ANESTHESIA CARE TEAM
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ANESTHESIA CARE TEAM
Anesthesia Medications ::: A wide variety of drugs are used in modern anesthetic practice. Many are rarely used outside of anesthesia, although others are used commonly by all disciplines. Anesthetics are categorized in to two classes: general anesthetics , which cause a reversible loss of consciousness, and local anesthetics , which cause a reversible loss of sensation for a limited region of the body while maintaining consciousness. Combinations of anesthetics are sometimes used for their synergistic and additive therapeutic effects, however, adverse effects may also be increased. **See Below For A Quick Look At Anesthesia Medications
ANESTHESIA CARE TEAM
STATEMENT ON THE ANESTHESIA CARE TEAM
Distinction between situations where students may be alone with patients: During supervision of non-physician anesthetist students it may become necessary to leave them alone in operating rooms or procedure rooms (OR/PR) to accommodate needs of brief duration. This should only occur if judged to cause no significant increased risk to the patient.
This practice must be distinguished from that of scheduling non-physician students to patients as the primary anesthesia provider, meaning no fully trained anesthesia practitioner also assigned to the case and expected to be continuously present monitoring the anesthetized patient. While the brief interruption of 1:1 student supervision may well be necessary for the efficient and safe functioning of a department of anesthesiology, the use of non-physician students in place of fully trained and credentialed anesthesia personnel is not endorsed as best practice by the American Society of Anesthesiologists. While the education of non-physician anesthetist students is an important goal, patient safety remains paramount. Therefore, the conduct of this latter type of practice must meet certain conditions intended to protect the safety and rights of patients and students, as well as the best interests of all other parties directly or indirectly involved (i.e. involved qualified practitioners, patients' families, institutions, etc.).
1. All delegating anesthesiologists and the department chairperson must deem these non-physician student anesthetists fully capable of performing all duties delegated to them, and all students being delegated to must express agreement with accepting any responsibility delegated to them.
2. Privileging - A privileging process must precede this practice to officially and individually label each student as qualified to be supervised 1:2 by a qualified anesthesia practitioner who remains immediately physically available. Students must not be so privileged until they have completed a significant predetermined portion of both their didactic and clinical training that may reasonably be assumed to make this practice consistent with expected levels of safety and quality (if at all, at the earliest the last 3-4 months of student training). Privileging must be done under the authority of the Chief of Anesthesiology and in compliance with all federal, state, professional organization and institutional requirements.
3. Case Assignment and Supervision - These students must be supervised on a one-to-one or on a one-to-two ratio. Assignment of cases with regards to students must always be done in a manner that assures the best possible outcome for patients and the best education of students and therefore must be commensurate with the skills, training, experience, knowledge and willingness of each individual non-physician anesthesia student. Care should be taken to avoid placing students in situations that they are not fully prepared for. It is expected that most students will get their experience caring for high risk patients under the continuous supervision of fully trained anesthesia personnel. This is in the best interest of both education and patient safety. As students are incompletely trained, the degree of continuous supervision must be at a higher level than that required for fully trained and credentialed Anesthesiologist Assistantss and Nurse Anesthetists. If an anesthesiologist is engaged in the supervision of non-physician students, he/she must remain immediately physically available throughout the conduct of the involved anesthetics, meaning not leaving the OR/PR suite to provide other services or clinical duties that are commonly considered appropriate concurrent activities while directing fully trained and credentialed Anesthesiologist Assistants or Nurse Anesthetists.
4. Backup support - If an anesthesiologist is concurrently supervising two non-physician anesthetists students assigned as primary anesthesia providers (meaning the only anesthesia personnel continuously present with a patient), the anesthesiologist could be needed simultaneously in both rooms. To mitigate this potential risk, one other qualified anesthesia practitioner must also be assigned and must remain immediately physically available if needed (e.g., alone on call anesthesiologist should not be supervising more than one student without appropriately trained and credentialed back up immediately available).
5. Informed Consent - The Chief of Anesthesia is responsible for assuring that every patient (or their guardian) understands through a standardized departmental informed consent process that they may be in the OR/PR with only a non-physician student physically present, although still directed by the responsible anesthesiologist. As it is in the best interest of all involved parties, documentation of this aspect of informed consent must be included in the informed consent statement.
6. Disclosure to Professional Liability Carrier - To be assured of reliable professional liability insurance coverage for all involved (qualified anesthesia practitioners, their employers and the institution), the Chief of Anesthesia must notify the responsible professional liability carrier(s) of the practice of allowing non-physician anesthesia students to provide care without continuous direct supervision by a fully trained, credentialed and qualified anesthesia practitioner.
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