saline nebulizer

calling all you Rn's out there. Is giving a patient a saline nebulizer beyond our scope of practice?? I work in a very busy ER where RNs give nebs without any respiratory around. We teach the patients how to use MDI's. We charge the patients an RT therapy charge.

This has come to my attention that it is beyoind my scope of practice. what do you all think?
Do you have an physician order or is there a protocol in place for the saline nebs (such as administering humidified O2 via mask)?

no nothing. this is a very busy division of the ED with no respiratory therapist and we do our own nebs. the only protocol in place is for respiratory distress and this allows for 02. nothing in place for saline neb blow by. My question is do we need a MD order for this??

For you to be able to do a charge with nebilized saline as a treatment, you should have the appropriate order from a physician with the specific concentration and indication for the saline. Depending on the RT code, you may also have to meet the CMS guidelines if the code falls within a "therapy" with appropriate documentation. If it is just for the equipment or medication then no problem. However, if saline is used as a "treatment", it is consider a medication and should be documented as such. You might also check your policy for initiating a "treatment". Saline is used as a treatment in some patients but usually with higher concentrations of saline. Sometimes a heated 0.9% saline neb will be used but with a specific order for indication and time. The benefits of a 5 minute 0.9% NaCl neb without additional medication is controversial. You should have good documentation with an order for this if you are charging with a med or therapy code or even the nebulizer equipment. For humidification with oxygen, including blow by, sterile water is used. The standard nasal cannula O2 humidifier charge may be included in the O2 setup code or a separate one from the supply.

If you require an order for O2....which you do...you need an order for the O2 saline blow by. Administering blow by 02 in an ED with saline is standard treatment on pedi patients as they are much more willing to tolerate blow by versus mask. Cool mist treatments are common to administer supplemental 02 in the ED but irt requires an order just like any other 02.Beyond your scope of practice? NO.....who told you that? Check your ED triage/policies and procedures for resp. distress and 02 administration I'm sure you'll find it there if not then you need to make a policy but beyond your scope of practice.....NO it is well within your scope to give O2.

Quote from Esme12If you require an order for O2....which you do...you need an order for the O2 saline blow by. Administering blow by 02 in an ED with saline is standard treatment on pedi patients as they are much more willing to tolerate blow by versus mask. Cool mist treatments are common to administer supplemental 02 in the ED but irt requires an order just like any other 02.

If it's used for the purpose of a medical treatment then you do need an order, if it is for patient comfort then you do not as long as it does not significantly alter normal body processes.Whether or not something is a medication or drug is defined by it's purpose or action, not by the substance. IV NS is sometimes a medical treatment, and therefore requires an order, and sometimes used for maintenance of an IV, such as flushes which actually do not require a physicians order. Although it's a widely held myth, you don't need an order for things like lidocaine jelly for foley insertion either, since it's purpose is for patient comfort, not to diagnose or treat a medical condition or disease process.