Compendium
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A: Legal Basis of Nurse Anesthesia Practice

B: OSANA Legislative History

C: Board of Nursing & Continuing Education

D: Ohio Administrative Code

E: Anesthesiologist Assistant

F: Centers for Medicare and Medicaid Services (CMS)

G: The Joint Commission Standards

H: Ohio Dental Anesthesia Laws

I: Ohio Podiatry Laws

J: Education and Practice Standards

K: Federal Trade Commission

Studies

 

A: Legal Basis of Nurse Anesthesia Practice

A1. Scope of practice as established in the Ohio Revised Code 4723.43 under section (B). 

A2. Definition of “Certified Registered Nurse Anesthetist” under section (G). 

A3. Definition of “Supervision” under section (M).

A4. Authority of APRNs to prescribe (other than CRNAs).

A5. OSANA General Counsel interpretation on CRNA Ketamine Clinics 

A6. OSANA & General Counsel Scope of Practice Letter

A7. Attorney General opinion on CRNA ordering 2013

 

B: OSANA Legislative History

Legislative Timeline

 

C: Board of Nursing & Continuing Education

C1. OSANA FAQ Regarding RN and APRN renewal and Class A and Class B credits

C2. Continuing education requirement for RN license = 24 contact hours during 2 year renewal period

C3. Continuing education requirement for APRN license = 24 contact hours during 2 year renewal period 

C4. One contact hour must be approved by or offered by a BON provider = Law CE under section (E)

C5.  Email from BON regarding using Class B credit 

C6. Ohio Board of Nursing APRN continuing education FAQ

C7. CRNA National Certifying Organization = NBCRNA 

C8. Consensus Model for APRN regulation 

 C9. Establishing BON Advisory committee on APRN practice: 1 CRNA chosen by the BON based off of recommendations submitted to the board by organizations representing APRN practice in the state.

C10. BON policy on advisory groups including APRN advisory committee

C11. Joint Regulatory Statement (2014-2018)

 

 

D: Ohio Administrative Code

D1. Definitions of Anesthesia services, General Anesthesia, Deep Sedation, Anxiolysis, Moderate Sedation, Regional Anesthesia

D2. Standards for surgery – Section (4) states that Delegating defined aspects of the postoperative medical care to licensees of other health regulatory boards who are licensed to independently provide the scope of practice and the level of care required, provided that the surgeon of record shall remain primarily responsible for the patient's overall care and must examine the patient during the postoperative period.

D3. Standards for Office Surgery using Anesthesia

D4. Definition of “Dangerous Drug” under section (F)

D5. Definition of “Terminal Distributor” under section (Q)

D6. Definition of “Compounding” under section (C)

D7. Immediate-Use, Sterile Non-Hazardous Drugs Compounded by a Prescriber.

D8. Protocols and Pre-Printed Orders

D9. Level 1 Maternity: Anesthesia, except that when a patient or patients are receiving a labor epidural, an anesthesiologist or certified registered nurse anesthetist acting within their scope of practice and under the supervision of a physician, shall remain in attendance with a patient until it is determined the patient is stable, but for at least 30 minutes. After it is determined the patient is stable, an anesthesiologist or certified registered nurse anesthetist may be on-call, but shall remain available to return in accordance with facility policy, but no longer than thirty minutes.

D10. Level 2 Maternity: Anesthesia, except that when a patient or patients are receiving a labor epidural, an anesthesiologist or certified registered nurse anesthetist acting within their scope of practice and under the supervision of a physician, shall remain in attendance with a patient until it is determined the patient is stable, but for at least 30 minutes. After it is determined the patient is stable, an anesthesiologist or certified registered nurse anesthetist may be on-call, but shall remain available to return in accordance with facility policy, but no longer than thirty minutes.


E: Anesthesiologist Assistant

E1. Definition

E2. An anesthesiologist assistant shall practice only under the direct supervision and in the immediate presence of a physician who is actively and directly engaged in the clinical practice of medicine as an anesthesiologist. An anesthesiologist assistant shall not practice in any location other than a hospital or ambulatory surgical facility.

E3. Supervision

E4. Enhanced Supervision

E5. AAs may perform epidurals and spinals

E6. Ohio BON rule on CRNAs supervising AA students

E7.  Hoffman v State Medical Board

 

F: Centers for Medicare and Medicaid Services (CMS)

F1. 2019 Anesthesia Conversion factors Fee Schedule

F2. Medicare Claims Processing Manual

Section 50 (pg 117) - Physician Anesthesiologist Services

Section 140 (pg170) – Nonphysician Anesthetist Services

            Section 140.5 – CRNA teaching SRNAs 

F3. CMS Title 42 requiring CRNAs to be supervised unless opted out

F4. CMS conditions of Participation: Anesthesia Services 482.52 (pg 473)

  • Anesthesia services must be under the direction of a MD or DO
  • Exemption of MD/DO supervision if the state submits a letter to CMS signed byh the Governor following consultation with the State’s Board of Medicine and Nursing.  The letter must attest that the Governor has consulted with the boards about issues related to access to and quality of anesthesia services in the state.
  • An anesthesiologist is considered “immediately available” … only if physically located within the same area as the the CRNA, eg., in the same operative suite or in the same labor and delivery unit…
  • Pre-anesthesia evaluation performed within 48 hours of procedure
  • Postanesthesia evaluation no later than 48 hours after surgery 

F5. Interpretive Guidelines - Analgesia Labor Epidural

F6. Interpretive Guidelines - Medical Staff Privileges

F7. Medicare: CY 2020 Revisions to Payment Policies Under the Physician Fee Schedule

F8. Medicare CY 2020 Revision Specific to Conditions for Coverage - Surgical Services

G: The Joint Commission Standards

G1. Anesthesia Standards 2010

A qualified doctor of medicine or osteopathy must direct Anesthesia Services (document pg #81)

Individuals able to administer anesthesia (document pg #212)

Preanesthesia assessment required within 48 hours of procedure (document pg #213)

Oxygenation, ventilation, and circulation are monitored continuously (document pg #213)

Patients who have received sedation or anesthesia as outpatients are discharged in the company of an individual who accepts responsibility for the patient (document pg #214)

 

H: Ohio Dental Anesthesia Laws

H1. Dental Practice Act: Use of General Anesthesia and Deep Sedation 4715-5-05 (Document’s page 59)

H2. ADA Guidelines for the use of Sedation and General Anesthesia by Dentists 

 

I: Ohio Podiatry Laws

I1. CRNAs may ONLY provide general anesthesia in colleges of podiatric medicine and surgery, and in hospitals approved by the joint commission or the America osteopathic association.

 

J: Education and Practice Standards

J1. Standards for Accreditation of Nurse Anesthesia Educational Programs (rev Jan 2018)

J2. Standards for Accreditation of Nurse Anesthesia Programs: Practice Doctorate (rev Jan 2015)

J3. COA Guidelines for Counting Clinical Experiences

J4. Scope of Nurse Anesthesia Practice: AANA 

J5. Standards for Nurse Anesthesia Practice

J6. Clinical Privileges and other Responsibilities of Certified Registered Nurse Anesthetists

J7. Analgesia & Anesthesia for the Obstetric Patient 

J8. Analgesia & Anesthesia for the Substance Use Disorder Patient 

J9. Informed Consent for Anesthesia Care

J10. Evaluation & Management of Patients undergoing Noncardiac Surgery: American College of Cardiology 

J11. Management of Patients with Valvular Heart Disease: American College of Cardiology

J12. ASRA Practice Advisory on Neurologic Complications 

J13. ASRA & ESRA Practice Advisory on Pediatric Regional Anesthesia 

J14. Regional Anesthesia in Patients with Preexisting Neuropathies 

J15. Regional in Patients taking antithrombotics 

J16. American College of Obstetricians and Gynecologists (ACOG) Consensus Levels of Maternal Care

J17. ACOG Opinion Nonobstetric Surgery During Pregnancy

 

K: Federal Trade Commission

K1. Competition and the Regulation of APRNS

K2. FTC letter supporting removing barriers to APRN practice 

 

STUDIES

Physician vs. Non-physician Provider of Anesthesia

No Harm Found Report

Institute of Medicine Report: Future of Nursing

Negrusa: Scope of Practice Laws & Anesthesia Complications