Responsibilities and Scopes of Practice
Responsibilities and Scopes of Practice
Responsibility for the anesthetist starts and finishes in the ward that is assessing the patient preoperatively and sending back to his ward after the effects of anesthesia wear out. Anaesthetized patients can be compared to people setting out on a journey -in this case a journey into unconsciousness and back - and it is the anesthesia professional that steers the course. Anesthesia professionals must therefore know as much as possible about their patients how they are made and how they function according their level. They must assess each patient carefully before the journey. They must know how to modify techniques to compensate for pre-existing problems and for when unexpected problems occur. The journey must be as safe as possible.
They must know their drugs, their equipment and their techniques - specific techniques for specific situations. They are honor-bound to watch their patients meticulously on the journey in order to detect any problems as soon as they arise and treat them appropriately. They must be experts in resuscitation. A safe journey back to consciousness must be the anesthesia professional's ultimate goal, though this cannot always be guaranteed. Ideally, the patient should be returned to the ward fully conscious, none the worse for the journey and if possible, even better.
Anesthesia and anesthesia-related care represents those services which anesthesia professionals provide by assignment or upon request of other healthcare provider authorized by law (e.g., surgeon, obstetrician, gynecologist...), most often to facilitate diagnostic, therapeutic and surgical procedures. The scope of practice of the anesthesia professional addresses the responsibilities associated with anesthesia practice that are performed in collaboration with other qualified healthcare providers.
Collaboration is a process which involves two or more parties working together, each contributing his or her respective area of expertise. Anesthetist nurse practice according to their expertise, state statutes and regulations, and institutional policy and are responsible for the quality of services they render and it includes:
- Perform a thorough and complete preanesthesia assessment.
- Obtain informed consent for the planned anesthetic intervention from the patient or legal guardian.
- Formulate a patient-specific plan for anesthesia care.
- Implement and adjust the anesthesia care plan based on the patient's physiologic response.
- Monitor the patient's physiologic condition as appropriate for the type of anesthesia and specific patient needs.
- Monitor ventilation continuously: Verify intubation of the trachea by auscultation, chest excursion, and confirmation of carbon dioxide in the expired gas. Continuously monitor end-tidal carbon dioxide during controlled or assisted ventilations. Inducing any anesthesia or sedation technique requiring airway support. Use spirometer and ventilator pressure monitor as indicated.
- Monitor oxygenation continuously by clinical observation and pulse oximetry.
- Monitor cardiovascular status continuously via electrocardiography and heart sounds. Record blood pressure and heart rate at least every five minutes.
- Monitor body temperature continuously on all patients receiving general anesthesia.
- Monitor neuromuscular function and status when neuromuscular blocking agents are administered.
- Monitor and assess the patient positioning and protective measures.
- There shall be a complete, accurate, and timely documentation of pertinent information on the patient's medical record.
- Transfer the responsibility for care of the patient to other qualified providers in a manner which assures continuity of care and patient safety.
- Adhere to appropriate safety precautions, as established within the institution, to minimize the risks of fire, explosion, electrical shock, and equipment malfunction. Documentation on the patient's medical record should reflect the anesthesia machine and equipment were checked.
- Precaution shall be taken to minimize the risk of infection to the patient, the nurse anesthetist, and other health care providers.
- Anesthesia care shall be assessed to assure its quality and contribution to positive patient outcomes.
- The nurse anesthetist shall respect and maintain the basic rights of patients.
- Participate in a managerial and administrative work as health care team.
- Provide assistance in emergency and other health care service when required.