Authority to use automated external defibrillators (AEDs)
What should nurses consider when applying an automated external defibrillator (AED)?
The use of this device falls under a controlled act (“applying or ordering the application of a form of energy”) in the Regulated Health Professions Act, 1991. It is not one of the controlled acts authorized to all nurses.
However, nurses may perform the act of applying a form of energy in one of two scenarios:
- Through delegation: when someone authorized to perform the act can transfer the authority to a nurse or nurses through a delegation process or
- Through the emergency exemption: when providing first aid or temporary assistance during an emergency.
The nature of the practice environment determines which option is the most appropriate. Whether the emergency exemption applies depends on the characteristics and the needs of the client(s), the expected occurrence of unpredictable events, and the types of services that the setting provides. Whoever has the decision-making authority within the practice environment must identify which option is appropriate.
If the emergency exemption does not apply, the nurse would require delegation and an order to apply the AED. For more information about the requirements for accepting delegation please see our Scope of Practice document. An order can be either a direct order or a directive. As with any procedure, having the proper authorizing mechanism in place does not mean it is always appropriate to perform the procedure.
Whichever option is chosen, nurses are held to the same expectations when applying an AED as they are when performing any procedure. These expectations include:
- Nurses are accountable for the decision to perform the controlled act and for its performance.
- Nurses must consider the client’s needs and best interests, and determine whether the client’s condition warrants the performance of the procedure.
- Nurses must have the knowledge, skill and judgment to perform the procedure safely, effectively and ethically.
- Nurses need to ensure that the practice environment has the appropriate resources to perform the procedure safely and manage reasonably expected outcomes. (For example, a nurse must consider that defibrillation is only one component in the continuum of care required during a cardiac arrest.)
- Nurses are accountable for participating in all aspects of the assessment and management of the procedure and its outcomes. They are also responsible for documenting this information.