Local Anesthesia guidelines

1. What are other facilities doing out there in terms of staffing ratio/assignment, and monitoring requirements for procedural cases that are straight LOCAL (no conscious sedation, propofol, general, etc.)? Do you have a RN dedicated to the patient only (no charting, no circulating)?

2. If Anesthesia defers a patient for a MAC case (propofol, general anesthesia) based on too high risk (ASA 3 or 4, large BMI, cardiac /renal disease, etc.), and if LOCAL is given as an option, does your facility comply, and what type of staffing ratio/assignment and monitoring requirements would you facility have for such cases?

3. Are any of the requirements in our facility based on other factors, such as expected length of case? (In my place, we have safely done local only biopsy cases for years without using a monitor, but the cases only last about 15 minutes on average. Vital signs are taken pre and post-case. However, I've been told this might not be what other places are doing.)

4. I am aware of the AORN guidelines. I have been told there are no regulatory (ie, CMS, The Joint Commission) guidelines. Any information to the contrary?

Anything to help out would be great. We seem to have repetitive problems with this, especially cases booked for Anesthesia care, bumped by Anesthesia. Also, all procedural areas require ACLS since nurses float (pre-, intra-, post-) so not an issue there, but what about the OR?

Thanks! :)