Many questions are posed to QUAD A regarding this requirement. Standard 8-B-24 states that the surgeon/proceduralist and the licensed or qualified anesthesia provider concur on the appropriateness of the procedures performed at the facility based on the medical status of the patient, age and physiological appropriateness of the patient, and qualifications of the providers and the facility resources. The intent of this standard is to ensure that everyone agrees with the anesthesia plan such as the anesthesia plan being appropriate for the type of procedure and the patient’s medical conditions. While a conversation usually takes place between the anesthesia provider and surgeon, and it is implied that there is agreement on the anesthesia plan. This agreement or concurrence must also be documented. Including everyone in the concurrence discussion during the time-out helps to prevent a team member from saying they didn’t want to proceed or were pressured to proceed in the event of an adverse outcome.
There are several locations in the clinical record that are appropriate to document this concurrence. A great way to achieve this documentation and an easy location, is to add it to the time-out section of the operative record. This can promote effective team communication while also verifying other important components such as all equipment and medications are available. Including a check box that the anesthesia provider and the surgeon/proceduralist concur, indicates compliance with the standard. This step provides the OR team with a final check that everything is in place and ready to proceed. There may be other locations in the operative record that also may be appropriate. The facility should include this in facility policies and procedures. As an additional point of clarification, when a registered nurse is providing sedation under the direction/supervision of the surgeon, 8-B-24 becomes not applicable.
Since 1980, QUAD A (a non-profit, physician-founded and led global accreditation organization) has worked with thousands of healthcare facilities to standardize and improve the quality of healthcare they provide – believing that patient safety should always come first.
