| (6) Certified registered nurse anesthetists shall verify that
the appropriate policies or procedures are in place. Policies, procedures,
or protocols shall be evaluated and reviewed at least annually. Agreements
with local emergency medical service (EMS) shall be in place for purposes
of transfer of patients to the hospital in case of an emergency. EMS agreements
shall be evaluated and re-signed at least annually. Policies, procedures,
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:
(A) Management of outpatient anesthesia-At a minimum, these
must address:
(i) Patient selection criteria
(ii) Patients/providers with latex allergy
(iii) Pediatric drug dosage calculations, where applicable
(iv) ACLS algorithms
(v) Infection control
(vi) Documentation and tracking use of pharmaceuticals: including
controlled substances, expired drugs and wasting of drugs
(vii) Discharge criteria
(B) Management of emergencies to include, but not be limited
to:
(i) Cardiopulmonary emergencies
(ii) Fire
(iii) Bomb threat
(iv) Chemical spill
(v) Natural disasters
(vi) Power outage
(C) EMS response and transport--Delineation of responsibilities
of the certified registered nurse anesthetist and person performing the procedure
upon arrival of EMS personnel. This policy should be developed jointly with
EMS personnel to allow for greater accuracy.
(D) Pursuant to §217.11(16) of this title (relating to
Standards of Professional Nursing Practice), adverse reactions/events, including
but not limited to those resulting in a patient's death intraoperatively or
within the immediate postoperative period shall be reported in writing to
the Board and other applicable agencies within 15 days. Immediate postoperative
period shall be defined as 72 hours.
(d) Registration.
(1) Beginning April 1, 2000, each certified registered nurse
anesthetist who intends to provide anesthesia services in an outpatient setting
must register with the board and submit the required registration fee, which
is non-refundable. The information provided on the registration form shall
include, but not be limited to, the name and business address of each outpatient
setting(s) and proof of current competency in advanced life support.
(2) Registration as an outpatient anesthesia provider must
be renewed and the registration renewal fee paid on a biennial basis, at the
time of registered nurse licensure renewal.
(e) Inspections and Advisory Opinions.
(1) The Board may conduct on-site inspections of outpatient
settings, including inspections of the equipment owned or leased by a certified
registered nurse anesthetist and of documents that relate to provision of
anesthesia in an outpatient setting, for the purpose of enforcing compliance
with the minimum standards. Inspections may be conducted as an audit to determine
compliance with the minimum standards or in response to a complaint. The Board
may contract with another state agency or qualified person to conduct these
inspections. Unless it would jeopardize an ongoing investigation, the board
shall provide the certified registered nurse anesthetist at least five business
days' notice before conducting an on-site inspection.
(2) The Board may, at its discretion and on payment of a fee,
conduct on-site inspections of outpatient settings in response to a request
from a certified registered nurse anesthetist for an inspection and advisory
opinion.
(A) The Board may require a certified registered nurse anesthetist
to submit and comply with a corrective action plan to remedy or address current
or potential deficiencies with the nurse anesthetist's provision of anesthesia
in an outpatient setting.
(B) A certified registered nurse anesthetist who requests and
relies on an advisory opinion of the board may use the opinion as mitigating
evidence in an action or proceeding by the board to impose an administrative
penalty or assess a monetary fine. The board shall take proof of reliance
on an advisory opinion into consideration and mitigate the imposition of administrative
penalties or the assessment of a monetary fine accordingly.
(C) An advisory opinion issued by the board is not binding
on the board and the board except as provided for in subsection (a) of this
section, may take any action in relation to the situation addressed by the
advisory opinion that the Board considers appropriate.
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