider is performing the critical task of airway management for the patient during rapid sequence intubation, provided the RN has the educational preparation and clinical competence to inject such agents.

The RN should be educated and competent in all aspects of rapid sequence intubation, mechanical ventilation and advanced cardiopulmonary resuscitation. This should include knowledge of the equipment, medical devices used, and medications to be administered.


NOTE:  Maine uses a “Scope of Practice Decision Tree” which can be accessed here:

https://www.maine.gov/boardofnursing/docs/scopeofpracticedecisiontree.pdf