I get a lot of questions concerning the ability of nurses to administer agents of deep sedation. I have put together my conclusion based on the following citations from CMS. Be aware that some states have written into the nurse practice act that RNs may not administer agents of deep sedation, or “non-reversable” agents for sedation purposes. My conclusion is, based on the actual CMS COP, that nurses may not administer these agents for the purpose of sedation. Actually, based on CMS, one would wonder if RNs could even MONITOR patients. By the way, supervision of nurses is not even addressed by CMS, so therefore the “supervision” aspect would be irrelevant. Be aware that whether something is Deep Sedation or MAC depends on the manufacturer’s definition of the drug.
482.52 Condition of Participation: Anesthesia Services
Monitored anesthesia care (MAC): anesthesia care that includes the monitoring of the patient by a practitioner who is qualified to administer anesthesia as defined by the regulations at §482.52(a). Indications for MAC depend on the nature of the procedure, the patient’s clinical condition, and/or the potential need to convert to a general or regional anesthetic. Deep sedation/analgesia is included in MAC.
§482.52(a) Standard: Organization and Staffing
Anesthesia must be administered only by —
(1) A qualified anesthesiologist;
(2) A doctor of medicine or osteopathy (other than an anesthesiologist);
(3) A dentist, oral surgeon, or podiatrist who is qualified to administer
anesthesia under State law;
(4) A certified registered nurse anesthetist (CRNA), as defined in §410.69(b) of this chapter, who, unless exempted in accordance with paragraph (c) of this
section, is under the supervision of the operating practitioner or of an anesthesiologist who is immediately available if needed; or
(5) An anesthesiologist’s assistant, as defined in Sec. 410.69(b) of this chapter, who is under the supervision of an anesthesiologist who is immediately available if needed.
Based on the above, it would also appear that Nurse Practitioners or Physician Assistants may also not administer deep sedation.