1. OUT OF HOSPITAL ANESTHESIA SERVICES IN ONTARIO Dr. Dennis Reid

2. OBJECTIVES. To ensure that Ontario Anesthesiologists are aware of the following: The C.P.S.O. guidelines for O.H.P.s. including the assessment of anesthesia services. The P.H.O advisory on” Infection Prevention and Control for Clinical Office Practice”. The C.AS. Standards for deep sedation and ETCO2 monitoring. The structure and function of the C.P.S.O. premises inspection team. Anesthesia assistance. Personal O.H.I.P advisory on preprocedural assessment for endoscopy.

3. REQUIRED READING Out –of-Hospital ( O.H.P} Premises Standards C.P.S.O. 2013. Applying the O.H.P. Premises Inspection Program Standards in Endoscopy 2014. Anesthesia assessment tool. Public Health Ontario Guidelines for administration of intravenous medications.

4. C.P.S.O. INSPECTION TEAM Procedural specialist C.P.S.O. nurse inspector Anesthesiologist

5. ISSUES FOR ANESTHESIOLOGY Preprocedural preparation. Intraprocedural patient monitoring. Preparation and disposal of intravenous medications. Postprocedural recovery and discharge. Anesthesia Assistants.

6. PREPROCEDURAL PREPARATION A.S.A. 3 patients. History and physical examination. Vital signs. Blood work if required e.g. glucose Consent for the procedure and sedation

7. INTRAPROCEDURAL MONITORING Debate regarding use of ETCO2. Not a C.P.S.O. standard for deep sedation. However it is a C.A.S.Standard for deep sedation –Ramsey score> 4. Current literature. Personal experience

8. PREPARATION AND DISPOSAL OF INTRAVENOUS MEDICATIONS Single use vials-propfol. Multidose vials Multiple patient preparation. Separate areas for clean and in-use medications. Lack of discussion Confusion and therefore inconsistency of applying the standard

9. OUR SOLUTION FOR CLEAN AND IN-USE AREAS

10. ANESTHESIA ASSISTANTS Respiratory therapists who have completed/ enrolled in the anesthesia assistant Training program. Independent contactors with a hospital appointment and up-to-date liability coverage. Recent C.P.S.O. advisory regarding immediate availability

11. THANK YOU.