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Create policies and define standards when it comes to anesthesia

Ambulatory Safety Monitor, June 4, 2003

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Standard 9-L of the AAAHC's new anesthesia standards requires personnel qualified in pediatric advanced life support (PALS) to be "immediately available until the patient is medically discharged."

The term "immediately available" causes headaches and confusion for many people, says Jack Egnatinsky, MD, an anesthesiologist on the board of directors at AAAHC. Because the AAAHC did not define the phrase, each facility must create its own policy with specific definitions. The AAAHC surveyor will decide whether the definitions are appropriate during an accreditation survey.

TIP: Egnatinsky considers a physician to be "immediately available" if he or she is not performing another procedure at the time of the emergency call and if the physician can walk to where the patient is undergoing the procedure. Although the physician does not need to resuscitate the patient, he or she should be able to help resuscitate the patient or provide guidance if necessary.

Standard 9-T is crucial to patient safety because it is difficult for one person to perform a procedure on a patient who is under moderate sedation and monitor the patient's vital signs at the same time, says Philip. Now, another person qualified to administer anesthesia in addition to the physician performing the procedure must monitor the patient. The standard allows the person monitoring the patient to assist with "minor, interruptible tasks," but the AAAHC did not define what minor, interruptible tasks are.

An example of a "minor, interruptible task," according to Egnatinsky, would be a nurse monitoring a patient's heart rate during an endoscopy and helping to manipulate the scope by pushing on the patient's stomach. The same nurse scrubbing in as part of the surgical team is not a "minor, interruptible task," says Egnatinsky.

TIP: Facilities should develop clear policies on exactly who can monitor patients under moderate sedation and a clear definition of "minor, interruptible tasks" as it applies to the individual center.

This week's tip was excerpted from Briefings on Ambulatory Accreditation, a monthly publication that reports on the activities of the ambulatory care accreditors, the JCAHO and the AAAHC. It illustrates exactly what you and your staff need to do to pass a survey and gain accreditation so that your organization is known for quality and can affiliate with other delivery systems. For more information, or to subscribe, click here.

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