Current through Reg. 49, No. 38; September 20, 2024
(a) Anesthesia
services, when provided in the abortion facility, shall be limited to those
that are approved by the governing body, which may include the following:
(1) Topical anesthesia--An anesthetic agent
applied directly or by spray to the skin or mucous membranes, intended to
produce transient and reversible loss of sensation to the circumscribed
area.
(2) Local
anesthesia--Administration of an agent that produces a transient and reversible
loss of sensation to a circumscribed portion of the body.
(3) Regional anesthesia--Anesthetic injected
around a single nerve, a network of nerves, or vein that serves the area
involved in a surgical procedure to block pain.
(4) Minimal sedation (anxiolysis)--A
drug-induced state during which patients respond normally to verbal commands.
Although cognitive function and coordination may be impaired, ventilatory and
cardiovascular functions are unaffected.
(5) Moderate sedation/analgesia ("conscious
sedation")--A drug-induced depression of consciousness during which patients
respond purposefully to verbal commands, either alone or accompanied by light
tactile stimulation. No interventions are required to maintain a patent airway,
and spontaneous ventilation is adequate. Cardiovascular function is usually
maintained. (Reflex withdrawal from a painful stimulus is NOT considered a
purposeful response.)
(6) Deep
sedation/analgesia--A drug-induced depression of consciousness during which
patients cannot be easily aroused but respond purposefully following repeated
or painful stimulation. The ability to independently maintain ventilatory
function may be impaired. Patients may require assistance in maintaining a
patent airway, and spontaneous ventilation may be inadequate. Cardiovascular
function is usually maintained. (Reflex withdrawal from a painful stimulus is
NOT considered a purposeful response.)
(7) General anesthesia--A drug-induced loss
of consciousness during which patients are not arousable, even by painful
stimulation. The ability to independently maintain ventilatory function is
often impaired. Patients often require assistance in maintaining a patent
airway, and positive pressure ventilation may be required because of depressed
spontaneous ventilation or drug-induced depression of neuromuscular function.
Cardiovascular function may be impaired.
(b) An anesthesia department shall be
required if moderate sedation/analgesia, deep sedation/analgesia, or general
anesthesia are administered at the facility and shall be under the medical
direction of a physician approved by the governing body upon the recommendation
of the abortion facility medical staff.
(c) The medical staff shall develop written
policies and practice guidelines for the anesthesia service, which shall be
approved, implemented and enforced by the governing body. The policies and
guidelines shall include consideration of the applicable practice standards and
guidelines of the American Society of Anesthesiologists, the American
Association of Nurse Anesthetists, and the licensing rules and standards
applicable to those categories of licensed professionals qualified to
administer anesthesia.
(d) Only
personnel who have been approved by the facility to provide anesthesia services
shall administer anesthesia. All approvals or delegations of anesthesia
services as authorized by law shall be documented and include the training,
experience, and qualifications of the person who provided the service. A
qualified registered nurse (RN) who is not a certified registered nurse
anesthetist (CRNA), in accordance with the orders of the operating surgeon,
anesthesiologist, or CRNA may administer topical anesthesia, local anesthesia,
minimal sedation and moderate sedation, in accordance with all applicable
rules, polices, directives and guidelines issued by the Texas Board of Nursing.
When an RN who is not a CRNA administers sedation, as permitted in this
paragraph, the facility shall:
(1) verify
that the registered nurse has the requisite training, education, and
experience;
(2) maintain
documentation to support that the registered nurse has demonstrated competency
in the administration of sedation;
(3) with input from the facility's qualified
anesthesia providers, develop, implement and enforce detailed, written policies
and procedures to guide the registered nurse; and
(4) ensure that, when administering moderate
sedation during a procedure, the registered nurse has no other duties except to
monitor the patient.
(e)
Anesthesia shall not be administered unless the operating surgeon has evaluated
the patient immediately prior to the procedure to assess the risk of the
anesthesia and of the procedure to be performed.
(f) The CRNA, the anesthesiologist, or the
operating surgeon shall be available until all of his or her patients operated
on that day have been discharged from the recovery room.
(g) Patients who have received anesthesia
shall be evaluated for proper anesthesia recovery by the operating surgeon or
the person administering the anesthesia prior to discharge from the recovery
room using criteria approved by the medical staff.
(h) Patients who remain in the facility for
extended observation following discharge from the recovery room shall be
evaluated immediately prior to leaving the facility by a physician, the person
administering the anesthesia, or a registered nurse acting in accordance with
physician's orders and written policies, procedures and criteria developed by
the medical staff.
(i) A physician
shall be on call and able to respond physically or by telephone within 30
minutes until all patients have been discharged from the abortion
facility.
(j) Emergency equipment
and supplies appropriate for the type of anesthesia services provided shall be
maintained and accessible to staff at all times.
(1) Functioning equipment and supplies which
are required for all facilities include:
(A)
suctioning equipment, including a source of suction and suction catheters in
appropriate sizes for the population being served;
(B) source of compressed oxygen;
(C) basic airway management equipment,
including oral and nasal airways, face masks, and self-inflating breathing bag
valve set;
(D) blood pressure
monitoring equipment; and
(E)
emergency medications specified by the medical staff and appropriate to the
type of surgical procedures and anesthesia services provided by the
facility.
(2) In
addition to the equipment and supplies required under paragraph (1) of this
subsection, facilities which provide moderate sedation/analgesia, deep
sedation/analgesia, regional analgesia and/or general anesthesia shall provide
the following:
(A) intravenous equipment,
including catheters, tubing, fluids, dressing supplies, and appropriately sized
needles and syringes;
(B) advanced
airway management equipment, including laryngoscopes and an assortment of
blades, endotracheal tubes and stylets in appropriate sizes for the population
being served;
(C) a mechanism for
monitoring blood oxygenation, such as pulse oximetry;
(D) electrocardiographic monitoring
equipment;
(E) cardiac
defibrillator; and
(F)
pharmacologic antagonists as specified by the medical staff and appropriate to
the type of anesthesia services provided.
