Office anesthesia guidelines modeled after ambulatory surgery regs

The regulations for office-based anesthesia adopted by the New Jersey State Board of Medical Examiners in Trenton are basically the same regulations governing ambulatory surgery centers, says Ervin Moss, MD, executive medical director of the New Jersey State Society of Anesthesiologists in Princeton Junction, NJ. The regulations spell out exactly what is expected of a physician providing anesthesia services within an office setting in these areas:

Policies and procedures.

Practitioners are required to have written policies addressing specific procedures performed in the office, responsibilities of staff members providing services, infection control practices, procedures to follow during patients’ recovery time, and procedures to follow if a patient experiences complications.

Incident reports.

Any incident related to surgery, anesthesia, or special procedures that results in a patient’s death, transport to a hospital, or complication has to be reported in writing to the Board of Medical Examiners within seven days.

Practitioner standards.

Physicians may only perform services they are credentialed to perform in a hospital. Physicians also must have a written agreement with a hospital and licensed ambulance service for transport of patients experiencing complications. The law defines requirements for history and physicals, informed consent, preoperative and postoperative care, and information required for the medical record as well as personnel authorized to perform general anesthesia, regional anesthesia, conscious sedation, and minor conduction blocks.

Equipment.

Equipment and safety systems required for all locations that provide anesthesia are defined. Examples of equipment required are precordial stethoscope or esophageal stethoscope and a peripheral nerve stimulator, pulse oximeter with appropriate alarms, continuous electrocardiograph with paper recorder, defibrillator, and a respirometer. Locations that provide services to children and infants are required to have emergency equipment and safety devices that are appropriately sized for pediatric patients.

Maintenance.

Service and maintenance records are to be kept on all anesthesia machines, ventilators, and vaporizers. A daily inspection of equipment is to be performed by the physician or a certified registered nurse anesthetist. Prior to each use, an inspection is to be performed and results documented on the anesthesia record.

A copy of the regulations is available at no charge from the New Jersey Board of Medical Examiners at (609) 826-7100.