Joint Commission updates standards for anesthesia
Joint Commission updates standards for anesthesia
Measure competence for conscious sedation
To comply with updated anesthesia standards from the Joint Commission on Accreditation of Healthcare Organizations, same-day surgery programs in hospitals and surgery centers will have to define and measure competence of providers who perform conscious sedation.
Conscious sedation is now part of the anesthesia standards, says Stephen A. Vitkun, MD, PhD, professor and vice chairman of anesthesiology and professor of pharmacological sciences (clinical pharmacology) at State University of New York at Stony Brook.
"The Joint Commission has established more definitive definitions of the different types or levels of sedation," Vitkun says. (The updated standards are posted on the Joint Commission’s Web site: www.jcaho.org. Click on "what’s new.")
In the past, some health care facilities have neglected to write policies and procedures or give special attention to staff competence in the area of conscious sedation, says Robert E. Lee Jr., MD, PhD, associate project director of the Division of Research at the Joint Commission.
"These new standards should greatly help," Lee says. "They define and include moderate sedation or conscious sedation in the standards, so there’s no question: Should this be in this there?" Because previous standards didn’t specifically mention conscious sedation, some providers might have assumed it didn’t have to be addressed in their competencies or policies and procedures. "Now that will have to be addressed," he says.
While anesthesiologists presumably were trained in all forms of anesthesia, the Joint Commission wasn’t certain of other providers, says Burton S. Epstein, MD, professor emeritus of anesthesiology and pediatrics at George Washington University Medical Center in Washington, DC, and former chair of the Committee on Standards for the American Society of Anesthesiologists.
"The problem the Joint Commission was having was a question of what were non-anesthesiologists doing and whether they were trained to do what they were doing," he says.
The most important concept to remember is that anesthesia is a continuum, Epstein says. "The state you originally aimed for is not necessarily the state that is arrived at. As a result, if the patient inadvertently drifts into a deeper state, the complications are more frequent and life-threatening, and you better know how to deal with them."
It’s up to facilities to ensure that the non-anesthesiologists are competent to handle that situation by rescuing the patient.
"The key is whether the individual has the qualifications, in terms of training, experience, and education, to administer the drugs, monitor the patients, and rescue the patient if the individual reaches a state unintentionally [that is] deeper than the one intended," Epstein says.
You must measure competence, regardless of where the conscious sedation is performed in the operating room or another area, such as an endoscopy lab, Lee emphasizes. The expectations and details for clinical privileges in conscious sedation can be separate or can be incorporated into specific areas such as endoscopy, he says.
EXECUTIVE SUMMARY
The Joint Commission on Accreditation of Healthcare Organizations has updated its anesthesia standards to include conscious sedation.
- Hospitals and surgery centers will have to define and measure competence of providers who perform conscious sedation.
- You must measure competence, regardless of whether it is performed in the operating room or another area, such as an endoscopy lab. The expectations and details for clinical privileges can be separate or can be incorporated into specific areas such as endoscopy.
- Providers must be capable of "rescuing" a patient who unintentionally reaches a deeper level of sedation.
Sources
For more information, contact:
- Joint Commission on Accreditation of Healthcare Organizations, Standards Interpretation Group, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Telephone: (630) 792-5900. Fax: (630) 792-5942. Web:
www.standard.org.
- Stephen A. Vitkun, MD, PhD, Professor and Vice Chairman of Anesthesiology, Professor of Pharmacological Sciences (Clinical Pharmacol-ogy), University Medical Center, Department of Anesthesiology, HSC L4-060, State University of New York at Stony Brook, Stony Brook, NY 11794-8480.
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