Section 205.530  Operative Care

a)         Surgical procedures shall be performed only by a qualified physician, dentist or podiatrist within the limits of the defined specific surgical practice privileges that have been granted to that individual by the consulting committee or a committee designated by the consulting committee.

b)         Administration of Anesthesia

1)         For the purposes of this Section, anesthesia shall include general anesthesia, intravenous sedation, spinal or epidural anesthesia, and any other specific anesthesia technique that is designated by the consulting committee.

2)         Anesthesia may be administered only by the following persons, each having been granted specific anesthesia privileges by the consulting committee or a committee designated by the consulting committee:

A)        A qualified anesthesiologist (as defined in Section 205.110 of this Part.)

B)        A physician licensed to practice medicine in all its branches.

C)        A dentist who has been approved by the Department of Financial and Professional Regulation to administer anesthesia for dental surgery only pursuant to Section 8.1 of the Illinois Dental Practice Act [225 ILCS 25].

D)        A certified registered nurse anesthetist (as defined in Section 205.110 of this Part) who is implementing the orders of a qualified anesthesiologist, or the physician, dentist, or podiatrist who is performing the procedure. The qualified anesthesiologist, physician, dentist, or podiatrist who has ordered the anesthesia must be on the premises of the facility during the administration of the anesthesia.

E)        A registered nurse.  If the ASTC policy allows the registered nurse to deliver moderate sedation ordered by a physician licensed to practice medicine in all its branches, podiatrist, or dentist, the following are required:

i)          The registered nurse must be under the supervision of a physician licensed to practice medicine in all its branches, podiatrist, or dentist during the delivery or monitoring of moderate sedation and have no other responsibilities during the procedure.

ii)         The registered nurse must maintain current Advanced Cardiac Life Support certification or Pediatric Advanced Life Support certification as appropriate to the age of the patient.

iii)        The supervising physician licensed to practice medicine in all its branches, podiatrist, or dentist must have training and experience in delivering and monitoring moderate sedation and possess clinical privileges at the ASTC to administer moderate sedation or analgesia.

iv)        The supervising physician licensed to practice medicine in all its branches, podiatrist, or dentist must remain physically present and available on the premises during the delivery of moderate sedation for diagnosis, consultation, and treatment of emergency medical conditions.

v)         The supervising physician licensed to practice medicine in all its branches, podiatrist, or dentist must maintain current Advanced Cardiac Life Support certification or Pediatric Advanced Life Support certification as appropriate to the age of the patient.

vi)        Local, minimal, and moderate sedation shall be defined by the Division of Professional Regulation of the Department of Financial and Professional Regulation.  Registered nurses shall be limited to administering medications for moderate sedation at doses rapidly reversible pharmacologically as determined by rule by the Division of Professional Regulation of the Department of Financial and Professional Regulation. (Section 6.7(b) of the Act)

vii)       Nothing in the Act or this Section precludes a registered nurse from administering medication for the delivery of local or minimal sedation ordered by a physician licensed to practice medicine in all its branches, podiatrist, or dentist.  (Section 6.7(a) of the Act)

F)         A podiatrist licensed under the Podiatric Medical Practice Act of 1987. (Section 6.5 of the Act)

3)         An anesthesia assistant who is licensed as a physician's assistant pursuant to the Physician Assistant Practice Act of 1987 [225 ILCS 95] may assist in the administration of anesthesia only under the direct supervision of a qualified anesthesiologist (as defined in Section 205.110 of this Part).

4)         The person administering anesthesia, or a person who has equivalent practice privileges, shall be present in the facility during the recovery of the patient to whom anesthesia was administered.

c)         Examination of Removed Tissues

1)         All tissues removed during surgery, except tissues and materials exempted under subsection (c)(3), shall be examined by a consulting pathologist, who shall provide a written report of the examination to the attending physician.

2)         A copy of the pathology report shall be filed in the patient's clinical record within seven days after removal of the tissue.

3)         The following tissues and materials are exempt from this requirement and do not need to be examined by a pathologist:

A)        Foreskin, fingernails, toenails, and teeth that are removed during surgery.

B)        Bone, cartilage, and soft tissue removed during the course of surgery and determined by the attending physician not to require pathological examination.

C)        Cataract lenses that are removed during the course of eye surgery.

D)        Foreign substances (e.g., wood, glass, pieces of metal, including previously inserted surgical hardware) that are removed during surgery.

d)         All x-rays, except those exempted by the consulting committee and as specified in the facility's policies and procedures manual, shall be read by a physician, podiatric physician, or dentist, each of whom shall have practice privileges at the facility, or by a consulting radiologist approved by the consulting committee.  A copy of the x-ray report shall be filed in the patient's clinical record within seven days.

e)         A registered nurse, qualified by training and experience in operating room nursing, shall be present in the operating room and function as the circulating nurse during all invasive or operative procedures requiring aseptic technique.  As used in this subsection, "circulating nurse" means a registered nurse who is responsible for coordinating all nursing care, patient safety needs, and the needs of the surgical team in the operating room during an invasive or operative procedure requiring aseptic technique.  (Section 6.5(2.5) of the Act)

(Source:  Amended at 40 Ill. Reg. 13933, effective September 21, 2016)