Minnesota Board of Nursing Review – October 2016
Reviewed by Sedation Certification – Jan. 8, 2019
State Sedation Policy – Yes
Can RN’s give sedation? – Yes
Can RN’s give Propofol/Ketamine? – No
Administration of medications is within the scope of practice of registered nurses and licensed practical nurses in the State of Minnesota as a delegated medical function. (See Minn. Stat. Sec. 148.171, subd. 14 and 15 (2014). Because nurses frequently administer medications, it may appear to be a routine activity. However, many medications have significant effects, even if administered correctly and within normal dose ranges. Therefore, it is the expectation of the Minnesota Board of Nursing that nurses will give careful consideration to each episode of medication administration and make a nursing judgment regarding whether the nurse may safely accept the delegation of medication administration under the given circumstances and specific setting.
Administration of medications classified as anesthetics for the purpose of procedural sedation and analgesia requires particular attention.1 The Institute for Safe Medication Practices has identified anesthetic agents and moderate sedation agents as “High Alert” medications that “bear a heightened risk of causing significant patient harm when they are used in error.” High alert medications may be population-specific.
Sedation is a continuum and it is not always possible to predict how an individual patient will respond to anesthetics. Nurses and providers administering sedation or monitoring sedated patients should be prepared to appropriately respond to patients whose level of sedation becomes deeper than initially intended.
American Society of Anesthesiologist Sedation Level Definitions
|Level of sedation||Definition|
|Minimal sedation (anxiolysis)||A drug-induced state during which patients respond normally to verbal commands. Although cognitive function and physical coordination may be impaired, ventilatory and cardiovascular functions are unaffected.|
|Moderate sedation/Analgesia (formerly conscious sedation)||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.|
|Deep sedation/Analgesia||A drug-induced depression of consciousness during which patients cannot be aroused easily but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatatory function may be impaired. Patients may require assistance in maintaining a patent airway and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.|
|Anesthesia||A drug-induced loss of consciousness during which patients are not arousable, even with painful stimulation. The ability to independently maintain ventilatatory 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.|
1 Utilizing appropriate, descriptive terminology is complicated by the properties of some medications and their effects. Medications may provide varying levels of sedation (minimal, moderate or deep sedation to anesthesia), depending on the dose. While the phrase “medications classified as anesthetics” is used in this document, it should be understood that classification of medications may change and new medications may be developed. The accountability statement applies to other medications with anesthesia inducing properties, even if not classified as anesthetics. “Procedural sedation” includes moderate and deep sedation. This statement is not intended to apply to continuous infusion of medications to ventilated patients or medications used for pain management.
Currently there is no uniformly accepted training or core competency for RNs to administer sedation. Additionally, there are numerous sedation guidelines and statements but no widely accepted, national standards of practice.
The Minnesota Board of Nursing believes that registered nurses may administer medications classified as anesthetics provided the RN has acquired the knowledge and skill to administer these medications safely.2 Registered nurses who administer medications classified as anesthetics are accountable to:
- Verify the policies and procedures of the employing facility or organization permit administration of medications for sedation by a registered nurse.
- Ensure guidelines for patient monitoring, drug administration, and protocols for managing potential complications or emergency situations are available and have been developed and updated in accordance with accepted standards of anesthesia and nursing practice.
- Provide clear and complete information to the patient or responsible party prior to, during, and following sedation.
- Adequately assess the patient prior to, during, and after administration of the medications. A baseline assessment will include, at a minimum, respiratory rate, oxygen saturation, blood pressure, cardiac rate and rhythm, and the patient’s level of consciousness. The components of the ongoing assessment of the patient will depend on the medications being administered and the condition of the patient with consideration given to the assessments identified above.
2 Because of the degree of assessment and clinical skill required to administer anesthetics, this is not within the licensed practical nurse scope.
- Personally possess specialized nursing knowledge, judgment, skill and current clinical competence to manage the nursing care of the patient including:
- Appropriate judgment in patient selection and screening.
- Knowledge of anatomy, physiology, pharmacology, cardiac arrhythmia recognition, oxygen delivery, respiratory physiology, transport and uptake.
- Skill in utilization of oxygen delivery devices and airway management.
- Familiarity with the medications to be administered including onset and duration of action, desired effects, normal dose range, route of administration, indications, contraindications, interactions with other medications, and possible side effects and adverse reactions. The nurse should also be familiar with reversal agents, if any, for the medications administered.
- Competent and safe administration of the medication by the specified route.
- Ability to anticipate and recognize potential complications of the medications being administered.
- Ability to recognize emergency situations and institute emergency procedures as appropriate to the patient condition and circumstance.
- Possess knowledge of the desired outcome of sedation.
- Monitor the patient as indicated by the patient’s condition and the medications administered. This includes the patient’s appearance, airway patency, ability to spontaneously ventilate, and response to verbal commands and physical stimuli. ECG monitoring should be considered for high-risk patients, during prolonged procedures or during deep sedation. Continuous pulse oximetry should be considered for patients with comorbidities effecting respiratory or circulatory functioning or when the medications administered may depress respirations. Capnography may be needed for high-risk patients
- Exclude any other duties or responsibilities while administering medications for moderate or deep sedation. Exclude other duties that would require leaving the patient unattended or compromise continuous monitoring of the patient by the nurse while the patient is sedated.
- Ensure immediate availability of emergency and resuscitation personnel and equipment appropriate to the medications being administered and the age and condition of the patient.
- Decline to administer medications classified as anesthetics or other medications if the registered nurse perceives the administration would be unsafe under the circumstances.
- Maintain safeguards for the appropriate management of controlled or abusable substances.
- Comply with all applicable Federal and state laws and rules. For example, under Minnesota Rule 4675.0500, only an anesthesiologist or qualified physician and/or anesthetist may administer anesthetics other than local infiltration anesthetics in out-patient surgery centers.
Adopted: October 2005
Reaffirmed: December 2009
Reaffirmed: October 2016
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