Propofol Administration by Non-Anesthesia Providers Micah Reece NRSG 808

What is the issue? Propofol (Diprivan™) is an intravenously delivered, short-acting hypnotic and amnestic agent utilized for induction and maintenance of general anesthesia, sedation of patients in need of mechanical ventilation, and perhaps most importantly: procedural sedation.

What is the issue (cont’d)? It is thus the ideal drug for short diagnostic procedures such as gastrointestinal endoscopies and colonoscopies. Who should be allowed to administer this drug, if not anesthesia professionals? What are the risks? What is the issue (cont’d)?

What is the source of the issue? Current FDA propofol labeling states, “Only those persons trained in the administration of general anesthesia should administer the drug.” There are no other federal guidelines for administration of this medication, leaving individual states to interpret this guideline, some more loosely than others. What is the source of the issue?

What is the source of the issue (cont’d)? Currently, only 24 states have laws that expressly forbid non-anesthesia providers from administering this medication Thus, 26 states have the legal ambiguity necessary for some clinics/organizations to press for greater RN and physician autonomy with administration of the drug to avoid anesthesia costs/fees. What is the source of the issue (cont’d)?

What is at stake? First and foremost: patient safety. Potential loss of clients and revenue taken from anesthesia providers. Debate between stakeholders: AANA ASA Insurance Companies Hospitals Medical Technology Companies Professional Organizations (i.e. Society of Gastroenterology Nurses etc…) What is at stake?

What has been the impact? Joint statement from AANA and ASA condemning use of propofol by non- anesthesia physicians and nurses. Corporate giants like Johnson & Johnson developing new technology like the Sedasys™ machine that evades use of anesthesia providers by putting the drug in the hands of minimally trained RN’s. What has been the impact?

Currently a great deal of confusion between individual states about how the FDA guideline can be interpreted. Organizations such as American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy, etc… commissioning studies and lobbying for greater propofol autonomy. Where are we now?

What is needed is a single, federal mandate that unambiguously explains that propofol should only be administered by anesthesia personnel that have the training to intervene in the event something goes wrong. Having 50 different states with 50 different legal interpretations is a clumsy and dangerous approach. Plans for the future

Plans for the future (cont’d) Our patients deserve the best: us. We must crush the opposition in it’s infancy before it’s too late. RN’s have no business administering anesthetic agents. A great way to stop petty infighting between the ASA and AANA and unite the anesthesia community (in this student’s opinion). Plans for the future (cont’d)

YOUR call to action. Support your state’s AANA chapter. Contact your local representative, make them aware of the issue. We can address this issue now or years from now when even more states allow non-anesthesia staff to give anesthetic medications. YOUR call to action.

American Association of Nurse Anesthetists. (2013, May 9) American Association of Nurse Anesthetists. (2013, May 9). Anesthesia Professionals Question Safety of Non Experts Giving Propofol to Patients via New Sedasys Machine. Retrieved July 13, 2014, from http://http://www.aana.com/newsandjournal/Ne ws/Pages/050913-Anesthesia-Professionals- Question-Safety-of-Non-Experts-Giving-Propofol- to-Patients-via-New-Sedasys-Machine-.aspx Bardach, E. (2012). A practical guide for policy analysis: The eightfold path to more effective problem solving. Los Angeles: Sage.   References

Rex, D. K. , Heuss, L. T. , Walker, J. A. , & Qi, R. (2005) Rex, D. K., Heuss, L. T., Walker, J. A., & Qi, R. (2005). Trained registered nurses/endoscopy teams can administer propofol safely for endoscopy. Gastroenterology, 129(5), 1384-91. Skidmore-Roth, L. (2008). 2008 Mosby's nursing drug reference. St. Louis, Mo: Mosby Elsevier. Society of Gastroenterology Nurses and Associates, Inc. (n.d.). Non-anesthesiologist Administered Propofol (NAAP). Retrieved July 11, 2014, from http://www.sgna.org/Issues/SedationFactsorg/S edationAdministration/Agents_DeliveryMethods/ Naap.aspx References (cont’d)