Rule 111-8-40-.29 - Anesthesia ServicesAny hospital offering surgical or obstetrical services shall have an organized anesthesia service which shall be responsible for all anesthesia delivered at the hospital. The anesthesia services will be provided in a manner which protects the health and safety of patients in accordance with generally accepted standards of practice.
(a)Organization of Anesthesia Services.1. Anesthesia services shall be directed by a qualified physician member of the medical staff who is responsible for organizing the delivery of anesthesia services provided by the hospital in accordance with generally accepted standards of practice.2. The anesthesia director shall be responsible for monitoring the quality and appropriateness of anesthesia services and for ensuring that identified problems are addressed through the quality management program.3. The anesthesia director shall be responsible for establishing an orientation and continuing education program for anesthesia services staff that include, at a minimum, instruction in safety precautions, emergency patient management, equipment use and inspections, and infection control procedures in the surgical suite.(b)Anesthesia Service Delivery.1. Anesthesia shall be administered only by qualified members of the medical staff or qualified individuals who have been granted clinical privileges to administer anesthesia in accordance with these rules and as permitted by state laws and regulations. Persons qualified to administer anesthesia may include: (iii) Dentists or oral surgeons possessing an active permit for administration of general anesthesia as issued by the State of Georgia;(iv) Certified registered nurse anesthetists administering such anesthesia under the direction and responsibility of duly licensed physicians who are members of the medical staff; and(v) Physician's assistants licensed by the State of Georgia with approved job descriptions as anesthesia assistants functioning under the direct supervision of anesthesiologists who are members of the medical staff and as otherwise authorized by applicable laws and regulations.2. A pre-anesthesia patient evaluation shall be completed for each patient by a person qualified and granted privileges to administer anesthesia within a reasonable period of time preceding the surgery. The patient evaluation shall be updated immediately prior to induction. The pre-anesthesia evaluation must include review of heart and lung function, diagnostic data (laboratory, x-ray, etc., as applicable), medical and anesthesia history, notation of anesthesia risk, any potential anesthesia problems identified, and notation of patient's condition immediately prior to induction.3. Checks of all anesthesia equipment shall be performed and documented immediately prior to each anesthesia administration.4. A person qualified and granted privileges to administer anesthesia shall be continuously present throughout the administration of all general anesthesia or major regional anesthesia and monitored anesthesia care.5. During the administration of anesthesia, patients shall be monitored as appropriate for the nature of the anesthesia. Such monitoring shall include as appropriate: (i) Heart and breath sounds, using a precordial or esophageal stethoscope;(iv) Circulatory function;(v) The qualitative content of expired gases, if the patient has an endotracheal tube; and(vi) The patient's temperature.6. The intraoperative anesthesia record shall document all pertinent actions and events that occur during the induction, maintenance, and emergence from anesthesia.7. The person qualified and granted privileges to administer anesthesia shall remain immediately available until the patient has been determined to be stable and is ready for discharge or transfer from the post-anesthesia care unit.8. A person qualified and granted privileges to administer anesthesia shall complete the post-anesthesia evaluation for each patient receiving anesthesia, and it shall be included in the patient's medical record.(i) The evaluation shall note at a minimum the presence or absence of anesthesia-related abnormalities or complications, the patient's level of consciousness and cardiopulmonary status, and any follow-up care needed.(ii) For outpatients, the post-anesthesia evaluation shall be performed prior to hospital discharge to check for anesthesia recovery in accordance with procedures and timelines established by the hospital's medical staff.(c)Anesthesia Safety Precautions. Safety precautions related to the administration of anesthesia shall be clearly identified in written policies and procedures which are enforced and shall include at a minimum: 1. Routine maintenance and inspection of anesthesia equipment, recorded in a service record for each machine;2. Emergency preparedness plans;3. Life safety measures, including alarm systems for ventilators capable of detecting disconnection of any components, monitoring for scavenger gases, and a system for internal reporting of equipment malfunctions and unavailability;4. Infection control procedures sufficient to adequately sterilize or appropriately disinfect all equipment components; and5. Procedures for ensuring patient safety.(d)Conscious sedation. The hospital shall develop and implement, with the assistance of the anesthesia services director, policies and procedures for the administration of conscious sedation, which shall be applicable hospital-wide. These policies and procedures shall be approved by appropriate members of the medical staff and shall include at least the following: 1. Designation of the licensed personnel authorized to administer conscious sedation and/or monitor the patient during conscious sedation;2. Drugs approved for use in administering conscious sedation;3. Patient monitoring requirements; and4. Criteria for discharge.Ga. Comp. R. & Regs. R. 111-8-40-.29
O.C.G.A. §§ 31-7-2.1, 43-22-21 and 43-26-11.1.
Original Rule entitled "Anesthesia Services" adopted. F. Feb. 20, 2013; eff. Mar. 12, 2013.