Oklahoma Administrative Code › Title 310 - Oklahoma State Department of Health › Chapter 600 - Abortion Facility Regulations › Subchapter 9 - Operational Program Narrative › Section 310:600-9-4 - Clinical services

Current through Vol. 41, No. 20, July 1, 2024
(a) The narrative
				shall describe all abortion procedures performed, equipment and supplies used
				for each procedure, and staff required to assist the physician. The narrative
				shall demonstrate the quantities of supplies, instruments, and equipment
				available in the facility are sufficient to provide emergency care and support
				the number of abortions performed on a daily basis.
(b) Drugs and biologicals maintained and
				administered in the facility shall be specified in the narrative. The narrative
				shall describe how the facility complies with federal and state laws regarding
				drug storage, administration and accountability.
(c) If the physician performing the abortion
				is not certified by the American Board of Obstetrics and Gynecology or the
				American Osteopathic Board of Obstetrics and Gynecology or an active board
				eligible candidate for certification in one (1) of the above, the narrative
				shall stipulate the facility protocols in place to assure consultation from a
				physician with these qualifications when required.
(d) Anesthesia services provided in the
				facility shall be fully described. The narrative shall stipulate the
				qualifications of the staff administering the anesthesia, if these individuals
				are supervised, and the level of service they are approved to deliver. The
				narrative shall demonstrate required services are provided by competent
				individuals in compliance with federal and state law as follows:
(1) An orderly preoperative anesthetic risk
				evaluation is to be done by the responsible physician and recorded on the chart
				in all elective cases, and in urgent emergency cases, the anesthetic
				evaluations will be recorded as soon as feasible.
(2) Every patient receiving general
				anesthesia, spinal anesthesia, or managed intravenous anesthesia (i.e. local
				standby, monitored anesthesia or conscious sedation), shall have arterial blood
				pressure and heart rate measured and recorded at least every five (5) minutes
				where not clinically impractical, in which case the responsible physician may
				waive this requirement stating the clinical circumstances and reasons in
				writing in the patient's chart.
(3)
				Every patient shall have the electrocardiogram continuously displayed from the
				induction and during maintenance of general anesthesia. In patients receiving
				managed intravenous anesthesia, electrocardiographic monitoring should be used
				in patients with significant cardiovascular disease as well as during
				procedures where dysrhythmias are anticipated.
(4) During all anesthetics, patient
				oxygenation will be continuously monitored with a pulse oximeter, and, whenever
				an endotracheal tube is inserted, correct positioning in the trachea and
				function will be monitored by end-tidal C02 analysis (capnography) throughout
				the time of placement.
(A) Additional
				monitoring for ventilation will include palpation or observation of the
				reservoir breathing bag, and auscultation of breath sounds.
(B) Additional monitoring for circulation
				will include at least on of the following: Palpation of the pulse, auscultation
				of heart sounds, monitoring of a tracing of intra-arterial pressure, pulse
				plethysmography, or ultrasound peripheral pulse monitoring.
(5) When ventilation is controlled
				by an automatic mechanical ventilator, there shall be in continuous use a
				device that is capable of detecting disconnection of any component of the
				breathing system. The device must give an audible signal when its alarm
				threshold is exceeded.
(6) During
				every administration of general anesthesia using an anesthesia machine, the
				concentration of oxygen in the patient's breathing system will be measured by a
				functioning oxygen analyzer with low concentration audible limit alarm in
				use.
(7) During every
				administration of general anesthesia, there shall be readily available a means
				to measure the patient's temperature.
(8) Availability of qualified trained
				personnel dedicated solely to patient monitoring.
(9) These desiderata apply for any
				administration of anesthesia, including general, spinal, and managed
				intravenous anesthetics (i.e. local standby, monitored anesthesia or conscious
				sedation), administered in designated anesthetizing locations and any location
				where conscious sedation is performed. "Conscious sedation" means a minimally
				depressed level of consciousness that retains the patient's ability to
				independently and continuously maintain an airway and respond appropriately to
				physical stimulation or verbal command, produced by a pharmacologic or
				non-pharmacologic method, or a combination thereof.
(10) In emergency circumstances in any
				situation, immediate life support measures can be started with attention
				returning to these monitoring criteria as soon as possible and
				practical.