On July 10, 2020, the South Carolina State Boards of Nursing, Medical Examiners, and Pharmacy released a joint advisory opinion regarding the administration of low-dose ketamine by nurses in the acute care setting for pain management purposes. Ketamine for sedation or anesthesia were not considered. The advisory opinion indicates that nurses in South Carolina may administer low dose ketamine infusions (using a locked pump) or may give low dose ketamine via IV push if they are in the ED or PACU (South Carolina State Boards of Medical Examiners, Nursing, & Pharmacy, 2020). The order for ketamine must originate from an attending physician and should involve a 48-72 hour stop date (South Carolina State Boards of Medical Examiners, Nursing, & Pharmacy, 2020). Patients must be monitored for side effects such as respiratory depression, hallucinations, nystagmus, and unresponsiveness (South Carolina State Boards of Medical Examiners, Nursing, & Pharmacy, 2020).

Three regulatory agencies were involved in issuing this advisory opinion: The South Carolina State Board of Nursing, the South Carolina State Board of Medical Examiners, and the South Carolina State Board of Pharmacy. All three agencies function to protect the public, but each has a slightly different focus (South Carolina Department of Labor, Licensing, and Regulation [SC LLR], n.d.-a). The Board of Nursing regulates the licensure of nurses, approves nursing schools, and handles the disciplinary process for nurses who fail to meet standards (SC LLR, n.d.-b). The Board of Medical Examiners also handles licensure and disciplinary action against licensed individuals, but for licensing physicians, physician assistants, and respiratory care practitioners, among others (SC LLR, n.d.-a). The State Board of Pharmacy “regulates the practice of pharmacy,” including the licensure of pharmacists and the certification of pharmacy techs (SC LLR, n.d.-c). Beyond licensure, the Board of Pharmacy also regulates anyone who distributes, sells, or manufactures drugs or devices in South Carolina (SC LLR, n.d.-c).

The advisory opinion of South Carolina regarding nurse administration of low-dose ketamine is slightly different from the advisory opinion released by the Arizona Board of Nursing (2020). The advisory opinion in Arizona was released by the Board of Nursing alone, rather than as a join opinion with other regulatory agencies (2020). In Arizona, nurses may give low-dose ketamine IV or intranasal for pain control, depression, and sedation (Arizona State Board of Nursing, 2020). However, if the ketamine were prescribed for moderate or deep sedation purposes, the nurse would need to consult a different advisory opinion (Arizona State Board of Nursing, 2020). Nurses may also administer low-dose ketamine as an IV bolus, as long as the unit has appropriate monitoring equipment for unintended sedation, and there is an ACLS/PALS certified provider available in the department (Arizona State Board of Nursing, 2020). In South Carolina, nurses may not give ketamine intranasally or via bolus, and only ED/PACU nurses may administer it via IV push (South Carolina State Boards of Medical Examiners, Nursing, & Pharmacy, 2020). The Arizona advisory opinion was more specific than South Carolina in that it defined the necessary education required for nurses to administer ketamine, as well as other terms used throughout the opinion (Arizona State Board of Nursing, 2020). The Arizona advisory opinion also included a section of cited references (Arizona State Board of Nursing, 2020).

 

References

Arizona State Board of Nursing. (2020). Advisory opinion: ketamine administration. https://azbn.gov/sites/default/files/2020-08/AO%20Ketamine%20Administration%20rev%205.2020.pdf

South Carolina Department of Labor, Licensing, and Regulation. (n.d.-a). South Caroline Board of Medical Examiners. https://llr.sc.gov/med/

South Carolina Department of Labor, Licensing, and Regulation. (n.d.-b). South Caroline Board of Nursing. https://llr.sc.gov/nurse/

South Carolina Department of Labor, Licensing, and Regulation. (n.d.-c). South Caroline Board of Pharmacy. https://llr.sc.gov/bop/

South Carolina State Boards of Medical Examiners, Nursing, & Pharmacy. (2020). Joint advisory opinion issued by the South Carolina State Boards of Medical Examiners, Nursing, & Pharmacy regarding the administration of low dose ketamine infusions in hospital settings, including acute-care, by nurses. https://llr.sc.gov/nurse/pdf/Low%20Dose%20Ketamine%20Joint%20Advi

sory%20Opinion%20Approved.pdf