| (a) The anesthesia services must be provided:
(1) in a well-organized manner;
(2) under the direction of a qualified physician approved
by the governing body; and
(3) in accordance with Texas Occupations Code Title
3, Subtitle B (relating to Physicians) and Texas Occupations Code
Chapter 301 (relating to Nurses).
(b) The LSRH is responsible for and shall document
all anesthesia services administered in the LSRH.
(c) The organization of anesthesia services shall be
appropriate to the scope of the services offered.
(d) Only personnel who have been approved by the LSRH
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 authorized 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
subsection, the LSRH shall:
(1) verify that the RN has the requisite training,
education, and experience;
(2) maintain documentation to support that the RN has
demonstrated competency in the administration of 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.
(e) 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.
(f) The medical staff shall develop written policies
and practice guidelines for the anesthesia service, which shall be
adopted, implemented, and enforced by the governing body. 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.
(g) Anesthesia services shall be consistent with needs
and resources. Policies on anesthesia procedures shall include the
delineation of pre-anesthesia and post-anesthesia responsibilities.
The policies shall ensure that the following are provided for each
patient.
(1) A pre-anesthesia evaluation by an individual qualified
to administer anesthesia under subsection (e) of this section shall
be performed within 48 hours before surgery.
(2) An intraoperative anesthesia record shall be provided.
The record shall include any complications or problems occurring during
the anesthesia, including time, description of symptoms, review of
affected systems, and treatments rendered. The record shall correlate
with the controlled substance administration record.
(3) A post-anesthesia follow-up report shall be written
by the person administering the anesthesia before transferring the
patient from the post-anesthesia care unit and shall include evaluation
for recovery from anesthesia, level of activity, respiration, blood
pressure, level of consciousness, and patient's oxygen saturation
level.
(4) Immediately prior to discharge, a post-anesthesia
evaluation for proper anesthesia recovery shall be performed by the
person administering the anesthesia, by an RN, within the scope of
their license and education, or physician in accordance with policies
and procedures approved by the medical staff and using criteria written
in the medical staff bylaws for postoperative monitoring of anesthesia.
(h) Anesthesia services provided in the LSRH 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--Administration of 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/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/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.)
(i) Patients who have 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.
(j) Patients 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.
(k) Emergency equipment and supplies appropriate for
the type of anesthesia services provided shall be maintained and accessible
to staff at all times. Functioning equipment and supplies that are
required for all LSRHs include the following:
(1) suctioning equipment, including a source of suction
and suction catheters in appropriate sizes for the population being
served;
(2) 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 (l) of this section, an LSRH that provides moderate
sedation/analgesia, deep sedation/analgesia, or regional analgesia
shall provide the following:
(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.
(m) The advanced practice registered nurse, the anesthesiologist,
or the operating surgeon shall be available until the surgeon's patients
operated on that day have been discharged from the post-anesthesia
care unit.
(n) Patients who have received anesthesia shall be
evaluated for proper anesthesia recovery in accordance with subsection
(g) of this section prior to discharge from the post-anesthesia care
unit using criteria approved by the medical staff.
(o) Patients who remain in the facility for extended
observation following discharge from the post-anesthesia care unit
shall be evaluated immediately prior to leaving the facility by a
physician, the person administering the anesthesia, or a registered
nurse acting in accordance with physician's orders and written policies,
procedures, and criteria developed by the medical staff.
(p) A physician shall be on call and able to respond
physically or by telephone within 30 minutes until all patients have
been discharged from the LSRH.
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