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
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
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)
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.
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.
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
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
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)
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
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.
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
K1. Competition and the Regulation of APRNS
K2. FTC letter supporting removing barriers to APRN practice
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