Open Forum

Propofol falls within the scope of the CRNA as anesthesia. This is not within the scope of the RN. 

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Amy Cadoret MHA MSN NEA-BC AMB-BC
Associate Nursing Officer
Vanderbilt Center for Women's Health
Co-Chair DEI committee AAACN
Murfreesboro TN
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Good morning Tanya!

This is a no from me. I'm not in a dental clinic but have worked in and provided nursing professional development for procedural areas (including staffing in the cardiac cath lab) where we administered moderate sedation. Are those nurses providing other sedation medications and monitoring moderate sedation? Even if they are doing that it'd still be a no from me. 

A few reasons why this gets a quick no- Are your nurses have age appropriate advanced life support certification (ACLS/PALS)? Would someone else be available to do all of the other nursing tasks while the nurse administering sedation and monitoring the patient performed those skills (sedation/monitor should have no other tasks that could distract them from that role). What capacity is there to resuscitate a patient who has an adverse event? 

Even if they are administering moderate sedation, it is too easy to move from moderate sedation to deep sedation on the anesthesia/sedation continuum. Due to this, Propofol is under the scope of the CRNA or other providers. 

https://pubs.asahq.org/anesthesiology/article/128/3/437/18818/Practice-Guidelines-for-Moderate-Procedural?_ga=2.197229871.1679405480.1714046114-361363124.1714046114&_gl=1*1rj0ez7*_ga*MzYxMzYzMTI0LjE3MTQwNDYxMTQ.*_ga_WXJRGHB075*MTcxNDA0NjExNC4xLjAuMTcxNDA0NjExNC42MC4wLjA.

https://www.jointcommission.org/standards/standard-faqs/ambulatory/provision-of-care-treatment-and-services-pc/000001645/

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Andrea Kelly MSN, RN, NPD-BC
Director, Population Health
ECU Health Physicians (formerly Vidant Medical Group)
Greenville NC
(252)847-3930
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I don't have experience in the context of the dental clinic, but I will add that I spent years as a pediatric ICU nurse in PICUs in 2 different states and the RNs did manage propofol drips in ICU patients, but it was a scope of practice allowance ONLY in the ICU setting in mechanically ventilated patients. This is likely an unsafe practice in an outpatient dental clinic, but outside of the opinions in this group, this really should be a question directly to you state board of nursing. Our system's propofol policy has direct verbiage from our State BON

Georgia Nursing Practice Act:
Georgia Position Statement: Administration of Propofol, Etomidate and Neuromuscular Blocking Agents
Procedural Sedation It is not within the scope of practice of the registered nurse (RN) who is not a Certified
Registered Nurse Anesthetist (CRNA) to administer agents used primarily as anesthetics for sedation, including
Propofol (American Association of Nurse Anesthetists – American Society of Anesthesiologists Joint Statement
Regarding Propofol Administration, 2004). This would include the non-intubated patient undergoing procedures,
including but not limited to, invasive cardiology, invasive radiology, endoscopic gastrointestinal procedures,
invasive bronchoscopy and emergent procedures.
Intubated and Mechanically Ventilated Patients in Critical Care Settings It is within the scope of practice for the
registered nurse (RN) to administer intravenous Propofol to the intubated, mechanically ventilated patient in
continuous and bolus dosing, for ongoing sedation/analgesia within the Critical Care setting.

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Brandy Williamson MSN RN CPN
Director, Ambulatory Nursing, Quality and Education
Children's Healthcare-Atlanta
Atlanta GA
(404)785-8978
brandy.williamson@choa.org
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