APNA & AANA Joint Position: Ketamine Infusion Therapy

Ketamine infusion therapy has been shown to have antidepressive properties and is increasingly becoming used to treat psychiatric disorders, including major depressive disorder (MDD), bipolar disorder, treatment-resistant depression, and post-traumatic stress disorder (PTSD).  The American Association of Nurse Anesthetists (AANA) and the American Psychiatric Nurses Association (APNA) support a patient-centered, interdisciplinary approach to managing patients who suffer from psychiatric disorders and may benefit from ketamine infusion therapy.  Each organization recognizes the professional scope of practice and expertise of certified registered nurse anesthetists (CRNAs), psychiatric mental health registered nurses (PMH RNs), and psychiatric mental health advanced practice registered nurses (PMH APRNs). PMH RNs and PMH APRNs are collectively referred to as PMH Nurses. These professionals complement each other’s skills and knowledge in the assessment, management, and delivery of ketamine infusion therapy for appropriate psychiatric disorders with a focus on improved patient safety, outcomes, and general well-being.

CRNAs, PMH RNs, and PMH APRNs practice in accordance with professional ethics, scope and standards of practice, sound professional judgment, available evidence, interests of the patient, and federal and state law.  When adding new activities to their practice, CRNAs, PMH -RNs, and PMH-APRNs assure that the new practice is in accordance with professional scope and standards of practice, federal and state law, and facility policy.^1,2

Certified Registered Nurse Anesthetists (CRNAs)

CRNAs, as anesthesia professionals, are educated and qualified to administer ketamine for sedation and general anesthesia as well as ketamine infusion therapy for psychiatric disorders and chronic pain management.³

When administering ketamine for the treatment of psychiatric disorders, CRNAs collaborate with psychiatric-mental health professionals whose practice includes diagnosing mental health and psychiatric disorders within their professional and state scope of practice (e.g., PMH APRNs).

As part of the collaboration, CRNAs should obtain a referral or past medical records, including a psychiatric history, medication list, and diagnosis, prior to providing ketamine infusion therapy for psychiatric disorders. When treating a psychiatric condition, the CRNA should not perform an infusion without confirmation of a psychiatric diagnosis from a PMH-APRN, psychiatrist, or other qualified psychiatric-mental health professional.

The CRNA’s role in ketamine infusion therapy may include, but is not limited to, reviewing healthcare records; obtaining a health history; conducting a pre-infusion assessment and evaluation; ordering and evaluating diagnostic tests; ordering or prescribing medications; initiating, maintaining, titrating, and discontinuing the infusion; monitoring the patient; conducting post-infusion assessment and evaluation, and managing infusion-related adverse events or complications.^3,4

Psychiatric Mental Health Registered Nurses (PMH RN) and Advanced Practice Registered Nurses (PMH APRN)

PMH Nurses are educated and specialize in promoting mental health through the assessment, diagnosis, and treatment of behavioral problems, mental disorders, and comorbid conditions across the lifespan.⁵

PMH Nurses support individuals with treatment-resistant mental health disorders by: promoting and fostering health and safety; assessing dysfunction and areas of individual strength; maximizing individual strengths; preventing further disability; and assisting individuals to achieve personal recovery goals by managing symptoms and gaining, re-gaining, or improving coping abilities and living skills.⁵

PMH-APRNs work with individuals who may benefit from ketamine infusion therapy by collecting and synthesizing comprehensive health data and analyzing that data to determine diagnoses, problems, and areas of focus for care and treatment, including level of risk.  PMH APRNs incorporate knowledge of pharmacological, biological, and complementary interventions with applied clinical skills.  PMH APRNs utilize prescriptive authority, referrals, and procedures, treatments and therapies in accordance with applicable law.⁵

PMH Nurses structure and maintain safe, therapeutic, recovery-oriented environments in collaboration with healthcare consumers, families, and other healthcare clinicians.⁵ PMH Nurses collaborate with PMH-APRNs and/or CRNAs who, within their scope of practice, administer ketamine infusion therapy for mental health disorders.³

Supporting Resources

• Ketamine Infusion Therapy Treatment Considerations Checklist (APNA)
• Ketamine Infusion Therapy for Psychiatric Disorders and Chronic Pain Management, Practice Considerations (AANA)
• Ketamine Infusion Therapy Checklist (AANA login required)

References

1. Considerations for Adding New Activities to Individual CRNA Scope of Practice. Rosemont, IL: American Association of Nurse Anesthesiology; 2021.
2. Ballard K, Haagenson D, Christiansen L, et al. Scope of Nursing Practice Decision- Making Framework. J Nurs Regul. 2016;7(3):19-21.
3. Scope of Nurse Anesthesia Practice. Rosemont, IL: American Association of Nurse Anesthesiology; 2020.
4. Standards for Nurse Anesthesia Practice. Rosemont, IL: American Association of Nurse Anesthesiology; 2019.
5. American Psychiatric Nurses Association. (2022). Psychiatric-mental health nursing: Scope and standards of practice 3rd Edition. Silver Spring, MD: American Nurses Association.

Adopted by the APNA Board of Directors June 2019; Revised June 2023
Adopted by the AANA Board of Directors August 2019; Revised August 2023