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RULE §192.2Provision of Anesthesia Services in Outpatient Settings

(j) The operating surgeon shall verify that the appropriate policies or procedures are in place. Policies, procedure, or protocols shall be evaluated and reviewed at least annually. Operating surgeons are responsible for verifying the level of advanced life support services the local, county-based emergency medical service (EMS) providers are licensed to provide. Operating surgeons who do not practice in counties with 9-1-1 service entities supported by EMS providers licensed at the advanced life support (ALS) level must enter into agreements with a local licensed EMS provider or accredited hospital-based EMS for purposes of transfer of patients to the hospital in case of an emergency. The EMS agreements must include terms delineating requirements and responsibilities for advanced life support services, including, but not limited to advanced airway management, and at a minimum must provide that the EMS provider or hospital-based EMS bring staff and equipment necessary for advanced airway management equal to or exceeding that which is in place at the surgeon's office. The EMS agreements shall be evaluated and re-signed at least annually. Regardless of the level of advanced life support services furnished by EMS providers, the operating surgeon is responsible for having appropriate advanced life support measures available in the office, sufficient to rescue and stabilize the patient until EMS arrives. Policies, procedure, and transfer agreements shall be kept on file in the setting where procedures are performed and shall be made available upon request. Policies or procedures must include, but are not limited to the following listed in paragraphs (1) - (2) of this subsection:

  (1) Management of outpatient anesthesia. At a minimum, these must include written policies, procedures, or protocols that address:

    (A) patient selection criteria;

    (B) patients/providers with latex allergy;

    (C) pediatric drug dosage calculations, where applicable;

    (D) ACLS (advanced cardiac life support) or PALS (pediatric advanced life support) algorithms;

    (E) infection control;

    (F) documentation and tracking use of pharmaceuticals, including controlled substances, expired drugs and wasting of drugs; and

    (G) discharge criteria.

  (2) Management of life-threatening emergencies. At a minimum, these must include, but not be limited to:

    (A) cardiopulmonary emergencies, which must include at a minimum a specific plan for securing a patient's airway pending EMS transfer to the hospital;

    (B) fire;

    (C) bomb threat;

    (D) chemical spill; and

    (E) natural disasters.

(k) An anesthesia provider must perform a presedation assessment of each patient having anesthesia services. The assessment must include, at a minimum:

  (1) an airway evaluation; and

  (2) an ASA physical status classification.

(l) All equipment and anesthesia-related services must remain available at the office-based anesthesia site until the patient is discharged.

(m) Physicians or surgeons must notify the board in writing within 15 days if a procedure performed in any of the settings under this chapter resulted in:

  (1) an unanticipated and unplanned transport of the patient to a hospital for observation or treatment for a period in excess of 24 hours;

  (2) an intraoperative death;

  (3) a death occurring within the first 24 hours of the postoperative time period.

Source Note: The provisions of this §192.2 adopted to be effective May 21, 2000, 25 TexReg 4350; amended to be effective November 30, 2003, 28 TexReg 10498; amended to be effective June 29, 2006, 31 TexReg 5107; amended to be effective January 20, 2009, 34 TexReg 342; amended to be effective May 2, 2010, 35 TexReg 3281; amended to be effective May 15, 2012, 37 TexReg 3583; amended to be effective March 18, 2013, 38 TexReg 1875; amended to be effective January 23, 2014, 39 TexReg 290; amended to be effective March 16, 2015, 40 TexReg 1380

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