North Carolina Board of Nursing Review – September 2022
Reviewed by Sedation Certification – September 29, 2022
State Sedation Policy – Yes
Can RN’s give sedation? – Yes
Can LPN’s give sedation? – No
Can RN’s give Propofol/Ketamine? – Yes
View entire position statement with link provided. Excerpts are copied below.
For questions contact www.ncbon.com
PROCEDURAL SEDATION/ANALGESIA POSITION STATEMENT
for RN Practice
A Position does not carry the force and effect of law and rules but is adopted by the Board as a means of providing direction to licensees who seek to engage in safe nursing practice. Board Position Statements address issues of concern to the Board relevant to protection of the public and are reviewed regularly for relevance and accuracy to current practice, the Nursing Practice Act, and Board Administrative Code Rules.
Issue: Administration of sedative, analgesic, and anesthetic pharmacological agents, for the purpose of Moderate or Deep Procedural Sedation/Analgesia, to non-intubated clients undergoing therapeutic, diagnostic, and surgical procedures, is within the non-anesthetist Registered Nurse (RN) scope of practice.
Administration of pharmacologic agents for Moderate and/or Deep Procedural Sedation/Analgesia by an RN (who is not a licensed/certified anesthesia provider) requires all of the following:
• Policies and procedures of employing agency authorize RN-administered Moderate and/or Deep Procedural Sedation/Analgesia;
• The RN possesses specific knowledge and validated competencies as described in this Position Statement;
• The RN responsible for sedation/analgesia administration and monitoring of a client receiving moderate or deep sedation/analgesia does NOT assume other responsibilities which would leave the client unattended, thereby jeopardizing the safety of the client;
• The Physician, CRNA, NP, or PA ordering RN-administered Moderate Procedural Sedation/Analgesia is physically present in the procedure area and immediately available during the time moderate procedural sedation/analgesia is administered; and,
• The Physician, CRNA, NP, or PA ordering RN-administered Deep Procedural Sedation/Analgesia is physically present at the bedside throughout the time deep sedation/analgesia is administered.
The intended level of sedation/analgesia may quickly change to a deeper level due to the unique characteristics of the pharmacological agents used, as well as the physical status and drug sensitivities of the individual client. The administration of these pharmacologic agents requires ongoing assessment and monitoring of the client and the ability to respond immediately to deviations from the norm.
Given the level of independent assessment, decision-making, and evaluation required for safe care, nursing care of these clients exceeds Licensed Practical Nurse (LPN) scope of practice.
Exclusions from NCBON Procedural Sedation/Analgesia Position Statement:
1. Advanced Practice Registered Nurse – Certified Registered Nurse Anesthetists (APRN-CRNAs) are professional anesthesia providers qualified by education, certification, licensure, registration, and experience to administer anesthesia and all levels of procedural sedation. CRNA scope of practice exceeds and is not limited by the constraints of this Position Statement.
Administration of general anesthesia, including the use of inhalation anesthetics, is limited solely to anesthesia providers, including CRNAs. (Note: Nitrous oxide, used as a procedural sedative/analgesic agent, is the ONLY agent that can be administered by non-anesthetist RNs via the inhalation route.)
2. Administration of sedation/analgesia for the purpose of intubation, including Rapid-Sequence Intubation (RSI), is within RN scope of practice with specific education, competence, and policies and procedures as detailed in the NCBON RSI Position Statement.
3. Administration of medications for moderate to deep sedation/analgesia of already-intubated, critically ill clients is within RN scope of practice and is not limited by the constraints of this Position Statement.
4. The following are within scope of practice for both RNs and LPNs and are not limited by the constraints of this Position Statement:
• Administration of Analgesia for pain control without sedatives,
• Administration of Minimal Sedation/Analgesia (Anxiolysis),
• Administration of Topical/Local Anesthesia, and,
• Administration of Sedation/Analgesia solely for the purpose of managing altered mental status.
RN Role in Moderate and Deep Procedural Sedation/Analgesia:
1. The administration and monitoring of sedating and anesthetic agents to produce moderate or deep procedural sedation/analgesia for non-intubated adult and pediatric clients undergoing therapeutic, diagnostic, or surgical procedures is within the non-anesthetist RN scope of practice.
2. The RN must be educationally prepared; clinically competent; permitted to administer moderate and/or deep procedural sedation/analgesia by agency written policies and procedures; and not prohibited from doing so by facility-focused laws, rules, standards, and policies.
3. A qualified anesthesia provider (anesthesiologist or CRNA) or appropriately credentialed attending physician, NP, or PA must assess client, determine ASA Physical Status Classification, select, and order the sedative/anesthetic agents to be administered; intended level of sedation/analgesia must be clearly communicated.
4. The RN is accountable for ensuring that moderate and/or deep procedural sedation/analgesia orders implemented are consistent with the current standards of practice and agency policies and procedures.
5. The RN accepts the assignment to administer ordered moderate or deep procedural sedation/analgesia only if competent and the practice setting has provided the age and size appropriate equipment, medications, personnel, and related resources needed to assure client safety.
6. The RN administers moderate procedural sedation/analgesia to adult and pediatric clients only if a Physician, CRNA, NP, or PA credentialed by the facility in moderate procedural sedation/analgesia, and competent in airway management, is physically present in the procedure area and immediately available in order to respond and implement emergency protocols in the event level of sedation deepens or another emergency occurs.
7. The RN administers deep procedural sedation/analgesia to adult and pediatric clients only if a Physician, CRNA, NP, or PA credentialed by the facility in deep procedural sedation/analgesia, and competent in intubation and airway management, is present at the bedside in order to respond to any emergency.
8. The RN role in moderate and deep procedural sedation/analgesia is dedicated to the continuous and uninterrupted monitoring of the client’s physiologic parameters and administration of medications ordered.
9. The administration of all medications via any appropriate route (including Nitrous Oxide via inhalation) for the purpose of moderate or deep procedural sedation/analgesia is within RN scope of practice. Medications, including Etomidate, Propofol, Ketamine, Fentanyl, and Midazolam, administered for moderate and/or deep procedural sedation/analgesia purposes, if ordered by Physician, CRNA, NP, PA, or other credentialed health care practitioner, and allowed by agency policy, is not prohibited provided the appropriate indications and precautions are in place.
LPN Role in Moderate and Deep Procedural Sedation/Analgesia: Given the level of independent nursing assessment, decision-making, and evaluation required for the safe care and management of clients undergoing therapeutic, diagnostic, and surgical procedures, the administration of sedation/anesthetic agents for the purposes of moderate or deep procedural sedation/analgesia is beyond LPN scope of practice.