Role of Registered Nurse (RN) in the Management of Patients Receiving ModerateSedation/Analgesia for Therapeutic, Diagnostic, or Surgical Procedures.
Minimal Sedation (Anxiolysis) is a drug-induced state during which patients respond normally to verbal commands.Example: Small amount of fentanyl or midazolam
Moderate Sedation/Analgesia (“Conscious Sedation”) is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Example: More midazolam or fentanyl
RNs who provide Moderate Sedation are trained and experienced in the administration of IV (intravenous) medications that induce a lowered state of consciousness within the patient. These medications are used during painful procedures (ex: resetting a broken bone), minor surgeries (ex: small face lifts), and uncomfortable exams (ex:colonoscopy, angiograms, biopsies). The moderate sedation RN has the knowledge and experience with sedation medications (commonly: fentanyl and versed), as well as, the skills to assess, interpret, and intervene in the event of complications. These nurses must be great at starting IV’s, completely comfortable placing adjunct airways (ex: nasal trumpet), and the proper use of reversal medications in case of over sedation.
These RNs work is settings such as inpatient hospitals, outpatient surgical centers, outpatient endoscopy centers, Interventional Radiology, Vascular lab, Pain management clinics, Cardiac Cath Lab, and outpatient procedural clinics.
Duties and responsibilities of the Moderate Sedation RN include, but are not limited to:
Administration of moderate sedation medications by non-anesthetist RNs is allowed by state laws and institutional policy, procedures, and protocol.
A qualified anesthesia provider or attending physician selects and orders the medications to achieve moderate sedation.
The registered nurse managing the care of patients receiving moderate sedation is able to:
Demonstrate the acquired knowledge of anatomy, physiology, pharmacology, cardiac arrhythmia recognition and complications related to moderate sedation and medications.
Assess total patient care requirements during moderate sedation and recovery. Physiologic measurements should include, but not be limited to, respiratory rate, oxygen saturation, blood pressure, cardiac rate and rhythm, and patient’s level of consciousness.
Understand the principles of oxygen delivery, respiratory physiology, transport and uptake, and demonstrate the ability to use oxygen delivery devices.
Possess the skills to monitor adequacy of the patient’s ventilation by monitoring exhaled CO2 (ie, end-tidal CO2 [EtCO2]) by capnography in addition to SpO2 by pulse oximetry during moderate sedation/analgesia procedures. Monitoring the patient’s EtCO2, SpO2, and performing visual assessments completes the cycle of respiratory monitoring of oxygenation and ventilation of patients undergoing moderate sedation/analgesia.
Anticipate and recognize potential complications of moderate sedation in relation to the type of medication being administered.
Possess the requisite knowledge and skills to assess, diagnose and intervene in the event of complications or undesired outcomes and to institute nursing interventions in compliance with orders (including standing orders) or institutional protocols or guidelines.
Demonstrate skill in airway management resuscitation.
Demonstrate knowledge of the legal ramifications or administering moderate sedation and/or monitoring patients receiving moderate sedation, including the RN’s responsibility and liability in the event of an untoward reaction or life-threatening complication.
Demonstrate competency, through ACLS or PALS or appropriate competency assessment, in airway management and resuscitation appropriate to the age of the patient and to meet facility requirements.
The registered nurse managing the care of the patient receiving moderate sedation shall have no other responsibilities that would leave the patient unattended or compromise continuous monitoring.
2 years recent working experience as a RN performing moderate sedation (not including clinicals)
Current Unencumbered RN license in state of practice.
Current BLS & ACLS Card (PALS required for care of adolescents)
Current TB Screen
Valid Identification/Driver's License
Successful completion of a Background Check and Medely's screening process