49 Pa. Code § 21.413 - Interpretations regarding the administration of drugs-statement of policy
(a) The following
nursing practices fall within the scope of registered nursing practice under
21.11, 21.12 and 21.14 (relating to general functions; venipuncture;
intravenous fluids; and administration of drugs):
(1) Intravenous administration of Pavulon to
a patient maintained on a mechanical ventillator.
(2) Use of lidocaine as an analgesic prior to
venipuncture.
(3) Use of lidocaine
or xylocaine for analgesia prior to use of a vascular access device of an
implantable infusion pump.
(b) The following nursing practices fall
within the scope of registered nursing practice under 21.11 and 21.14:
(1) The addition of medications to peritoneal
dialysate.
(2) The administration
of chemotherapy.
(3) The refilling
of implantable drug delivery systems following placement by a physician in the
proper anatomical site.
(4) The
administration of intrathecal medications by an externalized
ventriculoperitoneal shunt.
(5)
Monitoring and administering medications by epidural catheter or other pain
relief devices to be used as analgesia for pain control. Administration of
medications as used in this paragraph does not include initiation of the
medication.
(6) When a physician
writes a prescription order for a patient for a specific medication with a
range of dosage, the registered nurse shall use professional judgment to
determine the amount of medication within the range to be given to the
patient.
(c) The
following nursing practices fall within the scope of registered nursing
practice under §
21.11 and
21.15 (relating to monitoring,
defibrillating and resuscitating):
(1)
Measurement of a cardiac output by thermodilution method.
(2) Inflation of a Swan-Ganz catheter balloon
for the purpose of obtaining intermittent pulmonary capillary wedge pressure
readings.
(3) Establishment of
arterial lines with or without a cannula.
(4) Analysis of rhythm strips of patients
with permanent programmable pacemakers.
(5) Endotrachael intubation and
extubation.
(6) Endotracheal
intubation in infant intensive care unit.
(7) Needle aspiration of pneumothorax in
infant intensive care unit.
(8)
Performance of cardioversion in the presence or absence of a
physician.
(9) Umbilical vessel
catheterization in infant intensive care units.
(10) Pulling back on Swan-Ganz catheter when
it is wedged.
(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 conscious sedation
medications, under §
21.14, during minor therapeutic
and diagnostic procedures, when the following conditions exist:
(1) The specific amount of conscious sedation
medications has been ordered in writing by a licensed physician or certified
registered nurse practitioner and a licensed physician or certified registered
nurse practitioner is physically present in the room during
administration.
(2) Written
guidelines specifying the 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 when the conscious sedation is administered
intravenously.
(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 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 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.
Notes
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No prior version found.