Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-853 - Osteopathic physicians and surgeons › Section 246-853-650 - 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 board of osteopathic
				medicine and surgery establishes the following rule for physicians licensed
				under chapter 18.57 RCW who perform surgical procedures and use anesthesia,
				analgesia or sedation in office-based settings.
(2) Definitions. The definitions in this
				subsection apply throughout this section unless the context clearly requires
				otherwise:
(a) "Board" means the board of
				osteopathic medicine and surgery.
(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, and cardiovascular function may be impaired. 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, including procedures such as retrobulbar or
				periorbital ocular blocks only when performed by a board eligible or board
				certified ophthalmologist. It does not include procedures in which local
				anesthesia is injected into areas of the body other than skin or muscle where
				significant cardiovascular or respiratory complications may result.
(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" 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, intranasal, or intramuscular
				medications.
(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, including, but not limited to, local
				infiltration for tumescent liposuction, 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 an
				osteopathic physician licensed under chapter 18.57 RCW.