PURPOSE: This rule specifies the requirements for anesthesia services in a hospital.

1. (1) Anesthesia services, if provided, shall be under the medical direction of a qualified physician member of the medical staff and appointed by the governing body. This physician shall be responsible for implementing the rules of the medical staff governing the quality and scope of anesthesia care provided.
2. (2) Approved written policies and procedures shall include: patient and employee safety, preand post-anesthesia evaluation, care of equipment, storage of anesthesia agents and the administration of anesthesia.
3. (3) Anesthesia shall be administered only by qualified anesthesiologists, physicians or dentists trained in anesthesia, certified nurse anesthetists or supervised students in an approved educational program.
4. (4) An anesthesia record documenting the care given shall be a permanent part of the patient’s medical record. SENIOR SERVICES
5. (5) The pre-anesthesia patient evaluation shall be accomplished by a physician and documented within forty-eight (48) hours before surgery and shall include the history and physical examination; anesthetic, drug and allergy history; essential laboratory data; and other diagnostic test results to establish potential anesthetic risks. These procedures may be waived in the event of a life threatening emergency, provided the surgeon so certifies on the patient medical record.
6. (6) A post-anesthesia evaluation shall be documented in the patient’s medical record within twenty-four (24) hours after surgery.
7. (7) The use of flammable anesthetic agents shall be limited to those areas of the hospital which comply with all applicable requirements of the Standard for Inhalation Anesthetics 1980 published by the National Fire Protection Association.
8. (8) Prior to surgery, the patient’s medical record shall contain evidence that the patient has been advised regarding the surgical procedure(s) contemplated, the type of anesthesia to be administered and the risks involved with each. Evidence that informed consent has been given shall become a part of the patient’s medical record.
9. (9) There shall be a mechanism for the review and evaluation on a regular basis of the quality and scope of anesthesia services.

AUTHORITY: sections 192.006 and 197.080, RSMo 2000 and 197.154, RSMo Supp. 2007.* This rule previously filed as 19 CSR 30-20.021(4)(B). Original rule filed June 27, 2007, effective Feb. 29, 2008. *Original authority: 192.006, RSMo 1993, amended 1995; 197.080, RSMo 1953, amended 1993, 1995; and 197.154, RSMo 2004.