36States Require Physician Supervision of Nurse Anesthetists

Transcription

1 36States Require Physician Supervision of Nurse Anesthetists 34 states follow the federal requirement that physicians supervise nurse anesthetists. State law also requires physician supervision or direction in the following states: Alabama (APN) Nurse anesthetists are not subject to collaborative practice agreement, but function under the direction of a physician or a dentist who is immediately available. Code of Ala Surgical centers: anesthesia must be administered under the direct supervision of a physician. Ala. Admin. Code r Arkansas (APN) Nurse anesthetists work under the supervision of, but not necessarily in the presence of a physician, dentist, or other person lawfully entitled to order anesthesia. A.C.A Hospital and ASCs: A CRNA shall administer anesthesia under the supervision of a physician. Ark. Admin. Code (ASCs shall conform with hospital anesthesia services requirement) Arizona (Certified Registered Nurse) RNs may administer anesthesia under the direction and in the presence of a physician. Presence is defined as within the same room or an adjoining room or within the same surgical or obstetrical suite. A.R.S California (RN) It is unprofessional conduct for a nurse to administer controlled substances or dangerous drugs except as directed by a licensed physician and surgeon, dentist or podiatrist. Cal Bus & Prof Code 2762 Practice of registered nursing: the administration of medications and therapeutic agents, necessary to implement a treatment, disease prevention or rehabilitative regimen ordered by and within the scope of licensure of a physician, dentist, podiatrist Bus & Prof Code The utilization of a nurse anesthetist to provide anesthesia services in an acute care facility shall be approved by the acute care facility administration and the appropriate committee, and at the discretion of the physician, dentist or podiatrist. Cal Bus & Prof Code 2827 Authority of a nurse anesthetist includes administering a regional anesthetic only when ordered by and within the scope of licensure of a physician, dentist, or podiatrist and not under the standardized procedures mechanism of 2725(b)(4). 67 Ops.Cal.Atty.Gen. 122 (1984).

2 Connecticut (APRN) Nurse anesthetists practice in collaboration, but physician who medically directs prescriptive activity must be physically present in the institution, clinic, or other setting where the surgery is being performed. The advanced practice registered nurse may, in collaboration with a physician licensed to practice medicine in this state, prescribe, dispense and administer medical therapeutics and corrective measures and may request, sign for, receive and dispense drugs in the form of professional samples. except that an advanced practice registered nurse licensed pursuant to section 20-94a and maintaining current certification from the American Association of Nurse Anesthetists who is prescribing and administrating medical therapeutics during surgery may only do so if the physician who is medically directing the prescriptive activity is physically present in the institution, clinic or other setting where the surgery is being performed. (Conn. Gen. Stat a) Delaware (APN) Advanced practice nurses shall operate in collaboration with a licensed physician, dentist, podiatrist, or licensed Delaware health care delivery system to cooperate, coordinate, and consult with each other as appropriate pursuant to a collaborative agreement defined in the rules and regulations promulgated by the Board of Nursing, in the provision of health care to their patients. 24 Del. C Nurse Practice Act: Nothing contained in this chapter shall be deemed to permit acts of surgery or medical diagnosis; nor shall it be deemed to permit dispensing of drugs, medications or therapeutics independent of the supervision of a physician who is licensed to practice medicine and surgery, or those licensed to practice dentistry or podiatry.24 Del. C (8). Freestanding Surgical Centers: general anesthesia or anesthesia other than local must be done under the supervision of the operating physician. 16 DE ADC Florida (ARNP) ARPNs must work under a formal protocol between a specific ARNP and a specific physician supervisor that is filed annually with the Board of Nursing. ARNP s by law can diagnose and treat, but may not prescribe controlled substances. Hospital & surgical center: Requires on-site medical direction of a physician. Fla. Stat , RULE 59A ; 59A Georgia (APRN) Nurse Practice Act: CRNAs administer anesthesia under the direction and responsibility of a physician. O.C.G.A Hospital: CRNAS administer anesthesia under the direction and responsibility of duly licensed physicians. CRNAs may provide services in 4 areas: preanesthic preparation and evaluation; anesthesia induction, maintenance and emergence; perianesthic and clinical support; and postanesthesia care. Ga. Comp. R. & Regs. r Ambulatory surgical centers: Require a CRNA to administer anesthesia under the direction and responsibility of a physician with training and experience in anesthesia. Ga. Comp. R. & Regs. r

3 Hawaii (APRN) A CRNAs scope of practice allows a CRNA to be responsible for total anesthesia care of the patient including, but not limited to: pre-anesthetic preparation and evaluation, selection and administration of anesthetic agents or other agents administered in the management of anesthetic care, anesthesia induction, maintenance, emergence, and post anesthesia care; support life functions during the peri-operative period; recognize and be able to take appropriate action for untoward patient responses during anesthesia; observe and manage the patient's emergence from anesthesia; participate in the life support of the patient including, but not limited to, peri-anesthetic and clinical support functions; and participate in periodic and joint evaluation of services rendered including, but not limited to, chart reviews, case reviews, patient evaluations, and outcome of case statistics. WCHR The surgical center regulations require physician supervision of nurse anesthetists. WCHR Indiana (RN) CRNAs administer anesthesia under the direction of and in the immediate presence of a physician. Burns Ind. Code Ann Hospital: A CRNA must administer anesthesia under the direction of the operating practitioner or of a qualified physician who is immediately available if needed. 410 IAC ASC: A licensed physician with specialized training or experience in the administration of an anesthetic must supervise the administration of the anesthetic to a patient and remain present in the facility during the surgical procedure, except when only a local infiltration anesthetic is administered. Additionally, CRNA must administer anesthesia under the direction of and in the immediate presence of the operating physician or other physician. 410 IAC Illinois (APN) Nursing & Advanced Practice Nursing Act: APNs in hospitals & ASCs- An anesthesiologist, physician, dentist, or podiatrist shall participate through discussion of and agreement with the anesthesia plan and shall remain physically present and be available on the premises during the delivery of anesthesia services for diagnosis, consultation, and treatment of emergency medical conditions, unless hospital policy or ambulatory surgical treatment center policy provides otherwise. A CRNA may select, order, and administer medication for anesthesia services under the anesthesia plan agreed to by the anesthesiologist or the physician, in accordance with hospital alternative policy or the medical staff consulting committee policies of a licensed ambulatory. 225 ILCS 65/65-45 Kentucky (ARNP) Hospital: If an anesthesiologist does not administer anesthesia, the medical staff shall designate a medical staff anesthetist or RNA qualified to administer anesthetics at they administer anesthesia at the direction of the operating surgeon. 902 KAR 20:016

4 ASC: A nurse anesthetist acting under the direction of the operating surgeon shall administer the anesthetics and remain present during the surgical procedures and until the patient is fully recovered from the anesthetics. 902 KAR 20:106 Louisiana (APRN) CRNAs function under the direction and supervision of a physician or dentist. LA. Rev. Stat. Ann. 37:930. Maine (APRN) A CRNA may formulate and implement a patient-specific plan for anesthesia care which may include: (1) a pre-anesthetic assessment; (2) verification of informed consent; (3) adjustments and corrective actions as indicated. For aspects of anesthesia practice that require execution of the medical regimen, the CRNA must be responsible and accountable to a physician or dentist. CMR Hospital & Surgical center requires physician supervision of nurse anesthetists. ME ADC Ch. 112, Ch. 125 Maryland (RN) Collaboration is tantamount to direction Docket 115, Folio 2, File No , at 19 (Baltimore City Ct., May 12, 1980) Massachusetts (APN) Guidelines under which a nurse practices as a nurse anesthetist may authorize the CRNA to provide anesthesia only under the medical direction of a qualified physician expert by virtue of training or experience as a member of an anesthesia care team. The guidelines must also provide that a physician is immediately available. 244 CMR 4.25 CRNAs practice in accordance with written guidelines that must designate a physician who shall provide medical direction. 244 CMR 4.22 Michigan (RN) Supervision of the delegating practitioner. MCL Missouri (APRN) A nurse anesthetist must be permitted to provide anesthesia services without a collaborative practice arrangement provided that the nurse is under the supervision of an anesthesiologist or other physician, dentist, or podiatrist who is immediately available if needed R.S.Mo However nurse anesthetist are not prohibited or prevented from entering into a collaborative practice arrangement, except that the arrangement may not delegate the authority to prescribe any controlled substances listed in Schedules III, IV, and IV. ASC: All anesthetics shall be administered by anesthesiologists, physicians with training or experience in the administration of anesthetics, CRNAs or AAs supervised by an anesthesiologist, except for local anesthetic agents which may be administered by the attending physician, dentist or podiatrist. Each administration of a regional, general or intravenous sedation anesthetic shall be ordered by an anesthesiologist or a physician with training and experience in the administration of anesthetics. An anesthesiologist or

5 physician with training or experience in the administration of anesthetics shall be on the premises and readily accessible during the administration of anesthetics--whether local, general or intravenous sedation--and the postanesthetic recovery period until all patients are alert or medically discharged. 19 CSR Nevada (RN) The nursing statutes state that CRNAs are qualified to administer anesthetic agents to a person under the care of a licensed physician. Nev. Rev. Stat. Ann Hospital: A CRNA must be under the direction of the operating practitioner or of an anesthesiologist who is immediately available if needed. NAC ASC: Require the administration of anesthesia by a CRNA under the direction of the operating physician. NAC New Jersey (APN) ASC and Hospital: A CRNA may administer general or major regional anesthesia under the supervision of an anesthesiologist or physician who has privileges in accordance with medical staff bylaws to administer or supervise the administration of anesthesia; for conscious sedation, under the supervision of a privileged physician. N.J.A.C. 8:43A-12.5, N.J.A.C. 8:43G-6.3 New York (RN) Hospital: under the supervision of an anesthesiologist who is immediately available as needed or under the supervision of the operating physician who has been qualified by the governing body and medical staff to supervise the administration of anesthetics and has accepted responsibility for the supervision of a CRNA. 10 NYCRR ASC: When nonphysicians administer anesthesia, the anesthetist must be under the direct personal supervision of a qualified physician, who may be the operating surgeon. 10 NYCRR North Carolina (APRN) Nurse anesthetists may perform nurse anesthesia activities in collaboration with a physician, dentist, podiatrist, or other lawfully qualified health care provider, but may not prescribe a medical treatment regimen or make a medical diagnosis except under the supervision of a licensed physician. NC Admin. Code tit. 21, r NC courts declare state law as supervision. 169 N.C. App. 1; 610 S.E.2d 722; 2005 N.C. App. LEXIS 536; Review denied by N.C. Med. Soc'y v. N.C. Bd. of Nursing, 2005 N.C. LEXIS 1029 (N.C., Oct. 6, 2005) Ohio (APN) Supervision, which is defined as under the direction of a podiatrist, a dentist, or a physician, and, when administering anesthesia, the CRNA is in the immediate presence of the podiatrist, dentist, or physician. ORC Ann A CRNA may not administer general anesthesia under the supervision of a podiatrist in a podiatrist's office. Under the supervision and in the immediate presence of a physician, podiatrist, or dentist, a CRNA may administer anesthesia and perform anesthesia induction, maintenance, and

6 emergence, and may perform with supervision preanesthetic preparation and evaluation, postanesthesia care, and clinical support functions. ORC Ann ASC: The facility must apply to be certified by a national accrediting body approved by CMS for purposes of deemed compliance with the conditions for participating in the Medicare program as an ASC. The Conditions of Participation require physician supervision, unless the governor has opted out of such requirement. ORC Ann The ASC shall ensure that, following the administration of general anesthetics, patients are constantly attended by the responsible anesthesiologist, CRNA, anesthesia qualified dentist, physician or podiatrist acting within their scope of practice. OAC Ann Oklahoma (APN) Nurse Practice Act: A CRNA under the supervision of an MD/Do, podiatrist or dentist, and under conditions in which timely, on-site consultation by such individual is available, shall be authorized to order, select, obtain and administer legend drugs, Schedules II through V controlled substances, devices, and medical gases only when engaged in the preanesthetic preparation and evaluation; anesthesia induction, maintenance and emergence; and postanesthesia care. A CRNA may order, select, obtain and administer drugs only during the perioperative or periobstetrical period. 59 Okl. St a Hospital: If anesthetics are not administered by a qualified anesthesiologist, they shall be administered by CRNA under the supervision of the operating surgeon. O.A.C. 310: Pennsylvania (RN) Nursing regulations require cooperation with a surgeon or dentist. Cooperation is tantamount to collaboration. Hospital: Anesthesia care shall be provided by a CRNA under the supervision of the operating physician or anesthesiologist Pa. Code ASF: If a nonphysician administers the anesthesia, the anesthetist shall be under the overall direction of an anesthesiologist or a physician or dentist who is present in the ambulatory surgical facility. ASF. 28 Pa. Code Rhode Island (APN) Physician supervision is required. CRNA scope includes preoperative and postoperative assessment of patients; administering anesthetics; monitoring patients during anesthesia; management of fluid in intravenous therapy and management of respiratory care. R.I. Gen. Laws Hospital: physician supervision required; a physician must perform a pre-anesthetic. CRIR , 37.0 ASC: same as hospital; CRIR , 17 South Carolina (APRN) Nurse Practice Act: The physician or dentist responsible for the supervision of the CRNA must be identified on the anesthesia record before the administration of anesthesia. The

7 CRNA shall practice pursuant to approved written guidelines developed with the supervising physician. S.C. Code Ann (H) (2 &5) Tennessee (APN) Supervision is required by Tenn. Code Ann , which defines the practice of medicine. Services rendered by an RN must be under the supervision, control and responsibility of a licensed physician. CRNAs are now classified as APNs, who are RNs with advanced training in anesthesia. Pursuant to Tenn. Code Ann , nothing in this statute that defines APNS shall be interpreted to alter or change the current law as it existed on May 22, 2002, regarding prescriptive rights, supervision, or scope of practice for nurse anesthetists. Texas (APN) AG opinion states that the delegating physician retains discretion to impose a supervision requirement on his or her delegation to a nurse anesthetist working in a hospital or ASC. Opinion No. JC-0117 (1999) Utah (APRN-CRNA without prescriptive practice) Hospitals: Medicaid certified hospitals shall comply with the requirements of 42 CFR (a), Subpart D, Anesthesia Services. This is the federal law that requires physician supervision, unless the governor has opted out of this requirement. Utah is not an opt-out state. 42 CFR (a) Standard: Organization and staffing. The organization of the anesthesia services must be appropriate to the scope of services offered. Anesthesia must be administered only by - (1) A qualified anesthesiologist; (2) A doctor of medicine or osteopathy (other than an anesthesiologist); (3) A dentist, oral surgeon, or podiatrist who is qualified to administer anesthesia under State law; (4) A certified registered nurse anesthetist (CRNA), as defined in (b) of this chapter, who, unless exempted in accordance with paragrpah (c) of this section, is under the supervision of the operating practitioner or an anesthesiologist who is immediately available if needed; or (5) An anesthesiologist's assistant, as defined in (b) of this chapter, who is under the supervision of an anesthesiologist who is immediately available if needed. Virginia (NP)- CRNAs are classified as Nurse Practitioners (NP) NPs shall be authorized to engage in acts constituting the practice of medicine if such are performed in collaboration with and under the medical direction and supervision of a licensed physician. "Medical direction and supervision'' means participation in the development of a written protocol including provision for periodic review and revision; development of guidelines for availability and ongoing communications that provide for and define consultation among the collaborating parties and the patient; and periodic joint evaluation of services provided, e.g., chart review, and review of patient care outcomes.

8 Guidelines for availability shall address at a minimum the availability of the collaborating physician proportionate to such factors as practice setting, acuity, and geography. 18 VAC Hospitals: The anesthesia department/service shall be organized under written policies and procedures regarding staff privileges, the administration of anesthetics and supervision of anesthetists. 12 VAC (B) ASC: A. The anesthesia service shall be directed by and under the supervision of a physician licensed to practice medicine or surgery in Virginia. B. The physician responsible for the anesthesia service shall be present for the administration of anesthetics and recovery of patients when any general or major regional anesthetic is used. 12 VAC Wisconsin (APN) Hospital Regulations: If anesthetics are not administered by an anesthesiologist, they shall be administered by a registered nurse anesthetist, under supervision as defined by medical staff policy. The services provided by a nurse anesthetist shall be documented, as well as the supervision that the CRNA receives. Wis. Adm. Code DHS West Virginia (RN) Nursing regulations: CRNAs administer anesthesia in the presence and under the supervision of the physician or dentist. W. Va. Code Wyoming (APN) Nursing statutes & regulations allow collaboration; however, the hospital regulations require supervision. Hospital: CRNA administers anesthesia under the supervision of the operating physician. Wy ADC HLTH HQ Ch. 12 s. 10.