2023 Maryland Statutes › Health Occupations › Title 8 - Nurses › Subtitle 5 - Miscellaneous Provisions › Section 8-513 - Nurse Anesthetist

(a)    In this section, “perioperative assessment and management” means the assessment and management of a patient preoperatively, intraoperatively, and postoperatively.
(b)    (1)    A nurse anesthetist may perform the following functions:
(i)    Perioperative assessment and management of patients requiring anesthesia services;
(ii)    Administration of anesthetic agents;
(iii)    Management of fluids in intravenous therapy;
(iv)    Respiratory care; and
(v)    Subject to paragraph (4) of this subsection, prescription, ordering, and administration of drugs, including a drug that is classified as a controlled dangerous substance under Title 5, Subtitle 4 of the Criminal Law Article.
(2)    A nurse anesthetist has the right and obligation to refuse to perform a delegated act if in the nurse anesthetist’s judgment, the act is:
(i)    Unsafe;
(ii)    An invalidly prescribed medical act; or
(iii)    Beyond the clinical skills of the nurse anesthetist.
(3)    Paragraph (1) of this subsection may not be construed to authorize a nurse anesthetist to:
(i)    Diagnose a medical condition;
(ii)    Provide care that is not consistent with the scope of practice of nurse anesthetists; or
(iii)    Provide care for which the nurse anesthetist does not have proper education and experience.
(4)    A nurse anesthetist may prescribe drugs under paragraph (1) of this subsection:
(i)    Only in an amount that does not exceed a 10–day supply;
(ii)    Only for an individual with whom the nurse anesthetist has, at the time of prescription, established a client or patient record; and
(iii)    Only in connection with the delivery of anesthesia services.
(c)    A nurse anesthetist shall collaborate with an anesthesiologist, a licensed physician, or a dentist in the following manner:
(1)    An anesthesiologist, a licensed physician, or a dentist shall be physically available to the nurse anesthetist for consultation at all times during the administration of, and recovery from, anesthesia;
(2)    An anesthesiologist shall be available for consultation to the nurse anesthetist for other aspects of the practice of nurse anesthesia; and
(3)    If an anesthesiologist is not available, a licensed physician or dentist shall be available to provide this type of consultation.
(d)    The nurse anesthetist shall ensure that a qualified anesthesia provider:
(1)    Performs a thorough and complete preanesthetic assessment;
(2)    Obtains informed consent for the planned anesthetic intervention from the patient or an individual responsible for the patient; and
(3)    Formulates a patient–specific plan for anesthesia care.
(e)    The nurse anesthetist as part of the standards of practice shall:
(1)    Implement and adjust an anesthesia care plan as needed to adapt to the patient’s response to the anesthesia;
(2)    Monitor a patient’s physiologic condition for untoward identifiable reactions and initiate appropriate corrective actions as required;
(3)    Enter prompt, complete, and accurate documentation of pertinent information on a patient’s record;
(4)    Transfer responsibility for care of a patient to other qualified providers in a manner that ensures continuity of care and patient safety;
(5)    Ensure that appropriate safety precautions are taken to minimize the risks of fire, explosion, electrical shock, and equipment malfunction;
(6)    Maintain appropriate infection control standards;
(7)    Evaluate anesthesia care to ensure its quality;
(8)    Maintain continual competence in anesthesia practice; and
(9)    Respect and maintain the basic rights of patients.
(f)    This section may not be construed to require a written collaboration agreement between a nurse anesthetist and an anesthesiologist, a physician, or a dentist.