Pennsylvania Board of Nursing Review – March 12, 2015
Reviewed by Sedation Certification – July 23, 2020
State Sedation Policy – Yes
Can LPN’s give Sedation? – No
Can RN’s give sedation? – Yes
Can RN’s give Propofol/Ketamine? – No
For questions please contact http://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Nursing/Pages/default.aspx
28 Pa. Code § 555.31(a) Anesthesia Services
Approved Expedited Exception
The Department permits the use of propofol for sedation of patients undergoing surgical treatment in Class B ambulatory surgical facilities (ASFs).
Clinical evidence/support for this exception
The Department’s current regulations include a classification system that identifies three levels of ambulatory surgery facilities (class A, class B, and class C) based on the procedure, patient status, and anesthesia used. 28 Pa Code § 551.3 Definitions establishes that Class B facilities offer surgical treatments involving administration of sedation analgesia or dissociative drugs wherein reflexes may be obtunded.
Propofol is the generic name for a sedative drug also available as the brand name Diprivan.
Over the past 10 years the department has granted exceptions to 555.31(a) to permit the use of propofol in class B ASFs. The earliest requests for this exception were granted to endoscopy centers. As of August 1, 2014 Department records indicate this exception to 555.31(a) has been granted to 79 facilities. The Department is not aware of any reports of actual or potential harm to patients resulting from administration of propofol for sedation in ambulatory surgical facilities in this Commonwealth.
The Department’s “Guidance on Propofol use in Class B ASF”, used in the past to outline conditions that must be met by the facility, is now incorporated into this guidance document. the facility to
Minimum requirements for this exception
o Propofol will be administered only for sedation.
o No general anesthesia is to be administered at the Class B facility.
o Only a CRNA or anesthesiologist with training and experience in the management of general anesthesia and credentialed by the facility shall administer the propofol.
o The CRNA or anesthesiologist administering the propofol shall be qualified to rescue patients from any level of sedation, including general anesthesia.
o The facility must have equipment necessary for patient rescue readily available at all times.
o A facility seeking initial licensure must request an expedited exception to 551.31(a) within 48 hours of state licensure in order to avoid citation by the department’s surveyors.
Documentation to be provided to the Dept by the facility:
o Policies and procedures reflecting minimum requirements described above
§ 21.145a. Prohibited acts.
An LPN may not perform the following IV therapy functions:
§ 21.413. Interpretations regarding the administration of drugs—statement of policy.
(d) As used in this subsection, ‘‘conscious sedation’’ is defined as a minimally depressed level of consciousness in which the patient retains the ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal commands. The registered nurse who is not a certified registered nurse anesthetist may administer intravenous conscious sedation medications, under § 21.14, during minor therapeutic and diagnostic procedures, when the following conditions exist:
(1) The specific amount of intravenous conscious sedation medications has been ordered in writing by a licensed physician and a licensed physician is physically present in the room during administration.
(2) Written guidelines specifying the intravenous medications that the registered nurse may administer in a particular setting are available to the registered nurse.
(3) Electrocardiogram, blood pressure and oximetry equipment are used for both monitoring and emergency resuscitation purposes pursuant to written guidelines which are provided for minimum patient monitoring. Additional emergency resuscitation equipment is immediately available.
(4) The patient has a patent intravenous access.
(5) The registered nurse involved in direct patient care is certified in advanced cardiac life support (ACLS). Provisions shall be in place for back-up personnel who are experts in airway management, emergency intubation and advanced life support if complications arise.
(6) The registered nurse possesses the knowledge, skills and abilities related to the management of patients receiving intravenous conscious sedation with evaluation of competence on a periodic basis. This includes, but is not limited to, arrhythmia detection, airway management and pharmacologic action of drugs administered. This includes emergency drugs.
(7) The registered nurse managing the care of the patient receiving intravenous conscious sedation medication may not have other responsibilities during the procedure. The registered nurse may not leave the patient unattended or engage in tasks which would compromise continuous monitoring.
(8) The registered nurse monitors the patient until the patient is discharged by a qualified professional authorized to discharge the patient in accordance with established criteria of the facility.
The provisions of this § 21.413 adopted February 20, 1987, effective February 21, 1987, 17 Pa.B. 811; amended June 21, 1991, effective June 22, 1991, 21 Pa.B. 2818; amended January 17, 1992, effective January 18, 1992, 22 Pa.B. 300; amended November 12, 1993, effective November 13, 1993, 23 Pa.B. 5404; amended October 23, 1998, effective October 24, 1998, 28 Pa.B. 5345. Immediately preceding text appears at serial pages (214476) and (222949).