22 Tex. Admin. Code § 173.2 - Standards for Anesthesia Services

(a) General Standards. When providing or delegating anesthesia services in an outpatient setting, physicians must ensure:

(1) compliance with delegation and supervision laws under Chapter 157 of the Act, including §157.058, regarding CRNAs;

(2) counseling and preparing patients for anesthesia per ASA standards;

(3) performing:

(A) a pre-anesthetic evaluation; and

(B) a pre-sedation evaluation, that includes at a minimum an airway evaluation and an ASA physical status classification;

(4) obtaining informed consent in accordance with state law, which includes communicating with the patient any sharing of responsibility for a patient's care with other physicians or non-physician anesthesia providers; and

(5) providing continuous appropriate physiologic monitoring of the patient, determined by the type of anesthesia and individual patient needs, both during and post procedure until ready for discharge, with continuous monitoring of:

(A) ventilation,

(B) oxygenation; and

(C) cardiovascular status.

(b) Minimum Equipment Requirements and Standards.

(1) Minimum equipment required. The outpatient setting must have the following equipment and drugs onsite for the handling of emergencies:

(A) monitoring equipment for Level II through Level IV procedures:

(i) pulse oximetry;

(ii) continuous EKG;

(iii) non-invasive blood pressure measured at least every five minutes; and

(iv) if deep sedation or general anesthesia is utilized, an end-tidal CO2 analyzer;

(v) if general anesthesia utilizing a closed circuit, an O2 analyzer;

(B) appropriate intravenous therapy equipment;

(C) a precordial stethoscope or similar device, and non-electrical blood pressure measuring device, for use in the event of an electrical outage;

(D) emergency equipment appropriate for the purpose of cardiopulmonary resuscitation;

(E) AED or other defibrillator, difficult airway equipment, as well as the drugs and equipment necessary for the treatment of malignant hyperthermia, if using triggering agents associated with malignant hyperthermia or if the patient is at risk for malignant hyperthermia; and

(F) a means to measure temperature, which shall be readily available and utilized for continuous monitoring when indicated per current ASA standards.

(2) Equipment Standards.

(A) Equipment must be appropriately sized for the patient population being served.

(B) All anesthesia-related equipment and monitors must be maintained to current operating room standards.

(C) Regular service or maintenance checks must be completed by appropriately qualified biomedical personnel, at least annually or per manufacturer recommendations.

(D) A separate equipment maintenance log must contain:

(i) service check information including date performed;

(ii) a clear description of any equipment problems and the corrective action; and

(iii) if substandard equipment was utilized without corrective action, a description of how patient safety was protected.

(E) The equipment maintenance log must be retained for seven years from the date of inspection.

(F) An audible signal alarm device capable of detecting disconnection of any component of the breathing system shall be utilized.

(3) Emergency Supplies.

(A) All required emergency supplies must be maintained and inspected by qualified personnel for presence and proper function intervals established by protocol.

(B) All medication, drugs, and supplies must not be expired.

(C) Personnel must be trained on the use of emergency equipment and supplies.

(D) A separate emergency supply log must include dates of inspections. The log must be retained for seven years from the date of inspection.

(4) Emergency Power Supply and Communication Source.

(A) Outpatient settings must have a secondary power source as appropriate for equipment in use, in case of power failure.

(B) A two-way communication source not dependent on electrical current shall be available.

(5) Protocols.

(A) The outpatient setting must have written protocols regarding:

(i) patient selection criteria;

(ii) patients or providers with latex allergy;

(iii) pediatric drug dosage calculations, where applicable;

(iv) ACLS or PALS algorithms;

(v) infection control;

(vi) documentation and tracking use of pharmaceuticals, including controlled substances, expired drugs and wasting of drugs; and

(vii) discharge criteria.

(B) The outpatient setting must have written protocols regarding emergency transfer procedures for cardiopulmonary emergencies that include:

(i) a specific plan for securing a patient's airway pending EMS transfer to the hospital; and

(ii) have appropriate ACLS algorithms available in the office to assist with patient stabilization until EMS arrives.

(C) For outpatient settings that are located in counties lacking 9-1-1 service entities supported by EMS providers licensed at the advanced life support level, physicians must enter into emergency transfer agreements with a local licensed EMS provider or accredited hospital-based EMS. The agreement's terms must require EMS to bring staff and equipment necessary for advanced airway management equal to or exceeding that which is in place at the outpatient setting.

(D) The written protocols, including the emergency transfer agreements, must be evaluated and reviewed at least annually.

Notes

22 Tex. Admin. Code § 173.2

The provisions of this §173.2 adopted to be effective March 5, 2000, 25 TexReg 1623; amended to be effective December 30, 2007, 32 TexReg 9629; Adopted by Texas Register, Volume 50, Number 02, January 10, 2025, TexReg 0358, eff. 1/9/2025