A. Irvin C. Kokal K. Blum E. Shelnutt Propofol and Nursing Administration

S.M.A.R.T Goal and Problem Problem: It is against protocol, within the Bon Secours Health System to administer propofol. Goal: For registered nurses, in addition to mid level providers and physicians, to be able to push propofol in emergent situations in the Bon Secours Hospital System within the next five years.

Importance to Nursing Decrease the need for advanced providers to push propofol and decrease the time in which it is given. This would increase the efficiency of care. Difficult access to providers Increase work flow of floor because providers will not be tied up in one procedure

Clinical Recommendations Bon Secours Health Care System Policies Propofol can only be administered by MD or CRNA Comparison of EVB Other health systems within the Richmond area, such as VCU health system, push propofol. Evidenced based practice has supports the administration of propofol by registered nurses in the hospital setting.

Clinical Recommendations Proposed change To allow registered nurses to administer propofol in emergent situations Barriers/Facilitators Difficult to change and implement policy Education Storage of medication Nurse educators, providers and pharmacy as facilitators Financial Implications None EVB has shown a $5,365,691savings over 10,000 patient cases.

Supportive Articles Nursing administration of sedatives is increasingly common Cardiac cath lab Endoscopy Safe administration and high level of patient satisfaction Of 9,152 patients only 7 patients had cases of respiratory compromise Cost effective Rapid post operative recovery and increased discharge time

References Conway, A., Page, K., Rolley, J., & Worrall-Carter, L. (2011). Nurse-administered procedural sedation and analgesia in the cardiac catheter laboratory: An integrative review. International Journal of Nursing Studies, Walker, J., Mcintyre, R., Schleinitz, P., Jacobson, K., Haulk, A., Adesman, P.,... Rex, D. (2003). Nurse-administered propofol sedation without anesthesia specialists in 9152 endoscopic cases in an ambulatory surgery center. The American Journal of Gastroenterology, 98(8),