Role of the LPN in Intravenous Therapy Practice: CAD Pump and PCA Bolus

An opinion was requested on the role of the LPN in intravenous therapy practice.  Specifically:

1. Can a LPN adjust the “CAD” pump rate if there are orders to titrate/increase the dosages every hour until the patient is comfortable?  There is a triage RN available for consultation. The LPN can call the RN with a review of the symptoms and adjust the dosage based on the RN's recommendation.
   
   
2. Can a LPN administer a bolus if the patient has a pre-programmed pump that allows a certain amount of medication every 15 minutes and has a lockout of 3-4 per hour?

The Board of Nursing approved revisions to 201 KAR 20:490, LPN IV Therapy Scope of  Practice, that will permit the LPN to titrate intravenous analgesic medications for hospice patients in the future.  The proposed changes in the regulation became effective September 2006.  The revised regulation is posted on the KBN website.   
 
Following discussion of the questions posed, and the statutes governing nursing practice, it was the advisory opinion of the Board that a nurse may titrate/increase medication dosages only as prescribed for the patient.  A LPN may adjust the intravenous infusion pump rate as prescribed.  Following the effective date of the proposed changes to 201 KAR 20:490, the LPN with the requisite educational preparation and current clinical competency may titrate, as prescribed, analgesic medications for hospice patients.

Patients who are receiving analgesia via a Patient Controlled Administration (PCA) system should only receive medication when the individual patient is able to self-administer/push the button.  A nurse may administer a bolus dose if an order has been obtained for a “nurse activated bolus dose,” but the nurse should not push the button for the patient.