Okla. Admin. Code § 310:600-9-4

Current through Vol. 41, No. 19, June 17, 2024

Section 310:600-9-4 - Clinical services

(a) The narrative shall describe all abortion procedures performed, equipment and supplies used for each procedure, and staff required to assist the physician. The narrative shall demonstrate the quantities of supplies, instruments, and equipment available in the facility are sufficient to provide emergency care and support the number of abortions performed on a daily basis.

(b) Drugs and biologicals maintained and administered in the facility shall be specified in the narrative. The narrative shall describe how the facility complies with federal and state laws regarding drug storage, administration and accountability.

(c) If the physician performing the abortion is not certified by the American Board of Obstetrics and Gynecology or the American Osteopathic Board of Obstetrics and Gynecology or an active board eligible candidate for certification in one (1) of the above, the narrative shall stipulate the facility protocols in place to assure consultation from a physician with these qualifications when required.

(d) Anesthesia services provided in the facility shall be fully described. The narrative shall stipulate the qualifications of the staff administering the anesthesia, if these individuals are supervised, and the level of service they are approved to deliver. The narrative shall demonstrate required services are provided by competent individuals in compliance with federal and state law as follows:

(1) An orderly preoperative anesthetic risk evaluation is to be done by the responsible physician and recorded on the chart in all elective cases, and in urgent emergency cases, the anesthetic evaluations will be recorded as soon as feasible.

(2) Every patient receiving general anesthesia, spinal anesthesia, or managed intravenous anesthesia (i.e. local standby, monitored anesthesia or conscious sedation), shall have arterial blood pressure and heart rate measured and recorded at least every five (5) minutes where not clinically impractical, in which case the responsible physician may waive this requirement stating the clinical circumstances and reasons in writing in the patient's chart.

(3) Every patient shall have the electrocardiogram continuously displayed from the induction and during maintenance of general anesthesia. In patients receiving managed intravenous anesthesia, electrocardiographic monitoring should be used in patients with significant cardiovascular disease as well as during procedures where dysrhythmias are anticipated.

(4) During all anesthetics, patient oxygenation will be continuously monitored with a pulse oximeter, and, whenever an endotracheal tube is inserted, correct positioning in the trachea and function will be monitored by end-tidal C02 analysis (capnography) throughout the time of placement.

(A) Additional monitoring for ventilation will include palpation or observation of the reservoir breathing bag, and auscultation of breath sounds.

(B) Additional monitoring for circulation will include at least on of the following: Palpation of the pulse, auscultation of heart sounds, monitoring of a tracing of intra-arterial pressure, pulse plethysmography, or ultrasound peripheral pulse monitoring.

(5) When ventilation is controlled by an automatic mechanical ventilator, there shall be in continuous use a device that is capable of detecting disconnection of any component of the breathing system. The device must give an audible signal when its alarm threshold is exceeded.

(6) During every administration of general anesthesia using an anesthesia machine, the concentration of oxygen in the patient's breathing system will be measured by a functioning oxygen analyzer with low concentration audible limit alarm in use.

(7) During every administration of general anesthesia, there shall be readily available a means to measure the patient's temperature.

(8) Availability of qualified trained personnel dedicated solely to patient monitoring.

(9) These desiderata apply for any administration of anesthesia, including general, spinal, and managed intravenous anesthetics (i.e. local standby, monitored anesthesia or conscious sedation), administered in designated anesthetizing locations and any location where conscious sedation is performed. "Conscious sedation" means a minimally depressed level of consciousness that retains the patient's ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command, produced by a pharmacologic or non-pharmacologic method, or a combination thereof.

(10) In emergency circumstances in any situation, immediate life support measures can be started with attention returning to these monitoring criteria as soon as possible and practical.

(e) The maintenance of adequate sterile supplies and linens shall be described. If the facility sterilizes instruments and supplies, the narrative shall indicate how sterilization is achieved, maintained, and documented. The procedure for linen procurement, storage, and processing shall be defined.

(f) The narrative shall describe how informative, timely, confidential, and complete medical records are documented, filed, and maintained for each patient as required by state law. The composition of a complete record shall be described.

(g) The availability of clinical laboratory services required by physicians performing abortions shall be indicated. The narrative shall stipulate clinical laboratory services, including tissue examinations, are provided by laboratories possessing a current certificate appropriate for the extent of testing required issued by the Department of Health and Human Services.

(h) The narrative shall ensure that patients are informed of birth control methods that may be used after the procedure, advised of diseases that are sexually transmitted, and provided instructions regarding possible complications and activities to be avoided. The instructions shall include information on how to contact the attending physician or abortion facility should a complication arise. The instructions shall also specify when the patient shall return for follow-up care.

Okla. Admin. Code § 310:600-9-4

Added at 15 Ok Reg 3172, eff 7-13-98