Current through Register Vol. 50, No. 9, September 20, 2024
A.
Anesthesia services shall be available when surgical services are
provided.
B. Anesthesia services
shall be provided in a well-organized manner under the direction of an
anesthesiologist or the treating physician who is licensed and in good standing
with the State Board of Medical Examiners.
C. Anesthesia services and/or conscious
sedation shall be administered by licensed practitioners with clinical
privileges for which they have been licensed, trained and determined to be
competent to administer anesthesia and/or conscious sedation in accordance with
their respective state licensing board.
D. Anesthesia and conscious sedation may be
administered by the following practitioners who are qualified to administer
anesthesia under state law and within the scope of their practice:
1. anesthesiologists;
2. doctors of medicine or
osteopathy;
3. dentists or oral
surgeons;
4. podiatrists;
5. certified registered nurse anesthetists
(CRNAs) licensed by the State Board of Nursing who are under the supervision of
a physician or an anesthesiologist who is immediately available if needed, as
defined in the medical staff bylaws; and
6. registered nurses who have documented
education and demonstrated competency to administer minimal or moderate
sedation in accordance with the Nurse Practice Act, and who are under the
supervision of the treating physician.
a. The
RN (non-CRNA) monitoring the patient shall have no additional responsibility
that would require leaving the patient unattended or would compromise
continuous monitoring during the procedure.
E. The practitioner administering the
anesthesia and/or conscious sedation shall be present and immediately available
during the post-anesthesia recovery period until the patient is assessed as
stable in accordance with the ASCs established criteria.
F. The ASC shall develop policies and
procedures which are approved by the governing body including, but not limited
to:
1. staff privileges of licensed personnel
that administer anesthesia;
2.
delineation of pre-anesthesia and post-anesthesia responsibilities;
3. the qualifications, responsibilities and
supervision required of all licensed personnel who administer any type or level
of anesthesia;
4. patient consent
for anesthesia, including the American Society of Anesthesiologists (ASA)
physical status classification system;
5. infection control measures;
6. safety practices in all anesthetizing
areas;
7. protocol for supportive
life functions, e.g., cardiac and respiratory emergencies;
8. reporting requirements;
9. documentation requirements;
10. inspection and maintenance reports on all
of the supplies and equipment used to administer anesthesia; and
11. monitoring of trace gases and reporting
requirements.
G.
Anesthesia policies shall ensure that the following are provided for each
patient:
1. a pre-anesthesia evaluation
performed and recorded immediately prior to surgery to evaluate the risk of
anesthesia and of the procedure to be performed by an individual qualified to
administer anesthesia;
2. an
intra-operative anesthesia record that records monitoring of the patient during
any type or level of anesthesia and documentation of at least the following:
a. prior to induction of any type or level of
anesthesia, all anesthesia drugs and equipment to be used have been checked and
are immediately available and are determined to be functional by the
practitioner who is to administer the anesthetic;
b. dosages of each drug used, including the
total dosages of all drugs and agents used;
c. type and amount of all fluid(s)
administered, including blood and blood products;
d. estimated blood loss;
e. technique(s) used;
f. unusual events during the anesthesia
period;
g. the status of the
patient at the conclusion of any type or level of anesthesia; and
h. a post-anesthesia report written prior to
discharge of the patient by the individual who administers the anesthesia or
another fully qualified practitioner within the anesthesia department;
and
3. policies
developed, approved and implemented that define:
a. minimal, moderate and deep
sedation;
b. the method of
determining the sedation status of the patient;
c. how the sedation is to be carried
out;
d. who is to be present while
the patient is under any type or level of anesthesia; and
e. what body systems are to be monitored and
equipment to be used with each type of anesthesia administered.
H. Anesthesia policies
and procedures shall be developed and approved for all invasive procedures
including, but not limited to:
1.
percutaneous aspirations and biopsies;
2. cardiac and vascular catheterization;
and
3. endoscopies.
I. The ASC shall adopt an
individualized patient identification system for all patients who:
1. are administered general, spinal or other
types of anesthesia; and
2. undergo
surgery or other invasive procedures when receiving general, spinal or other
major regional anesthesia and/or intravenous, intramuscular or inhalation
sedation/analgesia, including conscious sedation that, in the manner used in
the ASC, may result in the loss of the patients protective reflexes.
J. The ASC shall develop, approve
and implement policies and procedures to ensure that the following requirements
are met for each patient undergoing:
1.
general anesthesia/total intravenous anesthesia:
a. the use of an anesthesia machine that
provides the availability and use of safety devices including, but not limited
to:
i. an oxygen analyzer;
ii. a pressure and disconnect alarm;
iii. a pin-index safety system;
iv. a gas-scavenging system; and
v. an oxygen pressure interlock
system;
b. continuous
monitoring of the patients temperature and vital signs, as well as the
continuous use of:
i. an electrocardiogram
(EKG/ECG);
ii. a pulse oximetry
monitor; and
iii. an end tidal
carbon dioxide volume monitor;
2. monitored anesthesia care (MAC):
a. monitored anesthesia care includes the
monitoring of the patient by an anesthesiologist and/or a CRNA. Indications for
MAC depend on the nature of the procedure, the patients clinical condition,
and/or the potential need to convert to a general or regional anesthetic. Deep
sedation/analgesia is included in MAC;
b. equipment sufficient to maintain the
patients airway and ventilatory function shall be immediately available and in
the OR/procedure room where the procedure is being performed;
c. continuous monitoring of the patients
vital signs and temperature as well as continuous use of an EKG/ECG and pulse
oximetry monitor; and
d. monitoring
by the licensed practitioner who administers the anesthetic;
3. conscious sedation:
a. policies and procedures shall be
developed, approved, and implemented by the medical staff as to the need for
pre-operative cardiac and pulmonary assessments of patients prior to being
administered conscious sedation; and
b. there shall be a minimum requirement of a
registered nurse to continuously monitor the patient who is receiving conscious
sedation;
4. regional
anesthesia (major nerve blocks):
a. equipment
sufficient to maintain the patients airway and to convert the case to another
form of anesthesia shall be immediately available and in the
operating/procedure room where the procedure is being performed;
b. continuous monitoring of the patients
vital signs and temperature, as well as the continuous use of an EKG/ECG and
pulse oximetry monitor;
c.
monitoring by the licensed practitioner who administers the regional
anesthetic;
5. local
anesthesia (infiltration or topical):
a.
continuous monitoring of the patients vital signs and temperature as well as
the continuous use of an EKG/ECG and pulse oximetry monitor; and
b. local anesthesia, interpreted to mean
those anesthetizing agents administered and affecting a very small localized
area that may be administered by the treating physician.
K. The ASC shall develop, approve
and implement policies and procedures regarding qualifications and duties of
all licensed personnel who administer any type or level of
anesthesia.
L. Policies and
procedures shall be developed, approved and implemented in accordance with
manufacturers guidelines for the equipment and medications to be used to
administer any level or type of anesthesia.
M. Policies and procedures shall be
developed, approved, and implemented as stipulated under the current state
licensing boards for patients undergoing any level or type of anesthesia
sedation. The patient under sedation shall be monitored for blood pressure,
respiratory rate, oxygen saturation, cardiac rate and rhythm and level of
consciousness. This information shall be recorded at least every five minutes
during the therapeutic, diagnostic or surgical procedure and, at a minimum,
every 15 minutes during the recovery period or more frequently as deemed
appropriate by the authorized prescriber.
N. The ASC shall define in policy and
procedures whether the use of reversal agents is to be considered an adverse
patient event.
O. The patient shall
be kept in the recovery room until assessed by a qualified anesthesia
professional as being stable in accordance with the ASCs established
criteria.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
40:2131-2141.
