Texas Register, Volume 30, Number 43, Pages 6973-7094, October 28, 2005 Page: 7,039
This periodical is part of the collection entitled: Texas Register and was provided to The Portal to Texas History by the UNT Libraries Government Documents Department.
- Highlighting
- Highlighting On/Off
- Color:
- Adjust Image
- Rotate Left
- Rotate Right
- Brightness, Contrast, etc. (Experimental)
- Cropping Tool
- Download Sizes
- Preview all sizes/dimensions or...
- Download Thumbnail
- Download Small
- Download Medium
- Download Large
- High Resolution Files
- IIIF Image JSON
- IIIF Image URL
- Accessibility
- View Extracted Text
Extracted Text
The following text was automatically extracted from the image on this page using optical character recognition software:
the word "direction" to better define the duties of the physician
related to the oversight of the anesthesia service.
Response: The department agrees. Although the rule as pro-
posed contained the same language as appears in the current
rule, and the department was unaware of any issues related to
the interpretation of this rule, the department has no objection to
adding the recommended language for clarification of the rule.
The requested changes have been included.
Comment: Regarding 135.11(a)(3), one commenter stated
that the medical staff should only be responsible for establishing
practice guidelines and standards, and the governing body
should be responsible for enforcing them.
Response: The department agrees and has made the requested
change.
Comment: Regarding 135.11(a)(3)(A), three commenters
stated that requiring a certified registered nurse anesthetist
(CRNA) to follow the ASA standards would be in direct conflict
with the rules and practice guidelines of the Board of Nurse
Examiners (BNE). One of the commenters suggested that it
would be more appropriate for the policies of the anesthesia
service to require that the anesthesia provider practice in
accordance with the practice standards and regulations of their
own licensing boards.
Response: The department agrees. The rule has been revised
to require that policies and guidelines for the anesthesia ser-
vice include only "consideration" of the standards and guide-
lines of the ASA, as well as the American Association of Nurse
Anesthetists (AANA), and the licensing rules and standards of
each relevant professional licensing board. The requirement
that ASCs follow the ASA guidelines and standards has been
deleted.
Comment: Regarding 135.11(a)(3)(A), a commenter requested
clarification of the application of the term "anesthesiologist" in
the ASA guidelines and whether this would apply to all types of
providers qualified to administer anesthesia under state law.
Response: The department has deleted the language in
135.11(a)(3)(A) - (C) requiring that ASCs follow the ASA
standards and guidelines.
Comment: Regarding 135.11(a)(3)(A), one commenter re-
quested that the department also include the following ASA
standards and guidelines in the final rules: Practice Guidelines
for Preoperative Fasting; Practice Advisory for Pre-Anesthesia
Evaluation; Guidelines for Non-Operating Room Anesthetizing
Locations; and Guidelines for Sedation and Analgesia by
Non-Anesthesiologist.
Response: The department agrees in part. Based on consider-
ation of other comments received, the department has deleted
the language requiring that ASCs follow the ASA standards and
guidelines. The revised rules only require that the ASA guide-
lines and standards be considered, along with the guidelines and
standards of the AANA, as well as practice standards from rele-
vant licensing boards. Each ASC should consider those guide-
lines and standards they deem appropriate to their organization.
No changes were made as a result of this comment.
Comment: Concerning proposed 135.11(a)(4)(C), one com-
menter was concerned because the rule implied that a CRNA
must practice under the supervision of the operating physician
or anesthesiologist, which is not consistent with Attorney Gen-
eral's Opinion JC-0117. The opinion states that the MedicalPractice Act does not require that a physician supervise a nurse
anesthetist's selection and administration of anesthesia. An-
other commenter recommended adding a reference to the Den-
tal Practice Act and changing operating "physician" to operating
"surgeon." Another commenter requested that a requirement for
physician delegation be included in this section.
Response: The department agrees with the first commenter and
has revised the rule in renumbered 135.11(a)(4)(A)(iii) to re-
move references to the CRNA practicing under the "supervision"
of the operating physician or anesthesiologist. The revised rule
states the CRNA must practice in accordance with the Nurse
Practice Act and the rules and regulations of the BNE, which
include the parameters for CRNA practice. It is not within the
scope of the department's authority to enforce nursing practice
issues. It is therefore not appropriate to include any reference
to the CRNA being required to practice under the "delegation"
or "supervision" of a physician since this is a practice issue. The
requested change regarding reference to the Dental Practice Act
is also not included in the revised rule since the reference to the
Medical Practice Act has been deleted.
Comment: Regarding 135.11(a)(4)(D), one commenter re-
quested that operating "physician" be replaced by operating
"surgeon" to include other types of surgeons who may practice
in an ASC settings
Response: The department agrees and the requested change
has been made in renumbered 135.11(a)(4)(B) because
135.11(a)(4)(D) was deleted.
Comment: Regarding 135.11(a)(4)(D), two commenters be-
lieved that the rule, as proposed, was misleading and implied
that a registered nurse (RN) who was not a CRNA could admin-
ister any level of sedation or anesthesia. Another commenter be-
lieved the proposed rule was consistent with the BNE's position
statement regarding RNs who are not CRNAs administering se-
dation under certain circumstances, but recommended that the
department add a qualifier to the rule to address the likelihood of
the differing perceptions among the various stakeholders related
to this issue.
Response: The department agrees in part. Although the depart-
ment believes that the rule, as proposed, clearly only allowed
the RN who was not a CRNA to administer topical or local anes-
thesia and minimal or moderate sedation, the recommendations
of the commenters have been incorporated by reorganizing this
section and including clarifying language in 135.11(a)(4)(B).
Comment: Regarding 135.11(a)(4)(D), two commenters stated
that the rule, as proposed, inappropriately deferred to the BNE
to establish the parameters of medical acts that could be dele-
gated by a physician. One of the commenters added that the rule
should be deleted, or at least clarified to reflect that the act was
one of following an order for administration of a medication. The
other commenter added that RNs who were not CRNAs should
not be allowed to administer moderate sedation.
Response: The department disagrees. The rule, as proposed,
did not defer to the BNE to establish parameters of medical acts
that could be delegated by a physician. The department rec-
ognizes that this is a determination that must be made only by
the physician. However, unlike unlicensed personnel, a licensed
nurse is required to follow the rules, guidelines and practice pa-
rameters issued by the BNE related to his or her nursing prac-
tice, even when practicing under physician's orders or physician
delegation. The proposed rule was not deleted, but the sec-
tion was reorganized and renumbered in 135.11 (a)(4)(B), andADOPTED RULES October 28, 2005 30 TexReg 7039
Upcoming Pages
Here’s what’s next.
Search Inside
This issue can be searched. Note: Results may vary based on the legibility of text within the document.
Tools / Downloads
Get a copy of this page or view the extracted text.
Citing and Sharing
Basic information for referencing this web page. We also provide extended guidance on usage rights, references, copying or embedding.
Reference the current page of this Periodical.
Texas. Secretary of State. Texas Register, Volume 30, Number 43, Pages 6973-7094, October 28, 2005, periodical, October 28, 2005; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth97316/m1/65/?q=%22%22~1: accessed July 16, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.