Can Pharmacists Administer Meds in a HOSPITAL?

[Truthspeaker]

Hey guys,

I'm still a resident and always treat my pharmacists with respect because they are SO helpful but I observed a situation that could have been handled a lot better.

A neurology resident with the neurologist in the room asked a pharmacist to give TPA (the clot buster) because the nurse had no idea what it did or how to give it. The pharmacist told the neurology team that it would be illegal for him to do so and said the nurse HAS to give it and he will walk her through giving it. The neurologists then told the nurse to "man up" and give the med. This was all in front of the patient's family.

I'm sure that pharmacist is a real straight shooter but I wanted to double check if anyone ever gave BIG LEAGUE meds like TPA (the clot buster) or otherwise in a hospital. Is it appropriate or not?

Thanks guys.

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[Seriously Serious]

As pharmacists, we do not receive that kind of training. We know about drugs, and how they are administered, but unfortunately, it is not practical for us to actually administer it - nor is it practical if there are nurses that are available to do it.

Just out of curiosity, why didn't the neurologist / resident administer it?

 

[zelman]

Drug administration was added to the pharmacist scope of practice to allow for immunizations. However, it’s likely against hospital policy and definitely not a good idea for pharmacists to administer IV meds.

 

[Carboxide]

Pharmacist did exactly the right thing. RN messed up, should have followed directions of the RPh or gotten the charge RN.

 

[steveysmith54]

Lol, i wouldn’t do it out of principle... but i would check board of Pharmacy laws for your state... i believe in California certains meds can be administered by the Pharmacist, injectable antipsychotics and injectable contraceptive are some of them, I believe .....

 

[steveysmith54]

In CA,
4052.1. Permitted Pharmacist Procedures in Licensed Health Care Facility
(a) Notwithstanding any other provision of law, a pharmacist may perform the following procedures or functions in a licensed health care facility in accordance with policies, procedures, or protocols developed by health professionals, including physicians, pharmacists, and registered nurses, with the concurrence of the facility administrator:
(3) Administering drugs and biologicals by injection pursuant to a prescriber's order.

 

[Chriskahn]

I think pharmacists can push certain meds in WA. Saw a pharmacist (my preceptor) push meds during a code a couple weeks ago

 

[njac]

Multiple variables including state law, hospital culture, and personal level of comfort.

I have ED Pharmacist friends who are comfortable pushing certain medications, and have the law to back them up, but choose not to in order to establish a common expectation of all of the pharmacists who cover that ED, in order to prevent an situation where a Pharmacist could be expected to do something out of their comfort zone, because “someone else does it”


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[njac]

I’ve definitely had the neuro resident push a tpa bolus when a floor nurse wasn’t comfortable and claimed it was “out of their scope”. (I beg to differ, but that wasn’t the time or place to have that discussion)


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[Sparda29]

Hey guys,

I'm still a resident and always treat my pharmacists with respect because they are SO helpful but I observed a situation that could have been handled a lot better.

A neurology resident with the neurologist in the room asked a pharmacist to give TPA (the clot buster) because the nurse had no idea what it did or how to give it. The pharmacist told the neurology team that it would be illegal for him to do so and said the nurse HAS to give it and he will walk her through giving it. The neurologists then told the nurse to "man up" and give the med. This was all in front of the patient's family.

I'm sure that pharmacist is a real straight shooter but I wanted to double check if anyone ever gave BIG LEAGUE meds like TPA (the clot buster) or otherwise in a hospital. Is it appropriate or not?

Thanks guys.

I've compounded/prepared/reconstituted tPA bedside but I've never administered it. (No idea on how to find veins, no idea how to open a line, no idea how to use an IV pump.)

 

[Digsbe]

Most states include drug administration in the practice act so it would be legal. However hospital policies or individual training may not allow for a pharmacist to administer. I had rotated in a hospital that wouldn't let pharmacists give immunizations even though we are the top immunization providers now.

 

[njac]

I've compounded/prepared/reconstituted tPA bedside but I've never administered it. (No idea on how to find veins, no idea how to open a line, no idea how to use an IV pump.)

At my previous hospital all the pharmacists were trained to program the pump for tPA. They were not expected to prime the tubing, but the pump just needed an RN to push start.


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[Dalteparin]

Your hospital probably has a policy that spells out who is allowed to give tPA and who isn’t. Consult the policy and educate the resident about it. I will be shocked if it allows RPhs to give tPA. (And if there isn’t a policy, get one in place!)


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[Fishdoc121]

Hey guys,

I'm still a resident and always treat my pharmacists with respect because they are SO helpful but I observed a situation that could have been handled a lot better.

A neurology resident with the neurologist in the room asked a pharmacist to give TPA (the clot buster) because the nurse had no idea what it did or how to give it. The pharmacist told the neurology team that it would be illegal for him to do so and said the nurse HAS to give it and he will walk her through giving it. The neurologists then told the nurse to "man up" and give the med. This was all in front of the patient's family.

I'm sure that pharmacist is a real straight shooter but I wanted to double check if anyone ever gave BIG LEAGUE meds like TPA (the clot buster) or otherwise in a hospital. Is it appropriate or not?

Thanks guys.

At my hospital we hang TPA all the time, of course the line is already started but Y-siteing a med is something we do pretty regularly

 

[lord999]

Even if legal (and some states still have administration explicitly illegal for pharmacists), I doubt credentialing would qualify pharmacists under usual circumstances to do any sort of med administration except those assigned to units where codes are expected or in a geographically distinct area. There's actually some training and practice you ought to do in this before you do the administration. I actually did due to sort of work I used to do, but it was a long intentional process, the pharmacist made the right judgment to refuse.

By the way, if I were that pharmacist, I'd be immediately reporting the neurologist to Credentialing and Privileging for a revoke order on attending privilege (the sort that gets you reported to NPDB) as they are supposed to be able to administer themselves and the nurse can refuse on technical grounds to a physician.

 

[Zynx]

We have a hospital policy that essentially states pharmacist administration acceptable in emergent situations where no one else was available and you inform a physician afterwards.
Meaning it would have to already be something on the MAR and no nurse around for something emergent, or I took a verbal from a physician who is with me on an emergent patient and there is no other nurse around, which all seems very unlikely.
However, if we have PEA/asystole, CPR in progress, and still no physician, I think I would actually go ahead and give the epinephrine. I'm not sure if this is commonplace or not actually, it wouldn't surprise me if there are places where the nurse is pulling epi from the crash cart and giving before the physician arrives (perhaps with a protocol).

 

[Son_Goku]

If it's one thing a Pharmacist knows (perhaps, even more then the drugs itself), is the law.

There is a reason why the head Neuro told the nurses to "man up" instead of the pharmacist.

 

[RNthenDoc]

Pharmacist did exactly the right thing. RN messed up, should have followed directions of the RPh or gotten the charge RN.

Just commenting because of this:
Administration of thrombolytics is risky and is only to be done by staff who have had specific training (varies from state-to-state and institution to institution). RN was 100% correct to not administer med, but could have found someone certified to do so. If a physician was standing there, why didn't that person "man up?"

 

[sakigt]

I reconstitute, pull waste, pull bolus, unwrap flush, prime tubing, set pump.....

Then hand all that crap over to the RN.

 

[Corytrade]

So many questions. Was this a code stroke situation? Why was the pharmacist there? What unit were you in? How did the nurse not even know what alteplase was, and why didn't the nurse leader/manager get involved? Why didn't the MD push the drug?

You're right... this situation could have been handled a whole lot better.

 

[Dred Pirate]

depends on state law - I work in the ED - and this comes up every now and then. usually it is out of our scope - which seems silly - but I am guessing there are not a lot of laws specifically addressing this.

I administer meds in codes or other times when a patient is in a critical situation and the RN doesn't have a free hand (intubated pt who is starting to wake up and the RN is holding the patient down - I will push versed). I have pushed TPA in a code, but this is the exception, not the rule, generally a code team/or even during regular pt care - the RN should be able to. I am here to answer any questions, give directions, but pharmacists (in general) lots of times don't necessarily know how all the lines work - this is something I do training and inservices on - but it is not part of a normal rph education.

 

[Truthspeaker]

So many questions. Was this a code stroke situation? Why was the pharmacist there? What unit were you in? How did the nurse not even know what alteplase was, and why didn't the nurse leader/manager get involved? Why didn't the MD push the drug?

You're right... this situation could have been handled a whole lot better.

Not going to lie, I am still embarrassed by the situation. When it comes to strokes, time is brain and the family is scared. Every stroke (code or not) is on a clock or timer. We have a pharmacist go to these strokes specifically to get the TPA moving faster. I don't have the numbers to show it, but I guarantee having that pharmacist at the stroke cuts the door to needle time of TPA in HALF. I've seen RNs unable to get the drug out of the alteplase vial without leaking all over the place or forget to pull the waste out. It's obvious the Neurology Attending saw the RNs were out of the element and wanted the pharmacist to take care of the administration piece too so they know the job gets done.

Just an update, this pharmacist that refused to give the clot buster has decided to move to a different floor in our hospital and will no longer be attending strokes. Also, the RNs and some doctors still want a pharmacist to be administering the TPA.

 

[Dalteparin]

Also, the RNs and some doctors still want a pharmacist to be administering the TPA.

What the hell? I have never heard of a hospital that allows pharmacists to do that, and I'm mystified as to why the RNs and MDs are asking for such a thing. Do they not realize that most of us aren't trained for that? Do they not realize that's actually against the law in some states? I completely understand having a pharmacist attend to mix the tPA (and I agree that it makes things go faster), but administering it is NOT something that we should routinely do.

Sounds like your pharmacist made the right decision both in refusing to give the drug and in refusing to attend more strokes. No way would I put my license at risk like that!

 

[Cryc_to_the_point]

...why on earth didn't the physician push the medication?

 

[Apotheker2015]

Hey guys,

I'm still a resident and always treat my pharmacists with respect because they are SO helpful but I observed a situation that could have been handled a lot better.

A neurology resident with the neurologist in the room asked a pharmacist to give TPA (the clot buster) because the nurse had no idea what it did or how to give it. The pharmacist told the neurology team that it would be illegal for him to do so and said the nurse HAS to give it and he will walk her through giving it. The neurologists then told the nurse to "man up" and give the med. This was all in front of the patient's family.

I'm sure that pharmacist is a real straight shooter but I wanted to double check if anyone ever gave BIG LEAGUE meds like TPA (the clot buster) or otherwise in a hospital. Is it appropriate or not?

Thanks guys.

It seems to me that the neurologist misfired there. You do not let a family see all of that while their loved on is having a stroke. The neurologist should have just given the drug, taken care of the patient and addressed the nurse outside. Why would the neurologist ask/order the pharmacist to give the drug without knowing whether the pharmacist is trained and comfortable doing that? As a pharmacist, I would like to know my potential liability should something go wrong. Even if there is training involved, it is way out of our scope of training.

Respectfully,

Apotheker2015

 

[BidingMyTime]

Just an update, this pharmacist that refused to give the clot buster has decided to move to a different floor in our hospital and will no longer be attending strokes. Also, the RNs and some doctors still want a pharmacist to be administering the TPA.

Is the hospital going to train pharmacists to administer TPA? I really don't understand why, if only from a liability standpoint, they wouldn't want a nurse or doctor doing this, as that is what they are trained and licensed to do. Not to mention, many states (probably most), don't allow this because pharmacists aren't trained to do it, and most docs and nurses don't want a pharmacist doing their job. Plus, as Apothekar brought up, would pharmacist (or even the hospital's) liability insurance cover a pharmacist administering TPA? Regardless of what a few RN's and doc's at your hospital want, this idea they are proposing really needs to be run through the legal department, as well as state laws checked.

 

[RNthenDoc]

Physicians administer meds/start lines, but I have never heard of a pharmacist who was trained in the assessment of intravenous accesses. This isn't a critique of pharmacy; honestly the code stroke nurse is supposed to be the one trained to do start intravenous access/assess them/administer meds, but in the absence of an RN comfortable with the task it's the doctor's job.

I will say that during a code recently a pharmacist was present to measure Epi for me (after initial doses we use multi-dose vials). I then pushed the doses per ACLS protocol. It *did* make me feel better that a trained pharmacist was handing me the drug vs. any of the other staff present during the code. I would *not* have expected that same pharmacist to then push the Epi, though, as it was a brand new line and he had no clue if it works or not (it's pretty simple to check for blood return and look at the surrounding tissue, but that's beside the point).
Just my perspective.

 

[Apotheker2015]

Physicians administer meds/start lines, but I have never heard of a pharmacist who was trained in the assessment of intravenous accesses. This isn't a critique of pharmacy; honestly the code stroke nurse is supposed to be the one trained to do start intravenous access/assess them/administer meds, but in the absence of an RN comfortable with the task it's the doctor's job.

I will say that during a code recently a pharmacist was present to measure Epi for me (after initial doses we use multi-dose vials). I then pushed the doses per ACLS protocol. It *did* make me feel better that a trained pharmacist was handing me the drug vs. any of the other staff present during the code. I would *not* have expected that same pharmacist to then push the Epi, though, as it was a brand new line and he had no clue if it works or not (it's pretty simple to check for blood return and look at the surrounding tissue, but that's beside the point).
Just my perspective.

Thank you for chiming in RNthenDoc! I am all for the pharmacist mixing and getting it ready for the nurse to administer it. Beyond that, lines are not part of our core training. To be clear, that is not part of our board examination.

 

[NYCGuy86]

Just commenting because of this:
Administration of thrombolytics is risky and is only to be done by staff who have had specific training (varies from state-to-state and institution to institution). RN was 100% correct to not administer med, but could have found someone certified to do so. If a physician was standing there, why didn't that person "man up?"

Agreed (I'm also an RN, and very recently stroke nursing certified).

Really depends on the setting (was this in the ED, stroke unit, neuro ICU, etc). So the RN didn't "have" to give it (hospitals typically also have policies about which meds RNs can give, which the physician/NP/PA has to give, which require the provider to be on the unit during administration, etc) Also, it isn't merely giving the drug, but also the clinical monitoring during administration (tPA requiring q15 vital signs and neuro assessments during administration). I'm assuming that if the RN in question didn't know what tPA is or how to give it, they also didn't know how to perform the neurological assessments required to assess for neurological deterioration. It's just like chemo and other high risk medications; if the RN is not in the appropriate setting to give the medication (i.e. continuous cardiac/oxygenation monitoring for certain drugs), or doesn't have the appropriate training to administer that medication and monitor the patient, then they absolutely should not administer it, whether or not the provider says to "man up" (lmao).

 

[Cryc_to_the_point]

I think it just bothered me that the physician didn't step in and make it happen. Whether from lack of knowledge, laziness, or some sort of misplaced understanding of his place he failed to make it happen (yet ordered it). I was a paramedic in a former life and maybe it's just me, but it bothers me to hear of a physician to order anything they aren't capable of making happen (in this instance).

 

[Rockinacoustic]

Just an update, this pharmacist that refused to give the clot buster has decided to move to a different floor in our hospital and will no longer be attending strokes. Also, the RNs and some doctors still want a pharmacist to be administering the TPA.

Assuming this is even legal, will the hospital c-suite support the FTEs for a trained pharmacist to be available 24/7/365 to push tPA and other acute meds?

If not, pharmacy leadership is the one that needs to "man up" and reset expectations

 

[gwarm01]

We require additional credentialing to even administer a vaccine and they expect you to push tpa?

 

[Truthspeaker]

I just gotta know, is it because the med asked for is TPA that makes the pharmacists uncomfortable to give it or is it ALL meds? At my hospital one of the ED attendings is trying to get the new ED pharmacist to push the RSI meds for him. This pharmacist said he would look into the law to see if he could do this but as far as I know he has not agreed to it.

Ya know something, this all started when the nurses at my hospital banded together somehow and are now refusing to push paralytics and any "sedation" drugs. That means the docs have to do it and it is really bad for patient care. Is this normal that nurses can't give those meds? Anyway, this attending said he would be on board with having the pharmacist not only draw up but administer the RSI meds claiming it would improve outcomes. How do pharmacists feel about pushing meds like Etomidate & Succinylcholine on demand?

 

[zelman]

I just gotta know, is it because the med asked for is TPA that makes the pharmacists uncomfortable to give it or is it ALL meds? At my hospital one of the ED attendings is trying to get the new ED pharmacist to push the RSI meds for him. This pharmacist said he would look into the law to see if he could do this but as far as I know he has not agreed to it.

Ya know something, this all started when the nurses at my hospital banded together somehow and are now refusing to push paralytics and any "sedation" drugs. That means the docs have to do it and it is really bad for patient care. Is this normal that nurses can't give those meds? Anyway, this attending said he would be on board with having the pharmacist not only draw up but administer the RSI meds claiming it would improve outcomes. How do pharmacists feel about pushing meds like Etomidate & Succinylcholine on demand?

Widespread nurses refusing administer meds is unacceptable. They all need to review their job descriptions and decide if they want a job or not.

 

[Dred Pirate]

I think as a pharmacist we shouldn't necessarily focus on what meds we can administer vs are we trained to verify an iv line is patent. The other day I had a rn ask me to feel to see if I though this line was working vs infiltrating while he pushed a saline flush in. This is something I have no idea how to tell and I think emphasizes the point that the Pushing of a med is a rn job. I asked him to teach me what to look for , but in no way do I feel competent. I go to codes on a nearly daily basis so I have pushed drugs in rare occasions. But they are very rare compared to my other activities during these situations.

 

[njac]

I just gotta know, is it because the med asked for is TPA that makes the pharmacists uncomfortable to give it or is it ALL meds? At my hospital one of the ED attendings is trying to get the new ED pharmacist to push the RSI meds for him. This pharmacist said he would look into the law to see if he could do this but as far as I know he has not agreed to it.

Ya know something, this all started when the nurses at my hospital banded together somehow and are now refusing to push paralytics and any "sedation" drugs. That means the docs have to do it and it is really bad for patient care. Is this normal that nurses can't give those meds? Anyway, this attending said he would be on board with having the pharmacist not only draw up but administer the RSI meds claiming it would improve outcomes. How do pharmacists feel about pushing meds like Etomidate & Succinylcholine on demand?

This makes zero sense. Why would ED RNs refuse to push RSI meds?

I can sort of see if it was a floor code or intubation and the ED Doc had to come up and do it and maybe a floor nurse wasn’t comfortable - but in that situation I would expect a rapid response/crisis nurse or house supervisor type there to assist as well.

Have I given RSI meds in an emergency? Yes. Do I want to do it routinely? No. While I attend nearly all the intubations in the ED while I’m at work sometimes I’m busy with something else, Unless it’s very complicated or very elective I don’t want to be the rate limiting step they’re delaying the intubation for, you know? Plus we have 4 hours/day of no ED Pharmacist coverage, what would happen during that time?

Now some states do not allow RNs to push medications for procedural sedation, citing they are being used for “anesthesia”. There are many interpretations of this, most commonly I see that RNs may not push Propofol or ketamine IV. But it’s all about intent - I teach my RNs that if the physician is at the head of the bed and has a ET tube in their hand and wants ketamine for RSI induction - RN can give. If physician has an ankle in their hand for a reduction and wants ketamine for procedural sedation - physician must give. But it’s state and institution specific. When we give IM ketamine to kids for procedural sedation, RNs can administer that.


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[CetiAlphaFive]

I just gotta know, is it because the med asked for is TPA that makes the pharmacists uncomfortable to give it or is it ALL meds? At my hospital one of the ED attendings is trying to get the new ED pharmacist to push the RSI meds for him. This pharmacist said he would look into the law to see if he could do this but as far as I know he has not agreed to it.

Ya know something, this all started when the nurses at my hospital banded together somehow and are now refusing to push paralytics and any "sedation" drugs. That means the docs have to do it and it is really bad for patient care. Is this normal that nurses can't give those meds? Anyway, this attending said he would be on board with having the pharmacist not only draw up but administer the RSI meds claiming it would improve outcomes. How do pharmacists feel about pushing meds like Etomidate & Succinylcholine on demand?

Why should the pharmacist do anything for free?

I think you're asking generalized questions when it's clearly state/institution specific.

Would you go into the IV room and mix up a lactated ringer?

 

[Dalteparin]

I just gotta know, is it because the med asked for is TPA that makes the pharmacists uncomfortable to give it or is it ALL meds? At my hospital one of the ED attendings is trying to get the new ED pharmacist to push the RSI meds for him. This pharmacist said he would look into the law to see if he could do this but as far as I know he has not agreed to it.

Ya know something, this all started when the nurses at my hospital banded together somehow and are now refusing to push paralytics and any "sedation" drugs. That means the docs have to do it and it is really bad for patient care. Is this normal that nurses can't give those meds? Anyway, this attending said he would be on board with having the pharmacist not only draw up but administer the RSI meds claiming it would improve outcomes. How do pharmacists feel about pushing meds like Etomidate & Succinylcholine on demand?

Personally, I would be completely uncomfortable pushing any medication! (I also don’t work in the ED, so that makes a difference.) Why are your RNs refusing to do something that’s such a fundamental part of their job? That would be akin to me deciding I don’t want to dose vancomycin anymore and I’m just going to let nursing do it! I’ve also never heard of a hospital where RNs couldn’t administer paralytics, and I’m really appalled at the way your RNs are abdicating their responsibilities.

Your ED pharmacist is trying to protect their license and protect your hospital from a huge liability. Respect that.


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[Truthspeaker]

Personally, I would be completely uncomfortable pushing any medication! (I also don’t work in the ED, so that makes a difference.) Why are your RNs refusing to do something that’s such a fundamental part of their job? That would be akin to me deciding I don’t want to dose vancomycin anymore and I’m just going to let nursing do it! I’ve also never heard of a hospital where RNs couldn’t administer paralytics, and I’m really appalled at the way your RNs are abdicating their responsibilities.

Your ED pharmacist is trying to protect their license and protect your hospital from a huge liability. Respect that.


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Nurses band together stronger than any other healthcare worker. The managers are nurses and they have made policies that nursing is not to give any paralytics or "sedation" medications and these have to be administered by the physicians. There was no meeting about this, we weren't asked if we had time to do it, one day we all just came into work and the nurses were flat out refusing to give the meds they had been doing for dozens of years.

I don't know if you guys know, but some nurses feel intimidated when there is a pharmacist in the room. I feel like a pharmacist has exposed a lot of the drug errors doctors and nurses were making. I was pulled aside once and told by an RN that she "didnt trust our pharmacists calculations" about a complicated infusion we don't usually give. I was shocked, why? I did the math myself after the nurse said what she was going to run. It turned out the RN math was way off and the pharmacist was spot on when he explained it all to us.

Perhaps nurses prefer the pharmacist to give the medications so they are out of the picture. Physicians on the otherhand want pharmacists to give the medications because we seen a lot of RN mistakes with dosing or because nursing has dumped that duty on us with their policies and we need the help. It seems that pharmacists have the right to refuse giving the medications. I don't blame you boys.

 

[Dred Pirate]

Nurses band together stronger than any other healthcare worker. The managers are nurses and they have made policies that nursing is not to give any paralytics or "sedation" medications and these have to be administered by the physicians. There was no meeting about this, we weren't asked if we had time to do it, one day we all just came into work and the nurses were flat out refusing to give the meds they had been doing for dozens of years.

I don't know if you guys know, but some nurses feel intimidated when there is a pharmacist in the room. I feel like a pharmacist has exposed a lot of the drug errors doctors and nurses were making. I was pulled aside once and told by an RN that she "didnt trust our pharmacists calculations" about a complicated infusion we don't usually give. I was shocked, why? I did the math myself after the nurse said what she was going to run. It turned out the RN math was way off and the pharmacist was spot on when he explained it all to us.

Perhaps nurses prefer the pharmacist to give the medications so they are out of the picture. Physicians on the otherhand want pharmacists to give the medications because we seen a lot of RN mistakes with dosing or because nursing has dumped that duty on us with their policies and we need the help. It seems that pharmacists have the right to refuse giving the medications. I don't blame you boys.

again I agree the medication being given should never be the issue - the act of giving the medication shouldn't matter - it doesn't matter what is in the syringe - it matters who is in the room - as long as all needed people are there. Pharmacists do the calculations and tell the RN how fast, etc. The RN assess the iv line. The MD does what procedure is to be done. We all have a role

 

[NYCGuy86]

Perhaps it would be helpful to read something from the nursing perspective on how nurses think when it comes to medication administration. For those interested, from the Arkansas State Board of Nursing, position statement on "Role of the Registered Nurse in the Management of Patients Receiving Moderate Sedation, Anesthetic Agents or Neuromuscular Blocking (paralytic) Agents For Therapeutic or Diagnostic Procedures"

 

[NYCGuy86]

again I agree the medication being given should never be the issue - the act of giving the medication shouldn't matter - it doesn't matter what is in the syringe - it matters who is in the room - as long as all needed people are there. Pharmacists do the calculations and tell the RN how fast, etc. The RN assess the iv line. The MD does what procedure is to be done. We all have a role

In my opinion, what is in the syringe does matter, because it dictates who is in the room. It isn't merely any physician doing a procedure, but a physician credentialed in and having demonstrated competency in the performance of that procedure. Likewise, various medications require the RN administering it to be credentialed and demonstrate competency in the administration of, and the necessary patient monitoring related to, the medication. For example, as a neuroscience RN, I am definitely not qualified to administer chemotherapy, and the heme/onc RN will administer it and carry out the patient monitoring related to it on our brain tumor patients, since they are trained and credentialed for that, I am not. And of course this goes beyond medications to the various patient technologies we use at the bedside, which in many cases is specific to specialty setting and competency demonstrated by the clinical staff. It isn't RN=RN anymore than MD=MD.

The ED is a special case, and typically ED RNs should have competency related to administration of a wide variety of medications from a wide variety of specialties (i.e. the ED RN should be able to start the tPA, and then transfer care to the stroke unit/neuro ICU RN who will continue the infusion and monitoring of the patient's neurological status and vital signs).

 

[zelman]

In my opinion, what is in the syringe does matter, because it dictates who is in the room. It isn't merely any physician doing a procedure, but a physician credentialed in and having demonstrated competency in the performance of that procedure. Likewise, various medications require the RN administering it to be credentialed and demonstrate competency in the administration of, and the necessary patient monitoring related to, the medication. For example, as a neuroscience RN, I am definitely not qualified to administer chemotherapy, and the heme/onc RN will administer it and carry out the patient monitoring related to it on our brain tumor patients, since they are trained and credentialed for that, I am not. And of course this goes beyond medications to the various patient technologies we use at the bedside, which in many cases is specific to specialty setting and competency demonstrated by the clinical staff. It isn't RN=RN anymore than MD=MD.

The ED is a special case, and typically ED RNs should have competency related to administration of a wide variety of medications from a wide variety of specialties (i.e. the ED RN should be able to start the tPA, and then transfer care to the stroke unit/neuro ICU RN who will continue the infusion and monitoring of the patient's neurological status and vital signs).

If you think it isn’t MD=MD, I have an interventional radiologist who insists they can prescribe adderall, and a psychiatrist or two who prescribe oxycodone/Soma/Xanax that I’d like you to explain that to. Legally, MD=MD as much as we’d like it to be otherwise.

 

[Dalteparin]

Nurses band together stronger than any other healthcare worker. The managers are nurses and they have made policies that nursing is not to give any paralytics or "sedation" medications and these have to be administered by the physicians. There was no meeting about this, we weren't asked if we had time to do it, one day we all just came into work and the nurses were flat out refusing to give the meds they had been doing for dozens of years.

You all need to do some digging on this. Why are they refusing? Was there a sentinel event?

 

[BidingMyTime]

If you think it isn’t MD=MD, I have an interventional radiologist who insists they can prescribe adderall, and a psychiatrist or two who prescribe oxycodone/Soma/Xanax that I’d like you to explain that to. Legally, MD=MD as much as we’d like it to be otherwise.

Legally yes, liability wise is another matter.

 

[zelman]

Legally yes, liability wise is another matter.

How so?

 

[BidingMyTime]

How so?

I'm assuming, that MD liability insurance has restrictions on it, just as pharmacist liability does. Like if I had a primarily consulting job, I'd have to pay more for liability than just regular pharmacist insurance. Insurance for pharmacy owners is more than for non-pharmacy owners.

Now, I know with doctors, insurance rates also vary depending on their specialty. So, I highly doubt an IM doctor who decided to start delivering babies at home as a side-gig, isn't going to be covered by his IM liability policy. Now granted, you gave pretty innocuous examples, I don't think insurance companies care if the rad doc is prescribing Adderall. I was objecting more to MD=MD......that just isn't true when it comes to insurance coverage and practicing specialties which one doesn't have the background for.

 

[NYCGuy86]

If you think it isn’t MD=MD, I have an interventional radiologist who insists they can prescribe adderall, and a psychiatrist or two who prescribe oxycodone/Soma/Xanax that I’d like you to explain that to. Legally, MD=MD as much as we’d like it to be otherwise.

Feel free to tell hospital credentialing that MD=MD. Can't wait for them to allow psychiatrists to perform heart surgery in their ORs.

I'm not talking about licensure (yes, physician and nurse licenses allow us to do anything within our scopes of practice of medicine and nursing, respectively).

 

[Cryc_to_the_point]

Prescribing and administering any medication by a physician in their relevant field is not restricted in any way. Period. Nurses sometimes need special credentialing legally. Otherwise, it's just hospital policies that dictate special credentials for physicians to practice medicine they're already board certified in.

 

[lord999]

I'm assuming, that MD liability insurance has restrictions on it, just as pharmacist liability does. Like if I had a primarily consulting job, I'd have to pay more for liability than just regular pharmacist insurance. Insurance for pharmacy owners is more than for non-pharmacy owners.

Now, I know with doctors, insurance rates also vary depending on their specialty. So, I highly doubt an IM doctor who decided to start delivering babies at home as a side-gig, isn't going to be covered by his IM liability policy. Now granted, you gave pretty innocuous examples, I don't think insurance companies care if the rad doc is prescribing Adderall. I was objecting more to MD=MD......that just isn't true when it comes to insurance coverage and practicing specialties which one doesn't have the background for.

For pharmacists, yes. Locum work is not ordinarily insured (you have to pay a separate rate). Fidelity and supervisory coverage are different riders as well.

Actually, there are IM rates based on general practice, so primary care has one, hospitalist has one, emergency medicine (where delivering a baby is not unexpected) has another. There's also limitations set on whether something is general and expected practice and when something is an emergency in terms of broadband coverage.

Depends on the state as well. The West Coast tends to have both looser interpretations about what precisely a practitioner can do while having stricter interpretations on using common sense. So that Interventional Radiologist case would need some clinical rationale why that would be in his scope of practice that you'd have to be convinced to pull off.