onward Dec 19, 1997, a notice in th...

onward Dec 19, 1997, a notice in the Federal Register alerted AORN to propos changes to the behaviors governing surgical and anesthesia services subject to the Conditions of Participation for Hospitals Receiving Medicare/Medicaid Reimbursement by way of the Health Care Financing Administration (HCFA). The propos government would eliminate the RN from supervising the OR and the scour person and from circulating duties.

Information about AORN's answer approved by the Board of Directors for submission to HCFA through the April 17, 1998, increaseed deadline, appears on page 653 Although AORN is alarmed and will vehemently oppose the removal of the RN from the OR, the of recent origin HCFA philosophy behind the mastery change has many positive aspects that also will be addressed in AORN's answer In addition to the official replication David Hebert, the AORN federal liaison at the American Association of cherish Anesthetists, arranged a meeting Feb 10 1998 between AORN President Jeannie Botsford; Peter Bouxsein, director of the HCFA Office of Clinical Standards and Quality; and Mary Vienna, director of the HCFA clinical standards assemblage to discuss our concerns and to glance at corrections.

This summary of the domination change outlines the existing governments governing surgical services staffing in facilities reimbursed end Medicare and Medicaid, the specific changes that affect perioperative nursing, and the other major points of the propos rule

now passing LAW

According to 42 CFR [sections] 48251 titled "Condition of Participation: Surgical Services," the standard for organization and staffing requires that an experienced RN or a doctor of medicine or osteopathy supervise ORs. Licensed practical suckles (LPNs) and surgical technologists (STs) referr to as "OR technicians," may obey as scrub persons under the supervision of an RN The sway authorizes qualified RNs to perform circulating duties in the OR; however, LPN and ST also may assist in circulatory duties if they are delegated by

a qualified RN who is

immediately available to

answer to emergencies in

accordance with applicable

state laws and approved

medical staff policies and

procedures

Surgical privileges are to be outlined for all practitioners performing surgery in accordance with the competencies and end of practice of each practitioner. A list of practitioners and their surgical privileges is to be maintained by way of the hospital surgical services for public review.

PROPOS CHANGES AFFECT PERIOPERATIVE NURSING

The of recent origin conditions proposed under Surgical and Anesthesia Services ([sections] 48245) will replace [sections] 48251 which pertains to surgical services, and [sections] 48252 which pertains to anesthesia services. the couple services are discussed together because of their complete relationship in the OR. This is the section that chiefly affects AORN members.

below the proposed rule change, requirements to have the rub hard and circulating duties associated with surgery that are supervised by dint of an RN would be eliminated In addition, the recently made known proposal would require that "surgical practices be performed only by practitioners with appropriate clinical privileges," and that CRNAs may administer anesthesia without supervision at another practitioner in hospitals, ambulatory surgery center and critical access hospitals. If state law has a more stringent authority patient care would need to be furnished consistent with state law.

With regard to maintaining patient safety, HCFA tenders to require that

a comprehensive assessment

be performed before surgery

and that a preanesthesia

evaluation be done by dint of an

individual qualified to

administer anesthesia.

Although RN usually ways patient assessments before surgery, the mastery change does not identify the provider to career this assessment, and the postanesthesia evaluation is required to be course of lifeed by an individual qualified to administer anesthesia.

Contending that the more specific requirements for documentation of care is consistent with existing surgical practices, HCFA requires the following information to be pierceed into the medical record:

* a report of the comprehensive or modified presurgical assessment before surgery reject in the case of an pass in which the report is allowed immediately after surgery;

* a suitably executed informed consent form;

* a surgical report describing complications, reactions, continuance of time, techniques, findings, and tissues remov or altered,

* a record of intraoperative anesthesia; and

* a report of the postanesthesia evaluation.

The practitioner responsible for making the assessments and ensuring that the appropriate documentation is made is not identified in the recent proposal, except in the case of reports involving anesthesia. In that case, reports are to be made by means of "a person qualified to administer anesthesia."

BACKGROUND TO THE PROPOSAL

Pursuant to President Clinton's and Vice President Gore's regulatory reform initiative, HCFA is attempting to streamline the behaviors and regulations for hospitals that participate in the Medicare and Medicaid programs in light of advances in patient care delivery and quality assessment practices in the last several years. The regulations have not been changed since 1986 The proposal also includes changes in the interaction between hospitals and organ procuration organizations, as well as conditions for the termination of a participating provider facility agreement.