Provider Orientation & Resources  

All Anesthesia Providers

 

Note: open ALL links and attachments that are applicable to your area(s) of practice.

Learn more about:

Surgical Care Improvement Project (SCIP)
Review of CMS core measures for patients under going a surgical procedure in inpatient and outpatient setting.


Correct patient, correct procedure and correct procedural site/side policy
All surgical sites involving laterality, level, and.or multiples will be marked by the surgeon by placing his or her initials on the operative site such that the mark is visible after the patient is prepped and drapped so that it can be reverified during the Surgical Time Out process. If it is not possible to mark the surgical site then the surgeon will mark the site on an anatomical diagram and anesthesia providers who are performing a procedure that involves laterality will mark the appropriate site with a “A” that is circled.


Safe surgery policy
Standardizes safe practices to ensure correct patient, correct procedure, and the correct procedural site/side for procedures performed in the operating room. This includes appropriate marking by surgeon’s initials at surgical site if procedure involves laterality or multiples, a formal briefing in the OR prior to starting the case with all members of the surgical team in the room, a formal Time Out lead by the surgeon and involving all members of the team (an orange Time Out towel is used as a memory trigger), a formal counting process, and formal debriefing process at the end of the case led by the surgeon.


Counts: Sponge, sharp and instrument policy
Outlines the counting procedure used to account for items such as sponges, sharps, and instruments to prevent injury to patients as a result of a retained item.


Clinical policy: Safe procedure policy – medical imaging and endoscopy
The purpose of this policy is to standardize safe practices to ensure correct patient, correct procedure, and the correct procedure site for procedures performed in Medical Imaging and Endoscopy including the process for conducting an interactive procedure time out just prior to the onset of procedure.  This policy is consistent with Safe Surgery policy and Counts policy utilized in Surgery and Labor and Delivery areas.


Clinical Practice: Central Line Management and Prevention of Vascular Catheter Associated Infections (VCAI)
Establishes protocols for insertion and needs assessment for central lines including central line infection outcome (infection rate), insertion protocols (central line bundle compliance rate), timeliness of central line necessity check (daily check rate), and formalized process for event investigation and documentation. Central line insertion bundle includes hand hygiene, maximal barrier precautions upone insertion (gloves, hat, mask, gown, draps), chlorhexidine skin antisepsis, optimal catheter site selection (avoidance of femoral vein for access), and daily review of line necessity.


Clinical practice: Anesthesia administration
This clinical practice applies to all inpatients and outpatients in any setting for any purpose, by any route that receive anesthesia (including the use of short acting anesthetic agents for procedural sedation) in Banner Health facilities. All inpatients and outpatients within the Banner Health facilities receiving anesthesia will be administered anesthesia by appropriately credentialed providers based on evidenced based practice, or in its absence will practice within consensus guidelines to best serve the safety of Banner Health patients.


Clinical Policy: Procedural sedation for therapeutic/diagnostic procedure
This clinical policy applies to both Adult and Pediatric Patients and defines the circumstances under which procedural sedation may be administered and define responsibilities and parameters for the management of the patient requiring procedural sedation for pre-intra-post, short-term diagnostic, or therapeutic procedures including monitoring requirements.  This clinical policy has been defined but not yet fully implemented.


Clinical practice: Quantitative and qualitative exhaled carbon dioxide measurements during procedural sedation pediatric and adult patients 
It is an expected clinical practice that all inpatients and outpatients of any age and clinical setting receiving anesthesia (moderate, deep, general and regional ((with sedation)) will, in addition to standard monitors, have the ventilation evaluated by continual observation of qualitative clinical signs and monitoring for the presence of exhaled carbon dioxide.  This clinical practice has been defined but not yet fully implemented.


Clinical Practice:  Administration of nitrous oxide/oxygen sedation for pediatric patients
For pediatric inpatients and outpatients requiring minor procedures that cause anxiety and/or pain, nitrous oxide oxygen (N²O/O²) sedation can be used to provide minimal or procedural sedation. Nitrous oxide/oxygen is an analgesic, amnestic and anxiolytic. It is a recommended Clinical Practice that Nitrous Oxide/Oxygen sedation be used following the General Principles Nitrous Oxide/Oxygen Administration for minimal sedation for anxiety and pain management. If a second agent is given along with nitrous oxide/oxygen, additional patient monitoring guidelines and protocols will be utilized as applicable. Nitrous oxide/oxygen sedation will be utilized in cases with an anticipated length of no more than 30 minutes. This clinical practice has been defined but not yet fully implemented, and will not be available at all Banner facilities.


Clinical Practice: Anesthesia care for adult endoscopy
It is an expected clinical practice that all adult patients undergoing endoscopy procedures will be evaluated by the performing providers to determine the need for involvement of an anesthesia provider based on procedure type and qualifying medical condition(s). If deemed necessary, then a qualified Anesthesia provider will be consulted to evaluate the patient and provide the anesthesia care service. Applicable documentation to support medical necessity and request for consult will be completed.


Clinical Practice: Intraoperative Goal – Directed Therapy (GDT) for Patients Undergoing Moderate and High-Risk Non-Cardiac Surgical Procedures
It is an expected clinical practice that all Adult non-cardiac surgical patients presenting for both medium and high risk surgical procedures will undergo intraoperative, physiologically based, goal-directed intravascular volume optimization which is known to reduce morbidity and hospital length of stay.  Key components of the IGDT clinical practice include: identification of patient candidates based on surgical procedure; EMR notifications and surgery schedule indicators to alert anesthesia providers of patient candidacy; standardization of dynamic volume measurements; standardization of minimally invasive and non-invasive hemodynamic monitoring equipment, and standardized documentation of process measurements.


Clinical practice: Preventing postoperative pulmonary complications (ADULT)
Adult surgical patients will be screened to identify risk for developing post-operative pulmonary complications (PPCs).  Patient specific interventions to reduce PPC risk will be applied.  These include pre-operative pulmonary optimization, intraoperative surgical and anesthetic modalities, post-operative pulmonary intervention through the use of pain control, patient mobilization and lung expansion maneuvers.

Clinical practice: Preoperative testing for elective surgeries - adults
It is an expected clinical practice that all elective surgery adult patients will receive preoperative testing based only on clinical indication. Avoid routine tests unless testing for specific indications or purpose.


Clinical Practice:  Management of Known Difficult Airway – Adult and Pediatrics (Excludes Neonatal)
It is an expected clinical practice that patients having a known difficult airway will receive care specific to the identified airway type that includes an electronic alert, coordination of care and airway management.  The patient will receive information and documentation related to their difficult airway and the need for notification of providers during future care.  The clinical practice design includes the creation of system-wide standards for the identification of patients with known difficult airways, EMR alerts and notifications across clinical modalities, preparation and approaches for intubation and extubation  including standardized airway carts and supplies, and the continuation of patient care planning outside the acute episode.


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