Section 1300.370  Provision of Conscious Sedation by Registered Nurses in Ambulatory Surgical Treatment Centers

a)         In accordance with Section 6.7 of the Ambulatory Surgical Treatment Center Act [210 ILCS 5], nothing in that Act precludes a registered nurse from administering medications for the delivery of local or minimal sedation ordered by a physician licensed to practice medicine in all of its branches, podiatrist or dentist.

b)         If the ASTC policy allows the registered nurse to deliver moderate sedation ordered by a physician licensed to practice medicine in all its branches, podiatrist or dentist, the following are required:

1)         The registered nurse must be under the supervision of a physician licensed to practice medicine in all its branches, podiatrist or dentist during the delivery or monitoring of moderate sedation and have no other responsibilities during the procedure.

2)         The registered nurse must maintain current Advanced Cardiac Life Support certification or Pediatric Advanced Life Support certification as appropriate to the age of the patient.

3)         The supervising physician licensed to practice medicine in all its branches, podiatrist or dentist must have training and experience in delivering and monitoring moderate sedation and possess clinical privileges at the ASTC to administer moderate sedation or analgesia.

4)         The supervising physician licensed to practice medicine in all its branches, podiatrist or dentist must remain physically present and available on the premises during the delivery of moderate sedation for diagnosis, consultation and treatment of emergency medical conditions.

5)         The supervising physician licensed to practice medicine in all its branches, podiatrist or dentist must maintain current Advanced Cardiac Life Support certification or Pediatric Advanced Life Support certification as appropriate to the age of the patient.

c)         Local, minimal and moderate sedation are defined as follows:

1)         "Local Anesthesia" is numbing medication injected into the skin or other surface at the site of the procedure.  The injection is usually near the surface, but may be deeper in some cases.  The total dose of local anesthesia does not exceed 50% of the commonly accepted toxic dose on a weight adjusted lean body mass basis.

2)         "Minimal Sedation" (anxiolysis) is a drug-induced state during which patients respond normally to verbal commands.  Although cognitive function and coordination may be impaired, respiratory and cardiovascular functions are unaffected.

3)         "Moderate Sedation Analgesia" (conscious sedation) is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation.  No interventions are required to maintain a patient airway and spontaneous ventilation is adequate.  Cardiovascular function is usually maintained.

d)         Registered nurses shall be limited to administering medication for moderate sedation at doses rapidly reversible pharmacologically.  [210 ILCS 5/6.7(c)] Acceptable medications are opioids, benzodiazepines and reversal agents:  Meperidine, Fentanyl, Diazepam, Midazolam, naloxone and flumazenil.  Nothing prohibits RN from monitoring or adjusting an FDA approved delivery device under the supervision of a physician.