| (a) If a facility furnishes anesthesia services, the
facility shall provide these services in a well-organized manner under
the medical direction of a physician approved by the governing body
and qualified in accordance with Texas Occupations Code Title 3, Subtitle
B (relating to Physicians) and Texas Occupations Code Chapter 301
(relating to Nurses), as appropriate.
(b) A facility that furnishes anesthesia services shall
comply with Texas Occupations Code Chapter 162, Subchapter C (relating
to Anesthesia in Outpatient Setting), unless the facility is exempt
under Texas Occupations Code §162.103 (relating to Applicability).
(c) A facility is responsible for and shall document
all anesthesia services administered in the facility.
(d) Anesthesia services provided in the facility shall
be limited to those that are recommended by the medical staff and
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--Administering 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 oral commands. Although
cognitive function and coordination may be impaired, ventilatory and
cardiovascular functions are unaffected.
(5) Moderate sedation or analgesia ("conscious sedation")--A
drug-induced depression of consciousness during which patients respond
purposefully to oral 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 or 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.)
(e) The medical staff shall develop written policies
and practice guidelines for the anesthesia service, which the governing
body shall adopt, implement, and enforce. 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.
(f) 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. On the order of a physician,
podiatrist, dentist, or other practitioner practicing within the scope
of their license and education, a qualified registered nurse (RN)
who is not a certified registered nurse anesthetist (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 the RN has the requisite training, education,
and experience;
(2) maintain documentation to support that the RN has
demonstrated competency in administering sedation;
(3) with input from the facility's qualified anesthesia
providers, develop, implement, and enforce detailed written policies
and procedures to guide the RN; and
(4) ensure that, when administering sedation during
a procedure, the RN has no other duties except to monitor the patient.
(g) Anesthesia shall not be administered unless the
physician has evaluated the patient immediately before the procedure
to assess the risk of the anesthesia and of the procedure to be performed.
(h) A patient who has received anesthesia shall be
evaluated for proper anesthesia recovery by the physician, or the
person administering the anesthesia, before discharge using criteria
approved by the medical staff.
(i) A patient shall be evaluated immediately before
leaving the facility by a physician, the person administering the
anesthesia, or an RN acting in accordance with physician's orders
and written policies, procedures, and criteria developed by the medical
staff.
(j) Emergency equipment and supplies appropriate for
the type of anesthesia services provided shall always be maintained
and accessible to staff.
(k) All facilities shall provide at least the following
functioning equipment and supplies:
(1) suctioning equipment, including a source of suction
and suction catheters in appropriate sizes for the population being
served;
(2) a source of compressed oxygen;
(3) basic airway management equipment, including oral
and nasal airways, face masks, and self-inflating breathing bag valve
set;
(4) blood pressure monitoring equipment; and
(5) emergency medications specified by the medical
staff and appropriate to the type of procedures and anesthesia services
provided by the facility.
(l) In addition to the equipment and supplies required
under subsection (k) of this section, a facility that provides moderate
sedation/analgesia, deep sedation/analgesia, or regional analgesia
shall provide:
(1) intravenous equipment, including catheters, tubing,
fluids, dressing supplies, and appropriately sized needles and syringes;
(2) advanced airway management equipment, including
laryngoscopes and an assortment of blades, endotracheal tubes, and
stylets in appropriate sizes for the population being served;
(3) a mechanism for monitoring blood oxygenation, such
as pulse oximetry;
(4) electrocardiographic monitoring equipment;
(5) cardiac defibrillator; and
(6) pharmacologic antagonists, as specified by the
medical staff and appropriate to the type of anesthesia services provided.
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