Section 555.33. Anesthesia policies and procedures

(a) In ASFs where an anesthesiologist is present, the anesthesiologist shall be designated the Director of Anesthesia Services and shall be responsible for directing the anesthesia services and establishing the general policies and procedures for the administration of anesthesia in the ASF which shall be approved by the governing body.

(b) In ASFs where there is no anesthesiologist, the governing body shall designate a physician or dentist to function as the Director of Anesthesia Services, who shall be responsible for directing the anesthesia services and establishing the general policies and procedures for the administration of anesthesia in the ASF which shall be approved by the governing body.

(c) Policies and procedures shall be developed for anesthesia services and shall include the following:

(1) Education, training and supervision of personnel.

(2) Responsibilities of nonphysician anesthetists.

(3) Responsibilities of supervising physicians or dentists.

(d) Anesthesia procedures shall provide at least the following:

(1) A patient requiring anesthesia shall have a pre-anesthesia evaluation by a practitioner, with appropriate documentation of pertinent information regarding the choice of anesthesia.

(2) A review and documentation shall be made of the condition of the patient immediately prior to induction of anesthesia, including pertinent laboratory findings, time of administration and dosage of preanesthesia medications.

(3) Prior to beginning the administration of anesthesia, the anesthetist shall check equipment to be used in administration of anesthetic agents. An anesthetic gas machine in anesthetising areas shall have a pin-index safety system.

(4) Following the procedure for which anesthesia was administered, the anesthetist shall remain with the patient as long as necessary to insure safe transport to the recovery area and shall advise personnel responsible for postanesthetic care of the condition of the patient.

(5) A patient receiving anesthesia shall have an anesthetic record maintained. This shall include a record of vital signs and all events taking place during the induction of, maintenance of and emergence from anesthesia, including the dosage and duration of anesthetic agents, other drugs and intravenous fluids.

(6) Intraoperative physiologic monitoring shall include the following at a minimum:

(i) The use of oxygen saturation by pulse oximetry.

(ii) The use of End Tidal CO₂ monitoring during endotracheal anesthesia.

(iii) The use of EKG monitoring.

(iv) The use of blood pressure monitoring.

(7) A patient may not receive general anesthesia unless one or more additional health care professionals besides the one performing the surgery, are present, one of whom is trained in the administration of anesthesia.

(8) Before discharge from the ASF, a patient shall be evaluated for proper anesthesia recovery by an anesthetist, the operating room surgeon, anesthesiologist or dentist. Depending on the type of anesthesia and length of surgery, the postoperative check shall include at least the following:

(i) Level of activity.

(ii) Respirations.

(iii) Blood pressure.

(iv) Level of consciousness.

(v) Oxygen saturation by pulse oximetry.

The provisions of this § 555.33 amended October 22, 1999, effective November 22, 1999, 29 Pa.B. 5583. Immediately preceding text appears at serial pages (256566) to (256567).