CMS’ Anesthesia Administration Guidelines Pose Risks to Patient Care in the ED

March 11, 2010

The Centers for Medicare & Medicaid Services (CMS) recently determined that anesthesia (which CMS interprets to include deep sedation) may be administered only by a physician, CRNA, or anesthesia assistant.

In a December letter to State Survey Agency Directors (updated February 5), CMS staff "clarify" the Medicare Conditions of Participation for hospitals in a way that would preclude RNs and possibly residents from administering drugs such as propofol in the emergency department.

"Like the ‘standing orders’ issue in 2008, these restrictions reflect a lack of understanding of the needs of patients and the dearth of designated anesthesia clinicians available in a 24/7 environment of the ED," said Barbara Tomar, ACEP’s Federal Affairs Director.

ACEP is working with the Emergency Nurses Association and affected physician specialty societies to urge CMS to rescind this overly broad interpretation, as the College did with standing orders.

If your hospital has already changed its policy and/or you would like to send an example of how this is or might affect practice in your emergency department, please contact Barbara Tomar.

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