St. Mark's Hospital - November 01, 2016

Effective immediately, the Nurse Administered Propofol Sedation (NAPS) protocol for moderate sedation may only be performed in HCA hospital facilities when both the physician and the nurse have completed current approved initial training with annual renewals. For physicians, documentation of current NAPS training must be submitted to the St. Mark's Hospital Medical Staff Office prior to engaging in NAPS. Current NAPS training received at one of our Utah-based HCA outpatient surgery centers using the WEC (Wasatch Endoscopy Center) standard process meets this documentation requirement. The physician must also hold current privileges for procedural sedation.

This new policy does not apply to patients on mechanical ventilation receiving an intravenous propofol drip. This policy does not apply to anesthesiologists.

Physicians holding privileges in procedural sedation, but WITHOUT documentation of approved NAPS training, may use propofol for moderate sedation, provided the physician pushes the propofol. There are two very narrow exceptions:

  1. A registered nurse may push propofol for a physician with privileges in definitive airway management (as defined in the procedural sedation policy), but only for the sole purpose of facilitating endotracheal intubation.
  2. For an ordering physician with privileges for BOTH procedural sedation and for definitive airway management, an advanced practice professional (APP: APRN or PA) whose delineation of privileges are documented in the Medical Staff Office as aligning with the ordering physician may push propofol under that physician's direct supervision (e.g. the physician in the room with the patient and the APP).

The NAPS protocol does not allow a nurse to administer other sedative agents in conjunction with propofol, however, a nurse may administer other medication combinations for moderate sedation (e.g. fentanyl / versed) as ordered by a physician with privileges in procedural sedation.

For physician-administered propofol, the physician orders the medication, then the nurse obtains the ordered medication from Pyxis and prepares it for intravenous administration. The nurse scans the medication. The physician pushes each dose of the propofol. The nurse documents the dose of medication as having been administered by the physician. The nurse wastes and documents the waste of any unused medication according to hospital policy. The physician documents the procedure.

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