Republic of the Philippines Department of Health OFFICE OF THE SECRETARY APR 08 2014 ADMINISTRATIVE ORDER No. 2014 - _ OO SUBJECT: Guidelines_on_the Department _of Health Anaesthesia Care Nursing Program I. RATIONALE: The DOH with its legal mandate to promote the health and well-being of every Filipino serves as the lead agency in ensuring equity, access and quality of health care services through policy formulation, standards development and regulations; it also serves as technical oversight agency in charge of monitoring and evaluating the implementation of health programs, projects, research, training and services, By virtue of Executive Order 102 (‘Redirecting the Functions and Operations of the Department of Health’), it was given the power to: “Ensure quality of training and health human resource development at all levels or the health care system”. Administrative Order No. 2012-0012 known as the: “Rules and Regulations Governing the New Classification of Hospitals and Other Health Facilities in the Philippines” orders that ail hospitals shall provide basic hospital functions such as, but not limited to, acute medical and surgical services, anesthesia services, emergency and outpatient services, nursing service, dental service, with common diagnostic and support units as pathology, radiology, and pharmacy. With the new classification of hospitals, Level I hospitals at the minimum should have the capacity to deliver surgical and anesthesia services among others. However, with the current distribution of physicians, specialists and anesthesiologists in the country which is primarily urban-centered, there will be hospitals in the rural and remote areas that will continue to have a shortage of these human resources for health. Therefore, there is a need to develop competent nurses in anesthesia care who would assist the anaesthesiologists, especially in the rural Local Government Unit (LGU) hospitals towards improving access to surgical and anesthesia health services, in support of Universal Health Care. The DOH developed a comprehensive Anesthesia Care Nursing Training Program that will provide the structure and mechanism for the establishment of competency-based training and development for nurses in anesthesia care. This program will eventually give rise to a supervised DOH Anesthesia Care Nursing program that will be available in identified DOH hospitals in areas of need to improve access to health care. ‘Building 1, San Lazaro Compound Rizal Avenue, St. Criz, Mania 1003» Trunklie: (32) 651-7800; Diret Line: (632) 71-9501, Fax: (632) 743-1829 743-1786 + URL: higsfwww.doh gov.ph E-mail: osec@doh.gov.ah resent 40This Order aims to provide the structure and guidelines for implementing the DOH Anesthesia Care Nursing Program in all hospitals capable of delivering surgical and anesthesia services. Il. OBJECTIVES: 1, To provide the organizational structure and mechanisms for the implementation of the DOH Anesthesia Care Nursing Program in participating hospitals at different levels of health care, 2. To prescribe the guidelines for the establishment of competency-based training and development for nurses in the standard Anesthesia Care Nursing Course 3. To prescribe mechanisms for program monitoring and evaluation, I. SCOPE: This Order shall apply to all DOH-retained regional hospitals and DOH-licensed LGU hospitals from Levels I to III. IV. DEFINITION OF TERMS 1. Competency ~ the ability to integrate knowledge, skills and attitudes through actual performance in the workplace setting. In the performance of nursing functions, ‘competency is determined in relation to established standards of performance. 2. Competency-Based Development — composed of learning and development interventions which results in measurable performance. The criteria are expressed as outcome and assessment is a core component. 3. Anesthesia Care Nursing —a special area in the nursing practice that deals with the care of patients under anesthesia and assistance to anaesthesiologists pre-, intra- and post- operatively 4, Anesthesia Care Nurse — a nurse trained and certi practices under the supervision of an anaesthesiologi $. Supervising Anesthesiologist ~ Board-cligible or a certified diplomate anaesthesiologist; a physician who completed an accredited anaesthesiology residency training program which has been approved by the corresponding medical specialty certification board ied in Anesthesia Care Nursing and Based on Administrative Order No. 2012-0012 “New Classification of Hospitals”) 6. Level I hospitals — has consulting specialists in: Medicine, Pediatrics, OB-Gyne and Surgery; has emergency and out-patient services; isolation facilities; surgical/maternity facilities; dental clinic; secondary clinical laboratory; a blood station; 1" level x-ray; and a pharmacy 7. Level II hospitals — has all Level 1 requirements plus: departmentalized clinical services, respiratory unit, general ICU, high-risk pregnancy unit, NICU, tertiary clinical laboratory, and a 2™ level x-ray with mobile unit 8 Level IIT hospitals ~ has all Level 2 requirements plus: teaching/training with accredited residency training program in the 4 major clinical services, physical medicine and rehabilitation unit, ambulatory surgical clinic, dialysis clinic, tertiary lab with histopathology, blood bank, 3 level x-ray prtpssnmna 4.09 ayV. GENERAL GUIDELINES: 1, Anesthesia Care Nursing shall be included as one of the specialty areas under the DOH Nurse Certification Program (Department Order No. 2012-0181 “Guidelines on the Department of Health Nurse Certification Program"), 2. Alll hospitals, beginning from the Level I category, shall have Operating Room Capacity (as per DOH Administrative Order No. 2012-0012) and shall have at least 1 Anesthesia Care Nurse supervised by an anaesthesiologist. 3. All Level Ill DOH-retained hospitals with accredited residency training program in anesthesiology shall serve as training centers of Anesthesia Care Nursing DOH Specialty hospitals shall serve as trainers and resource persons All Anesthesia Care Nurses shall be supervised by an anaesthesiologist. who are based in provincial hospitals 6. All provincial referral hospitals shall have at least one supervising anaesthesiologist. aR VI. SPECIFIC GUIDELINES: 1. Supervision of Training Program and Training Facilities a, The program shall be headed and supervised by DOH-HHRDB. b, All DOH-retained Level III hospitals with an accredited anesthesia residency training program are designated as training centers for the program. ©. The training program shall be supervised by the Medical Center Chief and the Head of Anesthesiology Department at institution level 4. DOH-designated training centers shall issue certificates to trainers upon completion of the training program. €. For government-employed nurses, training fees will be subsidized by the DOH subject to corresponding service obligation or return service in identified Level I hospitals in need of anesthesia care 2. Criteria for Trainers a. Must have any of the following: i. Minimum of 5 years clinical experience ii, Supervisory functions as an Anesthesiologist iii, Certificate as a Certified Registered Nurse Anesthetist (CRNA) iv. Certificate of Competency from the DOH NCP as an Anesthesia Care Nurse b, Must have acquired the necessary government certification or accreditation authorizing the practice of anesthesiology/anesthesia care nursing ©. Must have the necessary teaching and communication skills 3. Training Modules a. All training centers shall use the training modules prescribed by the DOH-HHRDB b. Training modules shall be reviewed every three (3) years by a pool of experts that will be designated by the DOH-HHRDB ey otpsde 4-08¢. Duration of training is minimum of six (6) months, but may vary subject to the results of the trainee assessments and findings and recommendations from the module reviews 4. Within the duration of the training, nurses will be required to undergo 24-hr duty subject to the requirements of the prescribed modules €. The scope of learning interventions is as follows: a) Level III — adult patients (19 years old and above), b) Level IV — pediatric patients (18 years old and below), c) Level V ~ adult and pediatric patients plus managerial and supervisory skills. 4. Scope of Practice of DOH Anesthesia Care Nurse a. Shall be subject to the Scope of Nursing Practice as provided by the national professional law for nurses and other professional regulatory laws b. Shall include, but shall not be limited to, the following tasks under the supervision of an anesthesiologist: Assessment and monitoring of patient’s condition pre-, intra- and post- operatively Assist the anesthesiologist Administer prescribed medications Start IV hydration or therapy vy. Perform intubation vi. Perform regular inspection of anesthesia machine before each procedure, including the leak test c. In emergency and life-saving situations and in the absence of a supervising anesthesiologist, anesthesia care nurses may perform the procedures cited above upon proper referral. 4. Scope of practice of Anesthesia Care Nurse may vary or be modified subject to existing national policies or government issuances Prerequisites for entry: a. Must be a practicing Critical Care Nurse with minimum of 1 year clinical experience in a critical care unit or must have completed a government accredited training program for critical care nursing b, Must have a recommendation from his/her Chief Nurse ¢. Must be a certified nurse in Intravenous (IV) therapy and Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) or have completed a DOH program in IV therapy, BLS and ACLS 4. Must not be more than 50 yrs old at the time of application ¢. Government-employed nurses must submit to the DOH-HHRDB a copy of the perfected Scholarship Service Contract with their respective institutions. 6. Liabilities a. The anesthesiologist in-charge of the surgical or emergency procedure shall be accountable for all legal liabilities that may be incurred by the Anesthesia Care Nurse being supervised. S ssa 4-09b. Anesthesia Care Nurses shall also be held liable for damages incurred when found acting out of his or her volition and without the supervision of an anesthesiologist. €. Hospitals shall be responsible for issuing the necessary implementing rules and regulations of the DOH anesthesia care nursing program to safeguard the rights and safety of the patient and its hospital staff. 7. Monitoring and Evaluation a, DOH-HHRDB shall prescribe monitoring and evaluation tools to evaluate the Anesthesia Care Nursing training program b. All nurses under the program shall undergo a pre- and post- assessment of competencies in their respective training centers c. Recipient hospitals shall conduct monitoring of patient safety in their respective areas of jurisdiction 8. Certification a. All nurses who would apply for a DOH Certification shall undergo the assessment and certification process prescribed by Department Order No. 2012-0181 “Guidelines on the Department of Health Nurse Certification Program”. VII. REPEALING CLAUSE All other issuances inconsistent with the provisions of this Order are hereby repealed/tescinded and modified accordingly. VIL. EFFECTIVITY DATE This Order shall take effect fifteen (15) days after publication to an official gazette or a newspaper of general circulation. ENRIQUE T. ONA, MD, FPCS, FACS Secretary of Health ots 4-09