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New CMS Anesthesia Guidelines Completely Rewrite Former Standards

Matt Phillion, for HealthLeaders Media, April 13, 2010

Supervision of anesthesiology assistants

The guidelines also include the supervision of anesthesiology assistants (AA) for those states that recognized this category of healthcare workers. Some states have opted out of the supervision requirement meaning that the CRNA does not need any physician supervision.

In states that have not opted out, the CRNA must be supervised by the operating physician or by an anesthesiologist who is immediately available.

Immediately available, explains Dill Calloway, means the anesthesiologist is within the same area, such as in the OR or the labor and delivery unit, and is not occupied. In other words, they should not be prevented from immediately conducting hands-on intervention, if needed.

If the hospital allows the operating surgeon to supervise the CRNA, there must be medical staff bylaws or rules and regulations that specify for each category of operating practitioner, the type and complexity of procedures that category of practitioner may supervise. However, individual operating surgeons do not need to be granted specific privileges to supervise a CRNA.

A pre-anesthesia evaluation must be done within 48 hours prior to surgery and documented in the medical record, Dill Calloway explains. This must be done by a qualified person, like a CRNA, AA, physician, or anesthesiologist for patients under going anesthesia such as a general, regional, or MAC. It must be done within 48 hours prior to the delivery of the first dose of medication given for the purpose of inducing anesthesia. CMS sets forth what should be documented as part of the pre-anesthesia evaluation as does The Joint Commission and ASA.

CMS now requires a few items to be documented as part of the intraoperative anesthesia record. This includes:

  • Name and hospital identification number of the patient

  • Name of practitioner who administered anesthesia, and as applicable, the name and profession of the supervising anesthesiologist or operating practitioner

  • Name, dosage, route, and time of administration of drugs and anesthesia agents

  • Techniques used and patient position, including the insertion/use of any intravascular or airway devices;
  • Name and amounts of IV fluids, including blood or blood products if applicable

  • Time-based documentation of vital signs as well as oxygenation and ventilation parameters

  • Any complications, adverse reactions, or problems occurring during anesthesia, including time and description of symptoms, vital signs, treatments rendered, and patient's response to treatment


Matt Phillion, CSHA, is senior managing editor of Briefings on The Joint Commission and senior editorial advisor for the Association for Healthcare Accreditation Professionals (AHAP).

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