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Northeast

Northeast

Connecticut   Maine   Massachusetts   New Hampshire   New Jersey   New York   Pennsylvania   Rhoda Island   Vermont

 

 

Connecticut

 

Source:Connecticut Board of Examiners for Nursing
Type of Guidance:Declaratory Rulings / Guidelines
Impact:RNs
Guidance*: Guidance Offered on Propofol Administration

The Board supports the position outlined in the AANA -ASA Joint Statement on Propofol Administration

Read the board’s guidance

 

Source:American Association of Nurse Anesthetists (AANA) / American Society of Anesthesiologists (ASA)
Type of Guidance: Position Statement(04/04)
Impact:RNs
Guidance*: (4-14-2004)

Whenever Propofol is used for sedation/anesthesia in non-intubated patients outside of the critical care setting, it should be administered only by persons trained in the administration of general anesthesia. Similar concerns apply when other intravenous induction agents are used for sedation, such as thiopental, methohexital or etomidate.

Read the AANA-ASA position statement

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Maine

 

Source:Maine State Board of Nursing
Type of Guidance:Board of Nursing Practice Questions
Impact:RNs
Guidance*:Practice Questions Related to Registered Professional Nurses: Anesthetic Agents (Reviewed 3-4-2010)

A RN may not administer anesthetic medications for the purpose of anesthesia unless the nurse is a certified registered nurse anesthetist.

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

The Board rescinded a portion of its previous position that “a registered professional nurse may, after appropriate documented training based on the facility’s established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.”Effective June 4, 2010, administration of Propofol for nonventilated patients is restricted to certified registered nurse anesthetists.

Read the Board’s statement

 

Source:
Type of Guidance:
Impact:
Guidance*:Chapter 010-144 125: Bureau of Medical Services Division of Licensing and Certification - Regulations Governing the Licensing of Ambulatory Surgical Facilities(02/01/04) – Page 11-12 4.D. 2 Administration of Anesthesia

Anesthetics must be administered by only:

  • A qualified anesthesiologist; or
  • A physician qualified to administer anesthesia, a certified nurse anesthetist, a supervised trainee in an approved educational program.

In those cases where a non-physician administers the anesthesia, the anesthetist must be under the supervision of the operating physician.

Read Regulation 010-144 125

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Massachusetts

 

Source: Massachusetts Board of Registration in Nursing
Type of Guidance: Advisory Rulings on Nursing Practice (09/13)
Impact: RNs
Guidance*:Advisory Ruling #9101:Administration of Medications Sedation/Analgesia(9-11-2013)

The Registered Nurse may engage in the administration of minimal to moderate sedation/analgesia:

  • Under the supervision of an authorized prescriber in accordance with accepted professional standards, and
  • Provided that the individual has the skills, knowledge and abilities to perform the practice and that organizational requirements are met.

A registered nurse who is duly trained and qualified to receive, accept, and transcribe orders from duly authorized prescribers for medications capable of producing deep sedation may administer medications intended for deep sedation:

  • When a patient is already intubated
  • Provided organizational policies include protocols for registered nurses to administer medications intended to produce deep sedation in non-intubated patients and a provider trained in anesthesia or expert in airway management whose sole responsibilityis to manage that patient’s airway is present

Read the complete Advisory Ruling

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New Hampshire

 

Source: New Hampshire Board of Nursing
Type of Guidance:Nursing Practice - Clinical Practice FAQ
Impact: RNs, LPNs
Guidance*:

What is the role of the RN, LPN in the administration of Anesthetics?

The licensed nurse must decline to administer medications classified as anesthetics* or other medications if the nurse perceives the administration would be unsafe under the circumstances or if the medication is restricted by manufacturer guidelines, including black box warning (such as is seen with propofol) or outside the scope of practice of the licensed nurse. The nurse should be cognizant of drugs that have the potential for rapid, profound changes in sedative/anesthetic depth and the lack of antagonist medications and drugs that contain manufacturer's warnings (black box) limiting administration to persons trained in general anesthesia, should receive care consistent with that required for deep sedation.

It is within scope of the registered nurse to administer moderate sedation when utilizing a US FDA approved Computer Assisted Personalized Sedation System (CAPS) in accordance with the US FDA approval labeling for indications, safety and training. This statement does not constitute an endorsement by the Board of Nursing of any CAPS device, nor does the Board make any assessment of, or representation regarding the safety of any CAPS device. (Added: October, 2014)

(*Propofol, for example, is classified by the Food and Drug Administration as a sedate/hypnotic at lower doses and as an anesthetic agent when given at sufficiently high doses. 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. It should also be understood that the medications might be used for other purposes, including procedural sedation and analgesia.)

Read the New Hampshire Board of Nursing guidance on the administration of anesthetics

(accessed 04/27/2015)

 

Source: New Hampshire Board of Nursing
Type of Guidance:Clinical Practice Advisories: January 2013 - December 2013
Impact:RNs
Guidance*: RN scope of practice to administer anesthesia drugs

Question:Is it within RN scope of practice to administer Ketamine for pain control?

Answer:The RN may monitor patients receiving medication via infusion pump if prescribed by a physician at subanesthetic doses. Administration of anesthetic drugs (propofol, brevitol, and etomidate) is outside the scope of practice for non-anesthesia nursing licenses except:

  • When assisting CRNA or anesthesiologist
  • When assisting in emergency situations
  • When providing palliative sedation

Read the Clinical Practice Advisories: January 2013-December 2013

Other State Resources:

New Jersey

 

Source:>State of New Jersey Board of Nursing
Guidance*:No direct guidance is offered by the Board of Nursing regarding the administration of moderate or deep sedation by Registered Nurses (RNs) within the state of New Jersey.

Source:New Jersey Department of Health and Senior Services
Type of Guidance: Standards for Licensure of Ambulatory Care Facilities (2014
Impact:MDs, DOs, RNs, CRNAs
Guidance*: New Jersey Administrative Code - Title 8; Chapter 43A, Subchapter 12.5.

Manual of Standards For Licensing Of Ambulatory Care Facilities(4-2014)

Anesthetic agents used for conscious sedation shall be administered only by the following:

  • A physician or dentist who has privileges in accordance with medical staff bylaws to administer anesthetic agents used for conscious sedation; or
  • Under the supervision of a physician who has privileges in accordance with medical staff bylaws to administer or supervise anesthetic agents used for conscious sedation who is immediately available:
  • A certified registered nurse anesthetist;
  • A registered nurse anesthetist;
  • A physician resident, dental resident, or a student nurse anesthetist participating in a nationally approved graduate training program leading to a recognized specialty; o
  • A registered nurse who is trained and experienced in the use of anesthetic agents used for conscious sedation shall be permitted to administer supplemental doses, after the initial dose is given by a privileged or supervising physician who shall remain present
Read N.J.A.C. 8:43A-12.5

 

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New York

 

Source:New York State Board of Nursing
Type of Guidance:Practice Alerts and Guidelines (4-2014)
Impact:RNs
Guidance*: New York Nursing Practice Guideline on the Administration of IV Anesthetic Agents by Non-Anesthetist Registered Nurses for the Purpose of Sedation and Anesthesia(01-31-2013)

  • Any drug that is considered an anesthetic agent must be administered by a trained anesthesia provider.
  • Drugs such as propofol, ketamine, etomidate, methohexital, and thiopental may not be appropriate agents for administration by RNs who are not qualified as CRNAs for the purpose of sedation and anesthesia.
  • Administration of IV Anesthetic Agents – Exception: In situations calling for conscious sedation, Propofol (Diprivan) is not an appropriate agent for administration by Registered Nurses unless they are Certified Registered Nurse Anesthetists. There is one exception, however. Registered Nurses, who are competent in the procedure through education and experience, may administer Propofol to intubated, ventilated patients in a critical care setting based on an appropriate medical order.

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Pennsylvania


Source:Pennsylvania Code

Type of Guidance:Chapter 21. State Board of Nursing Rules and Regulations (10/98)
Impact:RNs
Guidance*:Chapter 21.413:Interpretations regarding the administration of drugs—statement of policy (10-24-1998)

The registered nurse who is not a certified registered nurse anesthetist may administer intravenous conscious sedation medications during minor therapeutic and diagnostic procedures, provided that specified knowledge, skills, supervision, intuitional, and patient safety requirements are met.

Source:Pennsylvania Code
Type of Guidance:Title 28: Health And Safety (11/99)
Impact:MDs, RNs, CRNAs
Guidance*: Chapter 555.32 Ambulatory Surgical Facilities:Administration of anesthesia(10-22-1999)

Anesthetics shall be administered by anesthesiologists and certified registered nurse anesthetists.

Read Pennsylvania Code Title 28 Chapter 555.32

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Rhode Island


Source:Rhode Island Board of Nursing
Guidance*: No direct guidance is offered by the State Board of Nursing regarding the administration of moderate or deep sedation by Registered Nurses within the state of Rhode Island.

Source:State of Rhode Island Department of Health
Type of Guidance: Rules and Regulations for Licensing of Hospitals (R23-17-HOSP) March 2005
Impact:MDs, DOs, RNs, CRNAs 
Guidance*:Section 37.5: Anesthesia Service(3-2005) - Pages 47-48

(37.5 ) Anesthesia shall only be administered by:

  1. a qualified anesthesiologist;
  • a doctor of medicine or osteopathy (other than an anesthesiologist);
  • a dentist, oral surgeon, or podiatrist who is qualified to administer anesthesia under state law or regulation;
  • a certified registered nurse anesthetist (CRNA) acting within his/her scope of practice and as authorized by the governing body;
  • a physician assistant acting within his/her scope of practice and as authorized by the governing body;
  • a certified nurse-midwife acting within his/her scope of practice and as authorized by the governing body;
  • a certified registered nurse practitioner acting within his/her scope of practice and as authorized by the governing body
  • Read R23-17-HOSP(Pages 47-48)

    Source:State of Rhode Island Department of Health
    Type of Guidance:Rules and Regulations for the Licensure of Freestanding Ambulatory Surgery Centers (R23-17-FASC) March 2005
    Impact:MDs, DOs, RNs, CRNAs
    Guidance*:Section 17.0: Anesthesia Service(3-2005) - Page 12

    (17.1) A qualified anesthesiologist shall be on the staff.

    (17. 2)There shall be written policies and procedures regarding:

    1. privileges of staff for anesthesiology established in accordance with section 8.5 herein;
    2. emergency coverage;
    3. administration of anesthetics;
    4. the maintenance of safety controls; and
    5. qualifications and supervision of non-physician anesthetists.

    Read R23-17-FASC (Page 12)

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    Vermont

     

    Source:Vermont State Board of Nursing
    Type of Guidance: Board of Nursing Position Statement (7/2011)
    Impact:RNs
    Guidance*:Position Statement(Accepted 6-2005; Revised 7-2011):

    Role of the Nurse in the Administration and Monitoring of Moderate Sedation

    It is within the scope of practice of a registered nurse to non-anesthetic agents and to monitor patients in a state of moderate sedation.

    It is not within the registered nurse’s scope of practice to administer an anesthetic agent for any level of sedation.

    This position statement does not apply to the administration of pharmacological agents by the registered nurse practicing in an acute care setting where the patient may require emergent intubation, is intubated, requires mechanical ventilator breathing support, and/or is being continuously hemodynamically monitored. (See Vermont State Board of Nursing position statement on the administration of Propofol in critical care setting).

    Read the Board’s Position Statement and requirements

    Source:Vermont State Board of Nursing
    Type of Guidance:Board of Nursing Position Statement (7/2011)
    Impact:RNs
    Guidance*:Position Statement(Accepted 05-2007; Revised 07-2011)

    Role of the Nurse in the Administration of Propofol (Diprivan)

    It is within the scope of practice of an RN, under the direction of an attending physician, to administer Propofol in the following settings and specific patient conditions:

    • In critical care settings to intubated, ventilated patients
    • In critical care settings during intubation procedures (Rapid
      Sequence Intubation RSI)

    Read the Board’s Position Statement and requirements

    Other State Resources:

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    *This page was last updated 4/26/2015 This page is for informational purposes only and nothing on this website constitutes legal advice. Please consult the Connecticut State Board of Nursing or a legal professional before administering anesthetic or sedative products to determine proper conduct in your particular situation and to assess currentness of regulations.

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