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New Questions:

Licensed Personnel
Double-checking Certain Medications During Procedures
I work in a university-based hospital electrophysiology lab. We have a policy that requires 2 licensed persons to check certain medications prior to administration (e.g., heparin, insulin, chemotherapeutics, etc.) The policy arbitrarily states that these licensed practitioners may be a RN, MD, or resp. therapist. We would like to add the rad tech [RT(R)] as well. Frequently, during a “late” case, there may only be 1 RN, 1 MD, 1 rad tech and 1 CVT in the procedure room, and the MD would be scrubbed. It seems unreasonable to expect the MD to break scrub to sign off on a bolus of heparin during an atrial fibrillation ablation. We are planning to check scope of practice for RT(R) in our state and the hospital job description. Also would provide an annual medication competency.
I would like to add that the issue is not just visually checking the medication dose, but actually co-signing on the patients’ record at the time the dose is given — therein lies the issue. Any thoughts?
— Karen Wright, RN, BSN, BS, Elec Eng., MUSC
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Staffing Guidelines
Are there any set staffing guidelines for the EP lab? I realize some states require an RT to be in the room, but what about the number of RNs in the lab?
— Steven Fultz, RN, CAMC, Charleston, WV
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Under Discussion:

Credentialing and Education for EPs
Do you think there should be a credentialing exam for electrophysiology technologists, analogous to the RCIS examination? Also, in your opinion, is there a need for formal education programs for electrophysiology?
— Letitia P. Esbenshade-Smith, Staff Educator, Cardiac Electrophysiology
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I know of several people with 20 to 30 years of trained experience and not RCIS credential that now work in the EP program at our hospital. Formal education would be a great idea, separate from the RCIS exam. Other than online teaching (courses) that are available, there are no formal educational programs that I am aware of that exist.
— name withheld by request

Absolutely, on both notes. With the ongoing scrutiny of healthcare facilities by organizations such as JCAHO, I believe there has been an increased emphasis placed upon credentials for staffing as a means of ensuring qualified personnel. This can be demonstrated by the growing number of cath labs around the country that require the RCIS credential. I feel that HRS should have promoted the NASPExAM long ago as the EP Registry. However, for reasons known only to them, they have not done so. As for formal education, if the cath lab requires a unique subset of skills worthy of a formal program (which it does), then why not EP?
— anonymous

I think the NASPE (HRS) exam needs to carry more weight within the healthcare industry. Also, I know that in our area, most of the EP training is on-the-job. I think that formal education programs are needed not only for people interested in working in EP, but for the nurses caring for our patients on the floors. Most nurses have very little if any knowledge of EP.
— name withheld by request

Other Questions:

Practice Protocols
Is there a preprinted practice protocol reference for new trainees?
— anonymous
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Multiple Cardioversions, Same Session
How would you bill for multiple external cardioversions, same patient, same physician, same session? Can you only assign CPT code 92960, no matter how many times it takes to convert the patient?
— anonymous
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Finding a Buyer
Our EP lab is planning to install a new 3D mapping system next week and would like to know if there are any emerging EP labs that might be interested in a gently used, fully functional Medtronic LocaLisa. I have no idea where to post something like this or how to make contact with labs who might be interested. I hate to see it collecting dust in a closet when a new lab could benefit from the equipment and the low cost of buying it used. Any ideas would be appreciated.
— Sharon Purkis, MBA, VP Cardiovascular Services
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Pay for CVTs
Is there a database or has anyone done a study for the pay ranges for CVTs working in the EP lab? I am not able to find out the pay scales for the Midwest and what responsibilities/job descriptions the CVTs are accountable for. Many labs in the Michigan area have RNs, RVCTs, RCISs, and CVTs working the labs. Any help or direction would be appreciated.
— Patricia from St. John Health System
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