La. Admin. Code tit. 48 § I-4551

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-4551 - Anesthesia Services

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.

La. Admin. Code tit. 48, § I-4551

Promulgated by the Department of Health, Bureau of Health Services Financing, LR 431743 (9/1/2017).

AUTHORITY NOTE: Promulgated in accordance with R.S. 40:2131-2141.