An advanced practice nurse, or Certified Registered Practice Nurse (CRNA). Within this role, under the direct supervision of an Attending Anesthesiologist, the CRNA administers, monitors and manages patient care before and after the administration of anesthesia.
Duties and Responsibilities:
1. Pre-anesthesia assessment, induction and maintenance of and emergence from anesthesia, monitoring of the patient's physiological condition and performance of clinical intervention as necessary, directed by attending anesthesiologist.
2. In conjunction with Attending Anesthesiologist, performs a thorough and complete pre-anesthesia assessment. Obtains and reviews relevant tests and discusses findings with the attending.
3. Obtains or verifies that an informed consent has been obtained for the planned anesthetic intervention from the patient or legal guardian. Discusses anesthetic options and risks with the patient and/or legal guardian after discussion with Attending Anesthesiologist. Documents in the medical record that informed consent was obtained.
4. Formulates a patient-specific plan for anesthesia care in conjunction with the Attending Anesthesiologist. The plan is based upon comprehensive patient assessment, problem analysis, anticipated surgical or therapeutic procedure, patient and surgeon preferences, and current anesthesia principles.
5. Induces anesthesia under the supervision of an Attending Anesthesiologist and maintains anesthesia at required levels. Assesses continuously the patient's response to the anesthetic and/or surgical intervention and must immediately notify the Attending Anesthesiologist of significant changes in the patient's condition and intervenes as required, under the supervision of an Attending Anesthesiologist.
6. Monitors the patient's physiologic condition as appropriate for the type of anesthesia and specific patient needs.
7. Monitors ventilation continuously. Verifies intubation of the trachea by auscultation, chest excursion, and confirmation of carbon dioxide in the expired gas. Continually monitors end-tidal carbon dioxide during controlled or assisted ventilation. Uses spirometry and ventilatory pressure monitors.
8. Monitors oxygenation continuously by clinical observation, pulse oximetry, and if indicated, arterial blood as analysis.
9. Monitors cardiovascular status via electrocardiogram and heart sounds.
10. Records blood pressure and heart rate. Monitors body temperature continually on all pediatric patients receiving general anesthesia and when indicated, on all other patients.
11. Monitor neuromuscular function and status when neuromuscular blocking agents are administered. Monitors and assesses the patient positioning and protective measures.
12. The omission of any monitoring standards shall be documented and the reason stated in the patient's anesthesia record. The CRNA shall be in constant attendance of the patient until another qualified health care provider has accepted the responsibility for care.
13. Maintains complete, accurate, and timely documentation of pertinent information on the patient's medical records. Must document all anesthetic interventions and patient responses.
14. Transfers the responsibility for care of the patient to other qualified providers in a manner that assures continuity of care and patient safety.
15. Adheres to appropriate safety precautions, as established within the institution, to minimize the risk of fire, explosion, electrical shock and equipment malfunction. Documents on the patient's medical record that the anesthesia machine and equipment were checked.
16. Inspects the anesthesia machine prior to use, and monitors according to established guidelines. Checks the readiness, availability, cleanliness, and working condition of all equipment to be utilized in the administration of the anesthesia care. When the patient is ventilated by an automatic mechanical ventilator, monitors the integrity of the breathing system with a device capable if detecting a disconnection by emitting an audible alarm. Monitors oxygen concentration continually with an oxygen supply failure alarm system.
17. Takes precautions to minimize the risk of infection to the patient, the Nurse Anesthetist, and other healthcare providers.
18. Participates in departmental Grand Rounds, presenting relevant cases as appropriate.
19. Participates in the identification of performance improvement indicators and develops quality improvement with the health care team.
20. Participates in risk management activities including the identification and communication of risk in a timely manner.
21. Collaborates with members of the health care team in the development, implementation and ongoing review of policies, procedures and standards of care for a designated patient population.
22. Evaluates and documents the patient care outcomes for the Department of Anesthesia and influences Departmental changes in staffing, patient assignment and standards of care.
23. Responds to budgetary constraints and incorporates financial principles into program development, patient care activities and allocation of resources.
24. Formulates trends and identifies potential problems in the delivery of patient care in the perioperative setting and implements action plans and educational programs for faculty and staff.