Standards for Nurse Anesthesia Practice

Standard XI- Basic rights of patients

Respect and maintain the basic rights of patients

Standard IV- Implement care plan

Implement and adjust the anesthesia care plan based on the patient's physiologic status. Continuously assess the patient's response to the anesthetic, surgical intervention, or procedure. Intervene as required to maintain the patient in optimal physiologic condition.

Standard V (d)- Thermoregulation

When clinically significant changes in body temperature are intended, anticipated, or suspected, monitor body temperature in order to facilitate the maintenance of normothermia.

Standard VIII- Equipment safety/maintenance

Adhere to appropriate safety precautions as established within the practice setting to minimize the risks of fire, explosion, electrical shock and equipment malfunction. Based on the patient, surgical intervention or procedure, ensure that the equipment reasonably expected to be necessary for the administration of anesthesia has been checked for proper functionality and document compliance. When the patient is ventilated by an automatic mechanical ventilator, monitor the integrity of the breathing system with a device capable of detecting a disconnection by emitting an audible alarm. When the breathing system of an anesthesia machine is being used to deliver oxygen, the CRNA should monitor inspired oxygen concentration continuously with an oxygen analyzer with a low concentration audible alarm turned on and in use.

Standard V (c) - Cardiovascular

Continuously monitor cardiovascular status via electrocardiogram. Perform auscultation of heart sounds as needed. Evaluate and document blood pressure and heart rate at least every five minutes.

Standard V (a)- Oxygenation

Continuously monitor oxygenation by clinical observation and pulse oximetry. It indicated, continually monitor oxygenation by arterial blood gas analysis

Standard V (b)- Ventilation

Continuously monitor ventilation. Verify intubation of the trachea or placement of other artificial airway devices by auscultation, chest excursion, and confirmation of expired carbon dioxide. Use ventilatory pressure monitors as indicated. Continuously monitor end-tidal carbon dioxide during controlled or assisted ventilation and any anesthesia or sedation technique requiring artificial airway support. During moderate or deep sedation, continuously monitor for the presence of expired carbon dioxide.

Standard VI- Documentation

Document pertinent anesthesia-related information on the patient's medical record in an accurate, complete, legible, and timely manner.

Standard VII- Safe hand-off

Evaluate the patient's status and determine when it is safe to transfer the responsibility of care. Accurately report the patient's condition, including all essential information, and transfer the responsibility of care to another qualified healthcare provider in a manner that assures continuity of care and patient safety.

Standard III- Patient-specific anesthesia care plan

Formulate a patient-specific plan for anesthesia care.

Standard V (f)- Positioning

Monitor and assess patient positioning and protective measures, except for those aspects that are performed exclusively by one or more other providers.

Standard V- Intraoperative monitoring until hand-off

Monitor, evaluate, and document the patient's physiologic condition as appropriate for the type of anesthesia and specific patient needs. When any physiological monitoring device is used, variable pitch and threshold alarms shall be turned on and audible. The CRNA should attend to the patient continuously until the responsibility of care has been accepted by another anesthesia professional.

Standard II- Informed Consent

Obtain and document informed consent for the planned anesthetic intervention from the patient or legal guardian, or verify that informed consent has been obtained and documented by a qualified professional.

Standard X- Continuous evaluation

Participate in the ongoing review and evaluation of anesthesia care to assess quality and appropriateness.

Standard I - Preoperative Evaluation

Perform and document a thorough preanesthesia assessment and evaluation.

Standard IX- Infection Control

Verify that infection control policies and procedures for personnel and equipment exist within the practice setting. Adhere to infection control policies and procedures as established within the practice setting to minimize the risk of infection to the patient, the CRNA, and other healthcare providers.

Standard V (e)- Neuomuscular

When neuromuscular blocking agents are administered, monitor neuromuscular response to assess depth of blockade and degree of recovery.