Washington Board of Nursing Review – July 13, 2005
Reviewed by Sedation Certification – Jan. 10, 2019
State Sedation Policy – Yes
Can RN’s give sedation? – Yes
Can RN’s give Propofol/Ketamine? – Yes

 

Washington State advises nurses to utilize the Decision Tree approach:

https://www.doh.wa.gov/Portals/1/Documents/6000/AdminOfSedating,AnalgesicAndAnestheticAgents.pdf

 

Excerpt of the document:

The Nursing Care Quality Assurance Commission (NCQAC) concludes that registered nurses (RNs) may administer and maintain sedating, analgesic, anesthetic, and reversal agents prescribed by authorized providers (licensed physician and surgeons, dentists, osteopathic physicians and surgeons, naturopathic physicians, optometrists, podiatric physician and surgeons, physician assistants, osteopathic physician assistants, advanced registered nurse practitioners, or midwives). These medications include, (but are not limited to), diazepam, chloral hydrate, nitrous oxide, etomidate, propofol, ketamine, fentanyl, methohexital, bupivacaine, ropivacaine, succinylcholine, and midazolam. The NCQAC advises nurses to use the Scope of Practice Decision Tree to determine whether an activity is within the nurse’s individual scope of practice. Nurses must have the training, skills, knowledge, and ability to administer these drugs safely and competently. Nurses must have the ability to assess, interpret, and intervene in the event of complications. Completion of formal certifications does not imply that a nurse has the competence to perform these or related activities. Due to the complexity of the activities and nursing judgment required, the NCQAC determines it is beyond the scope of a licensed practical nurse (LPN) to lead these activities. LPNs may be a member of the team and assist in performing individual activities up to their lawful and individual scope of practice based on the Decision Tree. This statement may not address the use of these medications in every setting or for every procedure. Nurses should refer to best practice standards policy specific to the procedure and setting.

Conclusion
The NCQAC concludes that RNs may administer these medications, monitor patients, administer rescue medications, and provide emergency care within their individual and legal scope of practice. LPNs may assist RNs in administering, monitoring, and providing care for the purpose of sedation and anesthesia within their individual and legal scope of practice. Nurses should be knowledgeable and familiar with their institution’s policies and procedures, accreditation standards, and regulations that may apply in their facility.

Please follow the link to view the References for the above.

 

Scope of Practice for the Registered Nurse
in the Administration of Procedural Sedation
and the Management of Patients Receiving of Procedural Sedation

The Washington State Nursing Care Quality Assurance Commission affirms that it is within the role and scope of practice for the registered nurse (RN) to administer procedural sedation and to manage patients who are receiving and recovering from procedural sedation. Further, the Commission believes that this role is beyond the scope of practice for the licensed practical nurse or the tasks allowed for unlicensed assistive personnel.

Definition
Procedural sedation, also known as conscious sedation, is produced by the administration of pharmacological agents administered singly or in combination to induce a state that allows a patient to tolerate unpleasant procedures while maintaining cardio-respiratory function. A patient under procedural sedation has a depressed level of consciousness, but retains the ability to independently and continuously maintain a patent airway and respond appropriately to physical stimulation and/or to verbal command. Procedural sedation may easily progress to deep sedation or the loss of consciousness, because of the unique characteristics of the drugs used, as well as the physical status and drug sensitivities of the individual patient.

Process
Procedural sedation is used in short-term, therapeutic, diagnostic or surgical procedures.

The registered nurse administers medications to achieve conscious sedation by executing the order of a licensed independent practitioner with authority to prescribe the medications to be administered.

The registered nurse managing and monitoring the patient receiving procedural sedation shall have no other responsibilities during the procedure that would leave the patient unattended or compromise continuous monitoring.

During procedural sedation, there must be a licensed independent practitioner present who is credentialed by the facility as capable of recognizing and managing airway emergencies.

Competency
The administration of procedural sedation requires continuous monitoring of the patient and the ability to respond immediately to deviation from the norm. Procedural sedation should only be provided by an individual who is competent in thorough patient assessment, is able to administer drugs through a variety of routes, is able to identify responses which are a deviation from the norm, and is able to intervene as necessary to cardiac or respiratory rescue for the patient.

To ensure that nurses assisting in procedural sedation receive appropriate and continuous training and support with demonstrated competency, the Nursing Commission recommends that all providers and institutions using registered nurses in procedural sedation have in place written policies and procedures that contain, at a minimum, the following elements:

1. Guidelines for patient selection, monitoring, and drug administration.
2. Protocols for managing potential complications or emergency situations.
3. Specific educational and training requirements with evidence of competency.
4. Specific yearly evaluation and verification of continuing competency requirements.

Excluded from the guidelines in this position statement:

1. Patients receiving inhalation anesthetics (except for the use of Nitronox as an analgesic).
2. Patients who receive analgesia for pain control without sedatives.
3. Patients who receive sedation solely for the purpose of managing altered mental status.
4. Patients who are sedated for the purpose of intubation.

References Emergency Nurses Association (December 2000). Position Statement Conscious Sedation.

American Nurses Association (September 1991). Position Statement on the Role of the Registered Nurse in the Management of Patients Receiving IV Conscious Sedation for ShortTerm Therapeutic, Diagnostic, or Surgical Procedures.

Oregon State Board of Nursing (February 1999). Scope of Practice for the Registered Nurse in the Administration of Conscious Sedation and the Management of Patients Receiving Conscious Sedation.

Original position statement adopted by the Washington State Nursing Care Quality Assurance Commission January 2000. Final Draft Revision July 13, 2005