Standard of Care for Office Surgery

 

DEPARTMENT OF HEALTH

Board of Medicine

RULE NO.:RULE TITLE:

64B8-9.009Standard of Care for Office Surgery

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 40 No. 182, September 18, 2014 issue of the Florida Administrative Register.

The changes are in response to written comments and oral testimony submitted to the Board from interested parties at the public hearings held on December 5, 2014, and February 5, 2015. The changes are as follows:

1. Subparagraph (2)(g)3.b.II(B)(II) shall read: Blood oxygenation: During all anesthetics, a quantitative method of assessing oxygenation such as a pulse oximetry shall be employed.* When the pulse oximeter is utilized, the variable pitch pulse tone and the low threshold alarm shall be audible to the qualifed anesthesia provider.* Adequate illumination and exposure of the patient are necessary to assess color.*

2. Subparagraph (2)(g)3bIII.(B)(II) shall read: When an endotracheal tube or supraglottic airway laryngeal mask is inserted, its correct positioning must be verified by clinical assessment and by identification of carbon dioxide in the expired gas. Continual end-tidal carbon dioxide analysis, in use from the time of endotracheal tube/supraglottic airway laryngeal mask placement, until extubation/removal or initiating transfer to a postoperative care location, shall be performed using a quantitative method such as capnography, capnometry or mass spectroscopy.* When capnography or capnometry is utilized, the end tidal carbon dioxide alarm shall be audible to the qualifed anesthesia provider.*

3. The proposed amendments to Subsection (3)(a)4., shall be withdrawn.

4. Subparagraph (3)(b)1. shall read: Training Required. Surgeon’s continuing medical education should include: proper dosages; management of toxicity or hypersensitivity to regional anesthetic drugs. One assistant must hold current certification in an American Heart Association or American Safety and Health Institute approved Basic Life Support course, and the surgeon must hold current certification in an American Heart Association or American Safety and Health Institute approved Advanced Cardiac Life Support course Basic Life Support Certification is recommended but not required.

5. Subparagraph (4)(b)2. b. shall read: One (1) assistant must be currently certified in and by an American Heart Associaton or American Safety and Health Institute approved Basic Life Support course and the surgeon must be currently certified in and by an American Heart Associaton or American Safety and Health Institute approved Advanced Cardiac Life Support course.

6. Subparagraph (4)(b)3.a.XIV. shall read: Lidocaine appropriate for cardiac administration 100 mg

7. Subparagraph (4)(b)3.a.XIX. shall read: Paralytic agent that is appropriate for use in rapid sequence intubation Succinylcholine 1 vial

8. Subparagraph (4)(b)4. shall read: Assistance of Other Personnel Required. The surgeon must be assisted by a qualified anesthesia provider as follows: An Anesthesiologist, Certified Registered Nurse Anesthesist, or Physician Assistant qualified as set forth in subparagraph 64B8-30.012(2)(b)6., F.A.C., or a registered nurse may be utilized to assist with the anesthesia, if the surgeon is ACLS certified. An anesthesiologist assistant may assist the anesthesiologist as set forth in Rule 64B8-31.005, F.A.C. An assisting anesthesia provider cannot function in any other capacity during the procedure. If additional assistance is required by the specific procedure or patient circumstances, such assistance must be provided by a physician, osteopathic physician, registered nurse, licensed practical nurse, or operating room technician. A physician licensed under Chapter 458 or 459, F.S., a licensed physician assistant, a licensed registered nurse with post-anesthesia care unit experience or the equivalent, credentialed by an American Heart Association or American Safety and Health Institute approved in Advanced Cardiac Life Support course or, in the case of pediatric patients, by an American Heart Association or American Safety and Health Institute approved Pediatric Advanced Life Support course and, must be available to monitor the patient in the recovery room until the patient is recovered from anesthesia.

9. Subparagraph (5)(b)2. shall read: Assistance of Other Personnel Required. During the procedure, the surgeon must be assisted by a physician or physician assistant who is licensed pursuant to Chapter 458 or 459, F.S., or by a licensed registered nurse or a licensed practical nurse. Additional assistance may be required by specific procedure or patient circumstances. Following the procedure, a physician or physician assistant who is licensed pursuant to Chapter 458 or 459, F.S., or a licensed registered nurse must be available to monitor the patient in the recovery room until the patient is recovered from anesthesia. The monitor must be certified by an American Heart Association or American Safety and Health Institute approved in Advanced Cardiac Life Support course, or, in the case of pediatric patients, by an American Heart Association or American Safety and Health Institute approved Pediatric Advanced Life Support course.

10. Subparagraph (6)(b)1.b. shall read: One assistant must be currently certified by an American Heart Association or American Safety and Health Institute approved in Basic Life Support course and the surgeon must be currently certified by an American Heart Association or American Safety and Health Institute approved in Advanced Cardiac Life Support course.

11. Subparagraph (6)(b)3.c. shall read: Blood pressure monitoring equipment; EKG; end tidal CO2 monitor; pulse oximeter, precordial or esophageal stethoscope, emergency intubation equipment and a temperature monitoring device.

12. Subparagraph (6)(b)4. shall read: Assistance of Other Personnel Required. An Anesthesiologist, Certified Registered Nurse Anesthetist, Anesthesiologist Assistant, or Physician Assistant qualified as set forth in subparagraph 64B8-30.012(2)(c)6., F.A.C., must administer the general or regional anesthesia and an M.D., D.O., Registered Nurse, Licensed Practical Nurse, Physician Assistant, or Operating Room Technician must assist with the surgery. The anesthesia provider cannot function in any other capacity during the procedure. A physician licensed under Chapter 458 or 459, F.S., a licensed anesthesiologist assistant, a licensed physician assistant, or a licensed registered nurse with post-anesthesia care unit experience or the equivalent, and credentialed by an American Heart Association or American Safety and Health Institute approved in Advanced Cardiac Life Support course, or in the case of pediatric patients, by an American Heart Association or American Safety and Health Institute approved Pediatric Advanced Life Support course, must be available to monitor the patient in the recovery room until the patient has recovered from anesthesia.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: André Ourso, J.D., M.P.H., Executive Director, Board of Medicine, 4052 Bald Cypress Way, Bin #C03, Tallahassee, Florida 32399-3253