NAC449.385. Surgical services.

     1. If a hospital provides surgical services, the services must be well-organized and provided in accordance with nationally recognized standards of practice. If outpatient surgical services are offered, the services must be consistent in quality, in accordance with the complexity of the services, with similar services provided to inpatients.

     2. The operating rooms must be supervised by an experienced registered nurse or a doctor of medicine or osteopathy.

     3. A licensed practical nurse or a surgical or operating room technician may act as a scrub nurse or scrub technician only under the direct supervision of a registered nurse.

     4. Circulating duties in an operating room must be performed by a qualified registered nurse, who shall not perform circulating duties in more than one operating room at a time.

     5. Surgical privileges must be delineated for all practitioners performing surgery in accordance with the competency of each practitioner. A hospital shall maintain a roster of practitioners that specifies the surgical privileges accorded to each practitioner.

     6. Policies governing surgical care must be designed by the medical staff to ensure the achievement and maintenance of high standards of medical practice and patient care.

     7. Except in emergency cases and except as otherwise provided in this subsection, a complete history and physical work-up must be completed and placed in a patient’s chart before the patient undergoes surgery. A patient may undergo surgery before his or her complete history or physical work-up is placed in his or her chart if the complete history or physical work-up has been dictated but not yet recorded and a statement of that fact and an admission note have been placed in the patient’s chart by the practitioner who admitted the patient.

     8. Except in emergency cases, an informed consent form properly executed by a patient for the surgery must be placed in his or her chart before the surgery is performed.

     9. Each surgical suite must have readily available and in good working condition:

     (a) A call system;

     (b) A cardiac monitor;

     (c) A resuscitator;

     (d) A defibrillator;

     (e) An aspirator; and

     (f) A tracheotomy set.

     10. A hospital shall make adequate provision for immediate postoperative care.

     11. The operating room register must be complete and up-to-date at all times.

     12. Immediately following surgery on a patient, the surgeon shall write or dictate an operative report, which must be included in the medical record of the patient, describing the techniques used, findings and tissues removed or altered. The surgeon shall sign the report.

     13. The medical staff shall define which surgeries require the presence of a first assistant. A list of the surgeries that require the presence of a first assistant must be readily available to the surgical staff of the hospital.

     14. A registered nurse or operating room technician may serve as a first assistant if:

     (a) The medical staff has not otherwise required that the first assistant in a surgery be a physician; and

     (b) The medical staff has designated the nurse or technician as having sufficient training to assist in the procedure adequately and properly.

     15. A hospital shall establish and carry out policies and procedures relating to the cleaning and sanitation of a surgical suite.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I § XI subsec. A, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)