New CMS Anesthesia Regulations
August 24, 2010
By
Mary Peters, RN,BS
Objectives
After presentation you will be able to
understand:
 CMS definition of anesthesia
 Who can administer anesthesia
 Documentation and elements of the
pre-, intra- and post- operative
requirements
When and Why. . .
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Released December 9, 2009
Revised February 5, 2010
Clarification of the requirements
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Types of anesthesia services subject to the
requirements
Additional details on the pre-, intra-, and
post-operative anesthesia requirements
New regs applicable to. . .
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General
Regional
Monitored anesthesia care
Deep Sedation
Regulations do not apply to. .
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Topicals
Locals
Minimal sedation
Moderate sedation
Anesthesia Services
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Must be organized into one anesthesia
service no matter where they are
furnished, such as the OR, OB unit, ED,
psychiatric dept, GI unit, or outpatient
surgery areas
Must be under the direction of qualified
physician
Who can administer anesthesia?
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Qualified anesthesiologist
A MD or DO (who is not anesthesiologist)
Dentist, oral surgeon, or podiatrist who is
qualified under state law
CRNA who is supervised by the operating
practitioner or anesthesiologist
Anesthesiologist's assistant who immediately
available if needed
Hospital Policy
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Must address the circumstances under
which and MD Or Do who is not an
anesthesiologist is permitted to
administer anesthesia
Must follow accepted standards of
anesthesia care when establishing
policy and procedure
Hospital Policy
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Must address how the hospital’s anesthesia
services needs will be met
Should address: patient consent, infection
control measures, safety practices, protocol
for cardiac and respiratory emergencies,
reporting requirements, documentation
requirements, equipment requirements, and
delineation of pre-and post-anesthesia staff
responsibilities
Pre-anesthesia evaluation
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Performed for each patient who receives
general, regional or monitored anesthesia
Performed by someone qualified to administer
anesthesia
Cannot be delegated to practitioners who are
not qualified to administer anesthesia
Must be performed within 48 hours prior to
any inpatient or outpatient surgery or
procedure requiring anesthesia services.
Pre-anesthesia evaluation
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Must include at a minimum: review of medical history
Interview and examination of the patient
Notation of anesthesia risk
Identification of potential anesthesia problems
Additional pre-anesthesia evaluation, if applicable,
i.e., stress test, consultation
Development of the plan for the patient’s anesthesia
care to include discussion with patient or patient’s
representative of the risks and benefits of the deliver
of anesthesia
Intraoperative anesthesia record
Must include at a minimum:
 Patient name and ID number
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Name(s) of practitioner who administers anesthesia and as
applicable the supervisor
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Name, dosage, route and time of the administration of drugs
and anesthesia agents, techniques used and patient position
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Name and amounts of IV fluids (including blood products
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Timed-based documentation of vital signs, oxygenation and
ventilation parameters
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Any complication, adverse reactions, or problems occurring
during anesthesia
Post-anesthesia evaluation
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Must be completed and documented by
individual qualified to administer anesthesia
Must be no later than 48 hours after surgery
of procedure requiring anesthesia services
Calculation of the 48 hour timeframe begins
when patient is moved into the designated
recovery area (exception where post-op
sedation is necessary for the optimum patient
care, example ICU)
Post-anesthesia evaluation continued
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May not begin until the patient is
sufficiently recovered from anesthesia
so as to participate in the evaluation
Can occur in the PACU or other
designated recovery area
For outpatients, must occur prior to the
patient’ discharge
Post-anesthesia evaluation continued
Elements of documented evaluation must include:
 Respiratory function, including respiratory rate,
airway patency, and oxygen saturation
 Cardiovascular function, including pulse rate an d
blood pressure
 Mental status
 Temperature
 Pain
 Nausea and vomiting
 Postoperative hydration
Questions?????
Contact Mary Peters
 Email- mpeters@ghs.org