Chapter 4731-24 Anesthesiologist Assistants
As used in Chapter 4731-24 of the Administrative Code:
(A) "Administer" means to apply directly a drug, whether by injection, inhalation, ingestion, or any other means, and the infusion of blood, blood products and supportive fluids.
(B) "Assist" means to carry out procedures as requested by the supervising anesthesiologist, provided that the requested procedure is within the anesthesiologist assistant's training and scope of practice, is authorized by the practice protocol adopted by the supervising anesthesiologist, and is not prohibited by Chapter 4731. or 4760. of the Revised Code, or by any provision of Chapter 4731. of the Administrative Code.
(C) "Drug" means the same as in section 4729.01(E) of the Revised Code.
(A) A supervising anesthesiologist shall supervise an anesthesiologist assistant within the terms, conditions, and limitations set forth in a written practice protocol that is consistent with section 4760.09 of the Revised Code and this chapter of the Administrative Code. This supervision shall be direct supervision and in the immediate presence of the anesthesiologist assistant. "Direct supervision and in the immediate presence of" means all of the following:
(1) The supervising anesthesiologist shall remain physically present and available for immediate diagnosis and treatment of emergencies;
(2) The supervising anesthesiologist shall be physically present in the anesthetizing area or operating suite, as defined by the hospital or ambulatory surgical facility, and accessible by beeper, phone, or overhead page, such that he or she is immediately available to participate directly in the care of the patient with whom the anesthesiologist assistant and the supervising anesthesiologist are jointly involved;
(3) The supervising anesthesiologist shall personally participate in the most demanding procedures in the anesthesia plan, which shall include induction and emergence; and
(4) "Direct supervision and in the immediate presence of" shall not be interpreted to:
(a) Require the supervising anesthesiologist's presence in the same room as the anesthesiologist assistant for the duration of anesthetic management; or
(b) Prohibit the supervising anesthesiologist from addressing an emergency of short duration, administering labor analgesia or performing duties of short duration as required of a perioperative specialist in another location in the hospital or ambulatory surgical facility.
(B) An anesthesiologist assistant shall only perform those tasks assigned on a case-by-case basis by the supervising anesthesiologist. The anesthesiologist assistant shall implement the personalized plan for each patient as individually prescribed by the supervising anesthesiologist after that physician has completed a specific assessment of each patient. In determining which anesthetic procedures to assign to an anesthesiologist assistant, a supervising anesthesiologist shall consider all of the following:
(1) The education, training and experience of the anesthesiologist assistant;
(2) The anesthesiologist assistant's scope of practice as defined in section 4760.09 of the Revised Code and this chapter of the Administrative Code;
(3) The conditions on the practice of the anesthesiologist assistant set out in the written practice protocol;
(4) The physical status of the patient according to the physical status classification system of the american society of anesthesiologists, as in effect at the time the assignment of procedures is made. The classification system is available from the american society of anesthesiologists and shall be posted on the board's website;
(5) The invasiveness of the anesthetic procedure;
(6) The level of risk of the anesthetic procedure;
(7) The incidence of complications of the anesthetic procedure;
(8) The physical proximity of the supervising anesthesiologist and the anesthesiologist assistant or assistants he or she may be supervising concurrently; and
(9) The number of patients whose care is being supervised concurrently by the supervising anesthesiologist.
(C) During the first four years of an anesthesiologist assistant's practice, the supervising anesthesiologist shall provide enhanced supervision as defined in this chapter of the Administrative Code.
(D) The supervising anesthesiologist retains responsibility for the anesthetic management in which the anesthesiologist assistant has participated.
(A) A supervising anesthesiologist shall provide enhanced supervision of an anesthesiologist assistant during the first four years of the anesthesiologist assistant's practice.
(B) "Enhanced supervision" means the following:
(1) A supervising anesthesiologist shall require regular, documented quality assurance interactions between a supervising anesthesiologist and the anesthesiologist assistant in his or her first four years of practice. These regularly scheduled quality assurance interactions shall occur in greater number and with greater frequency during the first four years of an anesthesiologist assistant's practice than would be required for quality assurance purposes for anesthesiologist assistants in practice for more than four years and shall take place no less frequently than once every three months. An anesthesiologist assistant shall be required to file on a monthly basis during the first two years of practice a separate record of the cases of anesthetic management in which he or she participated. The record shall be reviewed by a supervising anesthesiologist as a component of the quality assurance interactions. The reviewing supervising anesthesiologist shall file a report of each quality assurance interaction with the appropriate committee.
(2) The supervising anesthesiologist shall make direct observations of the anesthesiologist assistant during the course of each case of anesthetic management. During the first year of an anesthesiologist assistant's practice, these direct observations shall be made more frequently than for comparable procedures for anesthesiologist assistants practicing beyond their first year, for each case of anesthetic management, in addition to induction and emergence. The supervising anesthesiologist shall document the enhanced supervision in the anesthetic record.
(3) Anesthesiologist assistants who have practiced in another state prior to beginning their practice in Ohio shall receive, for purposes of the enhanced supervision requirement, credit for the time they practiced in another state on a year-for-year basis except that the supervising anesthesiologist of an anesthesiologist assistant who practiced for a minimum of four years in another state prior to beginning his or her practice in Ohio shall be required to provide, for the first three months of the anesthesiologist assistant's practice in Ohio, enhanced supervision as defined in paragraph (B)(1) of rule 4731-24-03 of the Administrative Code.
(A) Nothing in this chapter of the Administration Code or Chapter 4760. of the Revised Code shall permit an anesthesiologist assistant to perform any anesthetic procedure not specifically authorized by Chapter 4760. of the Revised Code, including epidural and spinal anesthetic procedures and invasive medically accepted monitoring techniques. For purposes of this chapter of the Administrative Code, "invasive medically accepted monitoring techniques" means pulmonary artery catheterization, central venous catheterization, and all forms of arterial catheterization with the exception of brachial, radial and dorsalis pedis cannulation.
(B) An anesthesiologist assistant shall not practice in any location other than a hospital or ambulatory surgical facility.
(C) An anesthesiologist assistant shall not practice except under the direct supervision and in the immediate presence of a supervising anesthesiologist as defined in this chapter of the Administrative Code and Chapter 4760. of the Revised Code.