Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-922 - Podiatric physicians and surgeons › Section 246-922-650 - Safe and effective analgesia and anesthesia administration in office-based settings

Current through Register Vol. 24-14, July 15, 2024
(1) Purpose. The
				purpose of this rule is to promote and establish consistent standards,
				continuing competency, and to promote patient safety. The podiatric medical
				board establishes the following rule for physicians licensed under
				chapter
				18.22 RCW who perform
				surgical procedures and use analgesia or sedation in office-based settings.
				This rule does not apply to any office-based procedures performed with the use
				of general anesthesia.
(2)
				Definitions. The following terms used in this subsection apply throughout this
				rule unless the context clearly indicates otherwise:
(a) "Board" means the podiatric medical
				board.
(b) "Deep sedation" or
				"analgesia" means a drug-induced depression of consciousness during which
				patients cannot be easily aroused but respond purposefully following repeated
				or painful stimulation. The ability to independently maintain ventilatory
				function may be impaired. Patients may require assistance in maintaining a
				patent airway, and spontaneous ventilation may be inadequate. Cardiovascular
				function is usually maintained.
(c)
				"General anesthesia" means a state of unconsciousness intentionally produced by
				anesthetic agents, with absence of pain sensation over the entire body, in
				which the patient is without protective reflexes and is unable to maintain an
				airway. Sedation that unintentionally progresses to the point at which the
				patient is without protective reflexes and is unable to maintain an airway is
				not considered general anesthesia.
(d) "Local infiltration" means the process of
				infusing a local anesthetic agent into the skin and other tissues to allow
				painless wound irrigation, exploration and repair, and other
				procedures.
(e) "Major conduction
				anesthesia" means the administration of a drug or combination of drugs to
				interrupt nerve impulses without loss of consciousness, such as epidural,
				caudal, or spinal anesthesia, lumbar or brachial plexus blocks, and intravenous
				regional anesthesia. Major conduction anesthesia does not include isolated
				blockade of small peripheral nerves, such as digital nerves.
(f) "Minimal sedation" or "analgesia" means a
				drug-induced state during which patients respond normally to verbal commands.
				Although cognitive function and coordination may be impaired, ventilatory and
				cardiovascular functions are unaffected. Minimal sedation is limited to oral or
				intramuscular medications, or both.
(g) "Moderate sedation" or "analgesia" means
				a drug-induced depression of consciousness during which patients respond
				purposefully to verbal commands, either alone or accompanied by tactile
				stimulation. No interventions are required to maintain a patent airway, and
				spontaneous ventilation is adequate. Cardiovascular function is usually
				maintained.
(h) "Office-based
				surgery" means any surgery or invasive medical procedure requiring analgesia or
				sedation, performed in a location other than a hospital, or hospital-associated
				surgical center licensed under
				chapter
				70.41 RCW, or an
				ambulatory surgical facility licensed under chapter 70.230 RCW.
(i) "Physician" means a podiatric physician
				licensed under
				chapter
				18.22 RCW.