Per Diem Nurse Anesthetist-QHC/ELM-12270-033

Under the supervision of an Attending Anesthesiologist, this employee administers, monitors and manages patient’s care before and after anesthesia. Relies on experience and judgment to plan and accomplish goals.  Performs a variety of tasks. Reports to Attending Anesthesiologists. A certain degree of creativity and latitude is required.  Nurse Anesthetists will rotate responsibility for daily scheduling of case coverage.

1.  In conjunction with attending anesthesiologist, Nurse Anesthetist will perform a thorough and complete pre-anesthesia assessment. Nurse Anesthetist is responsible for obtaining reviewing relevant tests and discussing findings with the Attending.
   
    
2.  The Nurse Anesthetist shall obtain or verify that an informed consent has been obtained for the planned anesthetic intervention from the patient or legal guardian.  Discuss anesthetic options and risks with the patient and/or legal guardian after discussion with Attending Anesthesiologist.  Nurse Anesthetists must document in the patient’s medical record that informed consent was obtained.
   
    
3. The Nurse Anesthetist, in conjunction with the Anesthesiologist, must formulate a patient-specific plan for anesthesia care. The plan is based upon comprehensive patient assessment, problem analysis, anticipated surgical or therapeutic procedure, patient and surgeon preferences and current anesthesia principles.
   
    
4. The Nurse Anesthetist shall induce anesthesia under the supervision of an Attending Anesthesiologist and maintain anesthesia at required levels.  The Nurse Anesthetist shall continuously assess the patient’s response to the anesthetic and/or surgical intervention and must immediately notify the Attending Anesthesiologist of significant changes in the patient’s condition and intervene as required, under the supervision of an Attending Anesthesiologist to maintain the patient in a satisfactory physiologic condition.
   
    
5. The Nurse Anesthetist must monitor the patient’s physiologic condition as appropriate for the type of anesthesia and specific patient needs:
   
   A.        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 ventilation. Use spirometry and ventilatory pressure monitors.
    

            B.        Monitor Oxygenation continuously by clinical observation, pulse oximetry, and if                            indicated, arterial blood gas analysis.

            C.        Monitor cardiovascular status continuously via electrocardiogram and heart sounds.                        Record blood pressure and heart rate.

            D.        Monitor body temperature continuously on all pediatric patients receiving general                            anesthesia and when indicated, on all other patients.

            E.         Monitor neuromuscular function and status when neuromuscular blocking agents                             are administered.

            F.         Monitor and assess the patient positioning and protective measures.  The omission                           of any monitoring standards shall be documented and the reason stated on the patient’s anesthesia record. The Nurse Anesthetist shall be in constant attendance of the patient until another qualified health care provider has accepted the responsibility for care.

6. The Nurse Anesthetist is responsible for maintaining complete, accurate, and timely documentation of pertinent information on the patient’s medical record.  Must document all anesthetic interventions, and patient responses.

7. The Nurse Anesthetist is responsible for transferring the responsibility for care of the patient to other qualified providers in a manner that assures continuity of care and patient safety.

8. The Nurse Anesthetist must adhere to appropriate safety precautions, as established within the institution, to minimize the risks of fire, explosion, electrical shock and equipment malfunction. Document on the patient’s medical record that the anesthesia machine and equipment were checked.

Prior to use, the Nurse Anesthetist shall inspect the anesthesia machine and monitors according to established guidelines. The Nurse Anesthetist shall check readiness, availability, cleanliness, and working condition of all equipment to be utilized in the administration of the anesthesia care.  When the patient is ventilated by an automatic mechanical ventilator, monitor the integrity of the breathing system with a device capable of detecting a disconnection by emitting an audible alarm.  Monitor oxygen concentration continuously with an oxygen supply failure alarm system.

9. Precautions shall be