Facility Considerations

All personnel should be trained for emergency procedures. Under Centers for Medicare & Medicaid Services (CMS) Conditions for Coverage, Medicare-certified ASCs must have one annual emergency preparedness test.

To learn more, visit CMS’s Omnibus Burden Reduction Final Rule and the Ambulatory Surgery Center Association’s Emergency Preparedness page. Drills should involve all staff and focus on specific individual roles.

Equipment must be maintained, labeled, and inspected regularly according to manufacturer’s requirements. Standard 6 of the Standards for Nurse Anesthesia Practice states that CRNAs/nurse anesthesiologists must “adhere to manufacturer’s operating instructions and other safety precautions to complete a daily anesthesia equipment check” and “verify function of anesthesia equipment prior to each anesthetic.” Equipment should be available that can accommodate the needs of obese patients. The capacity limit is site-specific.

The AANA offers the Anesthesia Equipment and Supplies Checklist, which can be printed and kept in a log book.

Examples of Emergency Equipment

• Basic airway equipment (adult and pediatric)
  • Nasal and oral airway
  • Face mask (appropriate for patient)
  • Laryngoscopes, endotracheal tubes (adult and pediatric)
  • Ambu bag or other positive pressure ventilation device
• Difficult airway equipment (laryngeal mask airway, light wand, cricothyrotomy kit)
• Defibrillator
• Supplemental O2
• Emergency drugs
• Compression board
• Suction equipment (suction catheter, Yankaur type)
• Drugs and equipment to treat MH on site
• Back-up power

Outpatient facilities should develop policies based on their population needs and procedures to be performed. Anesthesia professionals evaluate each patient based on the policy and clinical judgment to optimize patient safety. The following criteria should be evaluated:

• Patient’s physical status (e.g., diagnoses, severity of the disease state)
• Degree of stability of that physical status
• Patient’s psychological status
• Patient’s support system at home
• Intensity and duration of post-procedure monitoring
• Risk of developing a deep vein thrombosis (DVT) and pulmonary embolism (PE) and the ability to provide thromboembolic prophylaxis

AANA Clinical Considerations (login required):

• Patient Selection Criteria: Elevated HbA1c
• Patient Selection Criteria: Elevated BMI

The following policies, procedures, and protocols are examples of what should be in place:

• Preoperative lab requirements
• Transfer to higher level of care
• AANA Infection Prevention and Control Guidelines for Anesthesia Care
• Infection Prevention and Control Resources
• Informed Consent for Anesthesia Care
• Discharge criteria, including case cancellations
  • AANA Postanesthesia Care
  • AANA Discharge After Sedation or Anesthesia on the Day of the Procedure
• Malignant Hyperthermia protocols
• AANA Latex Allergy Management
• Reporting adverse reactions
• Sharps safety
• The Occupational Safety and Health Administration (OSHA)’s Bloodborne Pathogens Standard (BBP) requires employers to provide information and training to workers. Visit the OSHA website to learn more.
• Emergency Policies, e.g.,
• Cardiopulmonary
• Chemical spill
• Fire
• Building evacuation
• Mass casualty (see Guidelines Regarding the Role of the CRNA in Mass Casualty Incident Preparedness and Response)
  • Workplace Shootings: CRNAs Surviving as the First and Second Victim
  • Disaster Preparedness and CRNA Wellness

• Facilities may be required to be licensed and/or accredited in accordance with state laws and regulations. In addition, facilities may voluntarily choose to be accredited by one of the accreditation programs (e.g. The Joint Commission, the Accreditation Association for Ambulatory Health Care (AAAHC), the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), or the Healthcare Facilities Accreditation Program (HFAP)).
• Facilities and CRNAs/nurse anesthesiologists should review federal, state, and local laws and regulations and accreditation requirements that apply to the facility.

Questions to ask the facility:

• Is the facility licensed? By whom?
• Is the facility accredited? By whom? What is the accreditation program?

For more information, visit Facility Accreditation.