We have been looking at the role of the LPN at our hospital. We have been specifically looking at Infusion Therapy (10.27.20.05 –C.) We would like clarification on what Direct Supervision means related to PICC, CVC and implanted ports for patients receiving TNP and Blood transfusions. If the RN is supervising the LPN with initiation of the TPN and Blood Transfusion can the LPN then monitor the patient or does the RN need to be with the LPN throughout the infusion?
Response: Thank you for contacting the Maryland Board of Nursing with a question about the roles of LPN and RN in infusion therapy, specifically for administration of blood and total parenteral nutrition.
You correctly identified COMAR 10.27.20 as the relevant chapter to research in determining the RN/LPN role in infusion therapy. That chapter of regulations actually does define "Direct Supervision" and I have pasted the pertinent section at the bottom of this response.
Additionally, here is a link to the entire chapter. It would be wise to read the entire chapter to get context for specific citations.
Please understand that practice decisions surrounding patient care and safety need to be based on evidence and support best practices that are more detailed and specific, as well as being updated more frequently, than regulations. Other sources of evidence to consider are position statements of relevant professional organizations, such as the Infusion Nurses Society, as well as your facility's polices. Hospital/agency policy and procedure must support the minimum standards put forth in board regulations but may be more stringent, and certainly may be more detailed than the regulations. For example, your facility may have a definition of "direct supervision" that is more restrictive than the regulatory definition. Please understand that board staff do not interpret regulations or speak to facility/agency policies. The consideration of board regulations is but one piece of evidence upon which to make crucial patient safety decisions in the area of infusion therapy. I encourage you to work with your agency's nursing leaders to resolve these questions and develop evidence-based policies that support patient safety.
(9) Direct Supervision.
(a) "Direct supervision" means oversight exercised by a registered nurse who is present on the unit of care during the infusion therapy process.
(b) "Direct supervision" includes the actions of:
(iii) Evaluation; and