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Resolved Hospital ED Procedures - Laceration Repair - Suturing by a LPN

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KellyM_22934

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Patient arrives to an ED in Ohio (adding this info for scope of practice research if needed) and needs a laceration repair. The LPN documents a single laceration to the left dorsal surface of the thumb was completed. Depth is subcutaneous, length is 1.5cm and the shape is linear. Closure: nailbed closed with 5-0 Plain Gut #5 simple interrupted sutures, Intermediate wound repair complexity. This procedure was directly supervised by another LPN.

For the hospital component, can the CPT code for the lac repair be reported since it was completed by an LPN with oversight from another LPN?
 
The information you provided is specific to NP's. I am asking about nurses and LPN's in the hospital ED setting.

"For the hospital component, can the CPT code for the lac repair be reported since it was completed by an LPN with oversight from another LPN?"
 
The information you provided is specific to NP's. I am asking about nurses and LPN's in the hospital ED setting.

"For the hospital component, can the CPT code for the lac repair be reported since it was completed by an LPN with oversight from another LPN?"

No, I do not think an LPN can supervise another LPN it must be by an RN or physician but it can vary by the state it seems.

Teaching nursing tasks to licensed practical nurses and individuals to whom the licensed practical nurse is authorized to delegate nursing tasks as directed by a registered nurse.” 3 October 2019 LPNs have a "dependent" practice, which means the LPN is authorized to practice only when the practice is directed by a registered nurse or any of the following who is authorized to practice in this state.



LPN Scope of Practice in all steps of the nursing process is limited and focused because, by law, it is a dependent and directed scope of practice. LPN practice requires assignment or delegation by and performance under the supervision, orders, or directions of a registered nurse (RN), physician, dentist, or other person authorized by State law to provide the supervision. LPNs implement health care plans developed by the RN and/or by any person authorized by State law to prescribe such a plan.

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SCOPE OF PRACTICE DECISION TREE FOR RN AND LPN
RN and LPN scopes of practice are defined by the Nursing Practice Act (Law). Because the roles and responsibilities of nurses are influenced by the healthcare system which is ever-changing
and increasing in complexity, it is important that the nurse makes valid, reliable decisions regarding his/her own scope of
practice. This tool is intended to provide direction in that decision making process. These questions offer additional
guidance for the nurse’s consideration.
I. Define the Activity/Task
a. Describe, clarify the problem/need.
b. Does it require a healthcare provider’s order?
c. Is the activity an independent RN action?
d. Does the task require an RN or other practitioner’s direction?
e. What is the clinical environment in which the task will be completed?
f. What will be needed to safely complete the activity?
g. Who should be involved in the decision?
II. Legality
a. Could the nurse perform the activity or task and meet the standards of safe nursing practice as defined by
NC nursing laws and rules?
b. Is the task prohibited by nursing law or rules, or precluded by any other law or rule (e.g., Pharmacy Practice
Act, Medical Practice Act, Facility Rules, etc.?)
c. Does the facility have a policy in place including the RN and/or LPN as appropriate to complete the activity?
d. Is the activity consistent with pre-licensure, post basic or approved continuing education?
e. Is there evidence to support that the activity is within acceptable and prevailing standards of safe nursing
care (i.e., national nursing organization/association standards, nursing literature/research, agency
accreditation standards, board position statement, and/or community standard)?
III. Competency
a. Is there documentation the nurse has completed appropriate education to perform the activity?
b. Is there documentation the nurse has demonstrated appropriate knowledge, skill and ability to complete the
activity?
IV. Safety
a. Is the activity safe and appropriate to perform with this patient/client at this time?
b. Is the activity safe and appropriate to perform only in specific environment where necessary assistive
equipment and personnel will be available in case of an unexpected response to assure patient safety and
quality of care?
c. What is the potential outcome for patient if you do or do not perform procedure?
V. Accountability
a. Is the nurse willing to be accountable for the activity?
b. Is the nurse prepared to accept the consequences of activity?
c. Would a reasonable or prudent nurse complete the activity?
VI. Additional considerations for LPN
a. Will adequate RN supervision be available?
b. Does activity have potential to significantly change the medical status of patient/client, resulting in the need
to provide assessment and care requiring a different level of professional licensure?
 
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