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Don,
Our home does not have PSS's, we are on the exempt list. We have the RCS course.
The initial concern was the change in direction without a sign of it coming. As you can see by the responses of some other instructors, teaching anything but insulin and bee sting seems to come as a surprise. We have used home health before without denial of payment or an implication that CRMA's could do the task. Something seems to have changed.
Regarding what I teach...I follow the state's curriculum, which does not cover the specifc injection techniques, as I understand it. The CRMA's are taught Diabetes education, including insulin injections, seperately after they get their certificates. If I had a choice, I would not teach CRMA's to give insulin.
Obviously, we can go round and round on this, when does observing for signs and symptoms become an assessment?
It comes down to what the individual RN feels comfortable with doing. Our comfort levels are different.
My CRMA's are good at what they do, and take excellent care of the residents, they are educated and capable. They are not medical providers, they are taught signs and symptoms of many drugs, treatments and illnesses, but they don't have the big picture that A&P, med/surg, microbiology, etc gives us.
Dialogue isn't criticism. It is in my nature to question. It is how I expand my horizons.
Kathleen
----- Original Message -----
From: Djgam100@aol.com
To: voodoosgirl@midmaine.com ; Peter.Mauro@maine.gov ; Dgrass@gwi.net ; Beas-crma@lists.state.me.us
Sent: Monday, December 13, 2004 10:58 PM
Subject: Re: beas-crma Fw: sub-cutaneous injections
Kathleen,
I am not sure where you are going with this question. If you feel uncomfortable teaching a CRMA to give this Medication, then don't do it. This is not a delegation issue it is a "Coordination and Oversight" issue. There are certainly more serious side effects to Epinephrine and Insulin than you indicate, seizures, status epilepticus, cardiac arrest, renal failure, etc. to name a few . What does it matter who gives the injection of Levonox? If the most severe of side effects are going to occur it is going to occur regardless of who gives the injection. Are the PSS's in the home taught to observe and report for the signs and symptoms of hemorrhage? Are the CRMA's? What is the benefit of having the RN give the injection if s/he is not there 24/7 to assess the resident? If they were there 24/7 what more could they do than call 911 for assistance? The same that a CRMA would do if the oversight and coordination from the RN were there. Also I have to ask, should the CRMA's not be allowed to give Coumadin or Plavix because they could cause hemorrhage?
Don
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