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Who is responsible for preanesthesia reevaluation?

Accreditation Connection, December 11, 2008

Q. 2009 standard PC.03.01.03, element of performance (EP) 8, requires that hospitals reevaluate patients immediately before administering moderate or deep sedation or anesthesia.Does thismean that the anesthesia provider no longer has to be the one that performs the immediate reevaluation?

A. The 2008 manual, under PC.13.20, had two pertinent EPs, 10 and 12. These were for the presedation assessment and the immediate reassessment just prior to induction.

Neither of these EPs explicitly stated that the anesthesiologist or certified RN anesthetist performed the assessments. However, that has been the expectation from The Joint Commission (formerly JCAHO). The theory behind this is that the person performing assessments has to have appropriate credentials and privileges.

The CMS Conditions of Participation regulations for medically directed anesthesia are very explicit in 415.110. These regulations state that the physician conducts the assessment and prescribes the anesthesia plan. In this section, the regulations further state that the physician alone inclusively documents the preanesthetic exam in the medical record. CMS leaves no ambiguity regarding who has to conduct the preanesthesia assessment. Thus, if you were anticipating a change or relaxation of your existing preanesthesia assessment process as a result of this wording change in the standards, you will want to cancel any anticipated changes.

Access the full story in the December issue of Briefings on The Joint Commission. Access is free for BOJ subscribers; nonsubscribers can purchase a copy of the story for $10 by clicking here.

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