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  • 1.  Medical Assistant giving IM Kenalog Injections

    Posted 09-11-2023 21:16

    I recently inherited a new clinic and this clinic was allowing the Medical Assistants to give IM Kenalog injections to patients of various doses 40 mg, 80 mg, 100 mg and 120 mg. The pyxis in the clinic has 2 different strengths of Kenalog 40 mg/ml in a 1ml vial or 40 mg/ml in a 5 ml vial. We have about 35 different specialty clinics staffed with both RN's and Certified medical Assistants. The guideline had always been that the medical assistant could not give any medication that had to have the dose calculated which is what this qualify as.

     

    Do you allow medical assistants to give medications like this where they would have to calculate how much needs to be given and draw up medications out of multiple vials to get the dosage you need or do you only allow RN's to do this?

     

    Kelly Clark MSN, MHA, RN-BC

    Ambulatory Services Manager II

    Neurology and Neursurgery Clinics

    Neurodiagnostics Lab

    Headache Fellowship Coordinator

    Johns Hopkins Bayview Medical Center

    301 Bldg, Suite 1201

    Baltimore, MD 21224

    Ofiice 410-550-1349

    Cell 443-980-2430

     



  • 2.  RE: Medical Assistant giving IM Kenalog Injections

    Posted 09-12-2023 06:35

    Hi Kelly,

    At our organization we only allow simple medication administration by the CMAs. We do not endorse CMAs making clinical judgement, which I believe calculating dosages falls under. We have a specific policy on scope of practice for CMAs and RMAs. Establishing this policy has helped our organization tremendously.

    Hope this helps!



    ------------------------------
    Torie Bonnet MSN OCN RN NE-BC
    Clinical Nurse Edu Specialist-Ambulatory Care
    UNC Health
    Raleigh NC

    torie.bonnet@unchealth.unc.edu
    ------------------------------



  • 3.  RE: Medical Assistant giving IM Kenalog Injections

    Posted 09-12-2023 07:28
      |   view attached
    Most state's Board of Medicine allow the medical assistant to perform unit dose injections such as vaccines and depots. There is no standardized curriculum for a medical assistant; so there is no assurance they have been taught the competencies required for independent decision making, such as medication calculations. 
    [Maryland .gov]

     10.32.12.03

    .03 Standards for the Licensed Physician Delegating to an Assistant.

    A. A licensed physician who delegates shall:

    (1) Evaluate the risk to the patient and the outcome of the delegated acts;

    (2) Delegate only those technical acts that are customary to the practice of the licensed physician;

    (3) Delegate only those technical acts for which the assistant has been trained;

    (4) Be responsible for the acts of the assistant; and

    (5) Supervise the assistant.

    B. The responsibility for the delegated act cannot be transferred from the delegating physician to another licensed physician without:

    (1) The expressed consent of the other physician; and

    (2) Informing the assistant.

    The State Board of Medicine in Maryland, allows (see attached ): 10.32.12.04

    (2) With on-site supervision:

    (a) Preparing and administering injections limited to intradermal, subcutaneous, and intramuscular (deltoid, gluteal, vastus lateralis) to include small amounts of local anesthetics;

    (b) Establishing a peripheral intravenous line; and

    (c) Injecting fluorescein-like dyes for retinal angiography; and

    (3) With direct supervision, injecting intravenous drugs or contrast materials.

    From my understanding, the regulation(s) do not specify or explicitly discuss whether the medication is prefilled, unit dose, or requires calculation. 

    Since nursing as a profession does not delegate such tasks to unlicensed personnel, you will need to determine who will be responsible (liable) for the medical assistant training and competencies. 



    ---------------

     

    Aleesa M Mobley PhD APN  (she/her/hers) Why Pronouns Matter

    Assistant Professor - Clerkship Director [Pain Management/Substance Use Disorder]

    Physical Medicine & Rehabilitation - Neuro Musculoskeletal Institute 

    Lippincott Procedures: Subject Matter Expert - Wolters Kluwer Publishing


    Rowan Medicine Bldg., 42 E. Laurel Rd, Ste 1700, Stratford New Jersey 08084 

    T: 856-566-7010 | F: 856-566-6956| C: 856-230-1229 

    mobley@rowan.edu | som.rowan.edu 


    Learning is not attained by chance, it must be sought for with ardor and attended to with diligence [Abigail Adams (1744 - 1818), 1780].
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    Attachment(s)

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    BOM-MD-10.32.12.04.pdf   208 KB 1 version


  • 4.  RE: Medical Assistant giving IM Kenalog Injections

    Posted 09-12-2023 11:47

    We only allow single dose prefilled syringe vaccine administration for our MAs and do not permit administration of anything that requires a calculation or even drawing up for that matter. Agreed that in this instance where multiple vials may be needed, medication calculation is a part of the process and this would fall in our nursing responsibilities, either RN or LPN.  



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    Brandy Williamson MSN RN CPN
    Ambulatory Nursing Manager
    Children's Healthcare-Atlanta
    Brookhaven GA
    (404)785-8978
    brandy.williamson@choa.org
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  • 5.  RE: Medical Assistant giving IM Kenalog Injections

    Posted 09-13-2023 12:39

    Hi Kelly,

    We recently added IM Kenalog injections to our CMOA scope. We also have vials with varying strengths of the medication; however in Epic, the order gives both the Mg and mL, so there is no calculation needed by the CMOA when drawing up the medication. They draw up and administer the exact dose as ordered in Epic by the provider.

    All of our CMOAs go through extensive education and competency validation prior to being allowed to administer medications and have oversight by the clinic. RNs and providers. Our nursing leadership group worked for 4+ years on the medication scope of service expansion for our CMOAs and the changes have been well received and successful thus far. I hope this provides some insight. 

    Thank you!

    Amy Brewer, MSN-Ed, RN
    Director of Ambulatory Nursing, Primary Care & Pediatrics
    UT Southwestern Medical Center, Dallas, TX 


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    Amy Brewer MSN BA RN
    Director of Ambulatory Nursing
    UT Southwestern Medical Center
    Carrollton TX
    (469)235-8822
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