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I strongly suggest that this training be done with only preloaded injections
prepared by a pharmacy or pharmaceutical supplier with a prepared heparin
like Lovenox. And even then it comes in the following doses:
-Pre-filled Syringes 30 mg / 0.3 mL, 40 mg / 0.4
mL
-Graduated Pre-filled Syringes 60 mg / 0.6 mL, 80 mg / 0.8 mL,
-Multiple-Dose Vials 100 mg / 1 mL, 300 mg / 3.0
mL
Multi dose heparin USP comes in 10 u / ml, 100 u / ml, 1000 u / ml, 5000 u /
ml, 10,000 u /ml
I have personally received the wrong multi dose vile of heparin from a
hospital pharmacy more than once. If that error is not picked up by the
individual preparing the injection the outcome could be a bleed or a clot.
I would proceed very carefully and have a tight QA program in place.
_____
From: owner-beas-crma@lists.state.me.us
[mailto:owner-beas-crma@lists.state.me.us] On Behalf Of Mauro, Peter
Sent: Thursday, June 02, 2005 2:42 PM
To: 'ConsultingRN@aol.com'; beas-crma@lists.state.me.us
Subject: RE: beas-crma Injections
-----Original Message-----
From: owner-beas-crma@lists.state.me.us
[mailto:owner-beas-crma@lists.state.me.us]On Behalf Of ConsultingRN@aol.com
Sent: Thursday, June 02, 2005 8:11 AM
To: beas-crma@lists.state.me.us
Subject: beas-crma Injections
Good morning,
My name is Linda Reed and I am an RN consultant for several assisted living
facilities in the Lewiston area. I am in the midst of trying to resolve a
dilemma that I hope someone can help with. I understand that in the past,
some of you may have had some discussion with the board of nursing in
regards to training and supervising direct care workers &/or CRMAs in
regards to performing nursing tasks.
Currently, I consult (training only) for an agency who serves an individual
who needs daily anticoagulant injections. Maine care will no longer pay for
home health and wants the staff to give the injection. (Thus, the agency
would like me to train the staff.) Licensing has stated that the agency can
request a waiver from the regulation that a CRMA may not [Mauro, Peter]
There is no waiver in place for this type of medication administration. I
am not sure who in licensing told you this. If this is a SC medication,
then under 7.16 (in Level IV, may be different in other levels) the
regulations give an RN permission to teach techniques, methods that are
under Chapter 6 of the BON rules. The board of nursing does not regulate
CRMA, but by putting in Chapter 6, is where they authorize RNs to do this
coordination and oversight administer injections except bee sting kits and
insulin (after additional training). Everyone at the licensing level seems
OK with all of this????? I seem to be the only one who is apprehensive.
Licensing suggests that there are several facilities who are currently doing
these types of injections.[Mauro, Peter] What we do recommend under this
7/16 is as long as the RN feels that the person being taught is competent
enough to be taught and competent enough to carry through once being taught.
We also recognize that no all nurses are willing to do this teaching.
My question is, has anyone been in this situation? How was it handled? Did
the State Board of nursing address this issue? If so, what was their
recommendation? I appreciate any feedback you have.
Linda Reed, RN
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