DEPARTMENT OF HEALTH
Board of NursingRULE NO: RULE TITLE
64B9-17.001: Statement of Intent of Purpose
64B9-17.003: Competency and Knowledge RequirementsNOTICE OF CHANGE
Notice is hereby given that the following changes have been made in accordance with subparagraph 120.54(3)(d)1., F.S. to the proposed rule, published in Vol. 31, No. 11 of the March 18, 2005 issue of the Florida Administrative Weekly. The changes reflect additional amendments to the proposed rule that have been made since a Notice of Change was published in Vol. 32, No. 22 of the June 2, 2006 issue of the Florida Administrative Weekly. These additional changes were made to address concerns expressed by the Joint Administrative Procedure Committee, and to delete unnecessary duplicate language. The additional changes were approved by the Board at its November 30, 2006 meeting. After the changes are made to the affected parts of the rule, those parts of the rule will read as follows:
Subsection (2) of Rule 64B9-17.001 will now read as follows:
(2) The purpose of this rule is to protect the public by ensuring that competent registered nurses administer conscious sedation and deep sedation. The rule sets out the education and/or competency verification necessary to administer medications for conscious sedation and deep sedation under specific conditions. Pursuant to Section 464.018(1)(h), F.S., the act of administering medications for conscious sedation by a registered nurse without the education and verification of competency outlined in these this rules would constitute unprofessional conduct and would also be a violation of Section 464.018(1)(j) and (n), F.S. Further, this role is beyond the scope of practice for the licensed practical nurse or the tasks allowed for unlicensed assistive personnel. The administration of medications via any route for the purpose of general anesthesia or medications that the manufacturer package insert indicates should be administered only by persons trained in the administration of anesthesia is not within the scope of registered nursing or licensed practical nursing practice.
Subsection (1) of Rule 64B9-17.003 will now read as follows:
(1) A registered nurse may administer medications to achieve conscious sedation during therapeutic, diagnostic, or surgical procedures, provided the registered nurse has completed the knowledge, education and competency requirements in this rule, and may manage patients who are receiving and recovering from conscious sedation.
Paragraph (1)(c) of Rule 64B9-17.003 will now read as follows:
(c) The registered nurse must have successfully completed a minimum of eight hours of education or training program in conscious sedation developed by the institution or by an approved continuing education provider. The content of that education or training program must, at a minimum, be eight hours in length, include instruction contain information on the definitions, knowledge, education and competency requirements and scope of practice set forth in this rule, including the continuum of levels of sedation;, and on drugs used during conscious sedation, including reversal agents, their actions, side-effects and untoward effects, and any manufacturer package insert;, and assessment and monitoring of the patient receiving the medication. The education or training program must also include instruction on address recognition of emergency situations;, institution of appropriate nursing interventions;, and evaluation of physiologic measurements, such as respiratory rate, oxygen saturation, blood pressure, cardiac rate and rhythm, and the patient’s level of consciousness. An educational or training program developed by the employing institution or an approved continuing education provider that meets the requirements of this rule may be used to demonstrate appropriate competency.
Subsection (2) of Rule 64B9-17.003 will now read as follows:
(2) In a hospice program, a registered nurse may administer medications to achieve conscious sedation for palliative care and may manage patients who are receiving conscious sedation, provided the registered nurse has completed the knowledge, education and competency requirements and adheres to the scope of practice provisions in this rule, and the hospice program meets the requirements of subsections (1)(i) and (j) of this rule. and may manage patients who are receiving conscious sedation.
(a) The registered nurse administers medications only in dosages titrated to achieve conscious sedation for palliative care.
(b) The registered nurse must have successfully completed a program in conscious sedation developed by the institution or by an approved continuing education provider. The content of that program must, at a minimum, be four hours in length, contain information on the definitions, knowledge, education and competency requirements in this rule, including the continuum of levels of sedation, and on drugs used during conscious sedation, including reversal agents, their actions, side-effects and untoward effects, manufacturer package insert, and assessment and monitoring of the patient receiving the medication. The program shall be appropriate to palliative care and must also address recognition of emergency situations, institution of appropriate nursing interventions, and evaluation of physiologic measurements, such as respiratory rate, oxygen saturation, blood pressure, cardiac rate and rhythm, and the patient's level of consciousness.
(c) The registered nurse administers medications to achieve conscious sedation by executing the order of a qualified anesthesia provider or physician licensed under Chapter 458 or 459, F.S. Although the determination of medical dosage and the patient’s medical status is a medical decision, the registered nurse has the right and the obligation to question orders and decisions which are contrary to acceptable standards of nursing practice, to refuse to participate in procedures which may result in harm to the patient, and to refuse to administer or continue to administer medications in amounts that may induce general anesthesia or that may lead to respiratory or cardiovascular compromise.
(d) The institution must have written protocols in place to include, but not be limited to: drug administration, location and availability of manufacturer package inserts for medication to be used in conscious sedation, and availability of a physician. These protocols must be reviewed at frequent intervals to assure that they are within current and accepted standards of practice. The frequency of review should be consistent with review of other policies in the institution or practice setting.
(e) The institution must have a mechanism for determining and documenting education/training, clinical competency, and a process for documenting the individual’s demonstration of knowledge, skills, and ability related to management of patients during conscious sedation. Both evaluation and documentation of competence shall be done on an annual basis and within current and expected standards of nursing practice and within parameters established in manufacturer package inserts for medications used for conscious sedation.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Rick Garcia, Executive Director, Board of Nursing, 4052 Bald Cypress Way, Bin C07, Tallahassee, Florida 32399-3259
