Header:
KANSAS ADMINISTRATIVE REGULATIONS
AGENCY 100 KANSAS STATE BOARD OF HEALING ARTS
ARTICLE 25. OFFICE REQUIREMENTS
Date:
08/31/2009
Document:
100-25-3. Requirements for office-based surgery and special procedures.
A physician shall not perform any office-based surgery or special procedure unless the office meets the requirements of K.A.R. 100-25-2. Except in an emergency, a physician shall not perform any office-based surgery or special procedure on and after January 1, 2006 unless all of the following requirements are met: (a) Personnel.
(1) All health care personnel shall be qualified by training, experience, and licensure as required by law.
(2) At least one person shall have training in advanced resuscitative techniques and shall be in the patient's immediate presence at all times until the patient is discharged from anesthesia care.
(b) Office-based surgery and special procedures.
(1) Each office-based surgery and special procedure shall be within the scope of practice of the physician.
(2) Each office-based surgery and special procedure shall be of a duration and complexity that can be undertaken safely and that can reasonably be expected to be completed, with the patient discharged, during normal operational hours.
(3) Before the office-based surgery or special procedure, the physician shall evaluate and record the condition of the patient, any specific morbidities that complicate operative and anesthesia management, the intrinsic risks involved, and the invasiveness of the planned office-based surgery or special procedure or any combination of these.
(4) The physician or a registered nurse anesthetist administering anesthesia shall be physically present during the intraoperative period and shall be available until the patient has been discharged from anesthesia care.
(5) Each patient shall be discharged only after meeting clinically appropriate criteria. These criteria shall include, at a minimum, the patient's vital signs, the patient's responsiveness and orientation, the patient's ability to move voluntarily, and the ability to reasonably control the patient's pain, nausea, or vomiting, or any combination of these.
(c) Equipment.
(1) All operating equipment and materials shall be sterile, to the extent necessary to meet the applicable standard of care.
(2) Each office at which office-based surgery or special procedures are performed shall have a defibrillator, a positive-pressure ventilation device, a reliable source of oxygen, a suction device, resuscitation equipment, appropriate emergency drugs, appropriate anesthesia devices and equipment for proper monitoring, and emergency airway equipment including appropriately sized oral airways, endotracheal tubes, laryngoscopes, and masks.
(3) Each office shall have sufficient space to accommodate all necessary equipment and personnel and to allow for expeditious access to the patient, anesthesia machine, and all monitoring equipment.
(4) All equipment shall be maintained and functional to ensure patient safety.
(5) A backup energy source shall be in place to ensure patient protection if an emergency occurs.
(d) Administration of anesthesia. In an emergency, appropriate life-support measures shall take precedence over the requirements of this subsection. If the execution of life-support measures requires the temporary suspension of monitoring otherwise required by this subsection, monitoring shall resume as soon as possible and practical. The physician shall identify the emergency in the patient's medical record and state the time when monitoring resumed. All of the following requirements shall apply:
(1) A preoperative anesthetic risk evaluation shall be performed and documented in the patient's record in each case. In an emergency during which an evaluation cannot be documented preoperatively without endangering the safety of the patient, the anesthetic risk evaluation shall be documented as soon as feasible.
(2) Each patient receiving intravenous anesthesia shall have the blood pressure and heart rate measured and recorded at least every five minutes.
(3) Continuous electrocardiography monitoring shall be used for each patient receiving intravenous anesthesia.
(4) During any anesthesia other than local anesthesia and minimal sedation, patient oxygenation shall be continuously monitored with a pulse oximeter. Whenever an endotracheal tube or laryngeal mask airway is inserted, the correct functioning and positioning in the trachea shall be monitored throughout the duration of placement.
(5) Additional monitoring for ventilation shall include palpation or observation of the reservoir breathing bag and auscultation of breath sounds.
(6) Additional monitoring of blood circulation shall include at least one of the following:
(A) Palpation of the pulse;
(B) auscultation of heart sounds;
(C) monitoring of a tracing of intra-arterial pressure;
(D) pulse plethysmography; or
(E) ultrasound peripheral pulse monitoring.
(7) When ventilation is controlled by an automatic mechanical ventilator, the functioning of the ventilator shall be monitored continuously with a device having an audible alarm to warn of disconnection of any component of the breathing system.
(8) During any anesthesia using an anesthesia machine, the concentration of oxygen in the patient's breathing system shall be measured by an oxygen analyzer with an audible alarm to warn of low oxygen concentration.
(e) Administrative policies and procedures.
(1) Each office shall have written protocols in place for the timely and safe transfer of the patients to a prespecified medical care facility within a reasonable proximity if extended or emergency services are needed. The protocols shall include one of the following:
(A) A plan for patient transfer to the specified medical care facility;
(B) a transfer agreement with the specified medical care facility; or
(C) a requirement that all physicians performing any office-based surgery or special procedure at the office have admitting privileges at the specified medical care facility.
(2) Each physician who performs any office-based surgery or special procedure that results in any of the following quality indicators shall notify the board in writing within 15 calendar days following discovery of the event:
(A) The death of a patient during any office-based surgery or special procedure, or within 72 hours thereafter;
(B) the transport of a patient to a hospital emergency department;
(C) the unscheduled admission of a patient to a hospital within 72 hours of discharge, if the admission is related to the office-based surgery or special procedure;
(D) the unplanned extension of the office-based surgery or special procedure more than four hours beyond the planned duration of the surgery or procedure being performed;
(E) the discovery of a foreign object erroneously remaining in a patient from an office-based surgery or special procedure at that office; or
(F) the performance of the wrong surgical procedure, surgery on the wrong site, or surgery on the wrong patient.
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