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PA Bulletin, Doc. No. 98-1751




[49 PA. CODE CH. 21]

Epidural Medications in Intrapartal Practice

   The State Board of Nursing (Board) amends § 21.413 (relating to interpretations regarding the administration of drugs--statement of policy) to authorize a registered nurse in intrapartal practice to administer medications by means of epidural catheter or other pain relief device. The policy statement subject to this amendment authorized a registered nurse to monitor and administer medications by means of epidural catheter or other pain relief device in all settings other than intrapartal practice. In intrapartal practice the registered nurse could only monitor, but not administer medications by this means.

   The Board published the amendment as a proposed statement of policy at 27 Pa. B. 6475 (December 13, 1997). This publication contains the Board's rationale for the amendment and a list of the professional associations that commented to or corresponded with the Board before the Board issued its notice of proposed statement of policy.


   After the proposed statement of policy was published, the Board received two public comments. PennState Geisinger Health System supported the proposed change for the same reasons the Board offered in its proposed statement of policy. Allegheny University Medical Centers, Forbes Regional, opposed the proposal and voiced their support for the position of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). AWHONN opposed the change because it believes that epidural analgesia administered by a registered nurse to a pregnant woman posed a risk-management concern.

   The former Physician General of the Commonwealth suggested that the Board develop guidelines to ensure that the attending physician write the order for medication in such a way that the range of dosage would be limited. The Board believes that § 21.14(a) (relating to administration of drugs) already addresses this concern. This regulation requires a physician to specify the dosage for a drug which the physician orders.

   The Board adopts the proposed policy statement as a final statement of policy without change. The Board believes that a nurse working under the supervision of a physician and in accordance with institutional policies and protocols and acceptable and prevailing standards of nursing practice can administer medications by means of an epidural catheter safely to a patient in labor. Standards of practice for the administration of medication by epidural means are widely available and have been adopted by no fewer than 21 nursing associations including the American College of Nurse Midwives and the American Nurses Association. The adoption of the statement of policy would not require Allegheny University Medical Centers to change its approach to the administration of epidural medication.

Statutory Authority

   This statement of policy is implemented under section 2.1(k) of the Professional Nursing Law (63 P. S. § 212.1(k)) and 49 Pa. Code § 21.401 (pertaining to interpretations: scope of practice).

Fiscal Impact

   The amendment should have no fiscal impact and will not impose additional paperwork on the private sector, the general public and the Commonwealth and its political subdivisions.

Effective Date

   This statement of policy will take effect upon publication in the Pennsylvania Bulletin.


   (Editor's Note:  The regulations of the Board, 49 Pa. Code Chapter 21, are amended by amending § 21.413 to read as set forth at 27 Pa.B. 6475.)

   Fiscal Note:  Fiscal Note 16A-518 remains valid for the final adoption of the subject regulation.

[Pa.B. Doc. No. 98-1751. Filed for public inspection October 23, 1998, 9:00 a.m.]

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