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  • 1.  MA drawing up Joint injections for provider

    Posted 22 days ago

    Any advice pro and con appreciated. We have a busy musculoskeletal clinic, within our family practice setting. A busy provider that performs many joint injections has requested that we consider training and adding a  responsibility for the MA's that work in this clinic. This would include drawing up the steroid and local anesthetic. This would be a double check with the provider. I have seen MA's perform this task under the supervision of the provider in dermatology offices, but this is usually one medication, not the mixing. Where do I begin to look for guidelines?



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    Joan Brewer
    MSN, RN Senior Director Clinical Operations
    Billings MT
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  • 2.  RE: MA drawing up Joint injections for provider

    Posted 21 days ago

    Hi Joan, this has been a debate at several organizations that I have worked for, and I have seen this come up in the forums many times. It might make sense to consult with your pharmacy department on their policy on compounding, which is what you are describing. At my current organization, we do not allow our MA's to compound due to the complexity of the task and the risk associated with compounding incorrectly. I would think if your pharmacy department is OK with allowing them to compound, they should be involved with creating the teaching and competency demonstration for the staff who are doing the compounding. That is just my perspective from an education and risk standpoint. 



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    Torie Bonnet MSN RN NE-BC NPD-BC
    Associate Director of Nursing
    Piedmont Health
    Raleigh NC

    bonnett@piedmonthealth.org
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  • 3.  RE: MA drawing up Joint injections for provider

    Posted 21 days ago

    Hi 
    We are too looking into this from a legal and pharmacy law perspective as it pertains to scope within our organization. What you are describing is USP 797 Compounding for immediate use. I agree with the other responder that you should involve pharmacy colleagues/leadership and also look at your state pharmacy law. We are examining this closely at this time and are probably going to move towards only licensed, competent clinical team members. USP 797 has a lot of requirements that need to be in place for Immediate Use Compounding (lean into pharmacy). 

    interested to continue to learn what other organizations are doing ? Centralization (pharmacy tech under pharmacy over site, RNs only ? LPNs? Athletic trainers ? ) 

    Thanks so much for posting 



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    Margaret Beckner, MSN, RN
    Administrator, Nursing Projects
    IU Health Medical Group, Indy Metro Region
    Indianapolis, Indiana
    317-709-1282 mbeckner@iuhealth.org
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  • 4.  RE: MA drawing up Joint injections for provider

    Posted 21 days ago

    Thank you Margaret. I found your advice helpful. We will be working with our pharmacy team.

    Joan



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    Joan Brewer
    MSN, RN Senior Director Clinical Operations
    Billings MT
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  • 5.  RE: MA drawing up Joint injections for provider

    Posted 21 days ago

    Hello Joan,

    Our organization allows for MAs to compound joint injections for providers. We require a double check and labeling per pharmacy regulations. I have two documents I can share that outline what clinical staff can prepare, what requires a double-check, and who is responsible. I can also share our document for labeling of medications that are prepared and then administered by another.

     

     

    Thank you,

     

    Sharon J.J. Peacock, MSN-Ed., RN, AMB-BC

    Professional Development Generalist, Sentara Ambulatory Services Division

    Chair, AAACN Staff and Patient Education SIG

     

    Office: 434-654-4529    Email: SJPEACOC@sentara.com

    590 Peter Jefferson Parkway, Suite 323, Charlottesville, VA 22911

     

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  • 6.  RE: MA drawing up Joint injections for provider

    Posted 21 days ago

    Thank you Sharon. I appreciate the guidance and the forms.

    Joan



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    Joan Brewer
    MSN, RN Senior Director Clinical Operations
    Billings MT
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  • 7.  RE: MA drawing up Joint injections for provider

    Posted 14 days ago

    I would love information regarding this work.  Our state does not allow compounding but we have had a consultant say we need to look at our staffing mix. Thank you. 



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    Joanie Jeannette ANO
    Associate Nursing Officer, Ambulatory Nursing
    VUMC
    Nashville TN
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  • 8.  RE: MA drawing up Joint injections for provider

    Posted 14 days ago
    Hello all,
    After careful consideration we have determined that our MA's will not be compounding any medications in our clinic settings. Montana is pretty liberal about what an MA can do under the providers' license, so this was not the barrier.  Understanding how this falls under Pharmacy regulations also, and that we do not have the capacity to supervise this task, we chose not to add this. We also looked at the responsibility of a provider and licensed professional responsibilities and felt this was not appropriate to delegate. The most important factor was patient safety. With constant shortages of medications, there is always the possibility for the use of multi-dose vials. The safety techniques used in the drawing up of medications, the order of medications drawn up, and the possibility of medication substitutions, we felt there was too much risk in our clinics to assure that all MA's have the training and capacity to do this safely. I must admit that I have enjoyed the process to investigate how to consider adding a responsibility to any role in the clinic setting.

    Joan Brewer, MSN, RN

    Senior Director of Clinical Operations

    Community Health Centers

    RiverStone Health
    123 South 27th St. Billings, MT 59101
    Office: 406.247.3295

    Cell: 406.861.2678

     Joan.bre@RiverStoneHealth.org

    RiverStoneHealth.org

     

    Our Mission is to Improve Life, Health, and Safety