Standards¹

1. Physicians must meet the standard of practice of the profession, which applies regardless of the setting in which care is being provided.
2. Physicians administering anesthesia or sedation must do so in accordance with the Canadian Anesthesiologists’ Society Guidelines to the Practice of Anesthesia, including requirements for patient assessment, pre-procedural testing, fasting guidelines, patient monitoring, documentation of care in the patient record², and anesthesia support personnel.
   1. Where a physician is administering anesthesia or sedation to a pediatric patient they must do so in accordance with the Canadian Pediatric Society’s Recommendations for procedural sedation in infants, children, and adolescents³
3. Physicians must use the Surgical Safety Checklist for all surgical procedures.
4. Medical Directors must ensure that care provided in the OHP complies with the National Association of PeriAnesthesia Nurses of Canada Standards for Practice, including requirements for appropriate staffing, discharge of patients from recovery phases, documentation of care in the patient record and appropriate discharge instructions.
5. Prior to procedure acceptance, physicians must have assessed the suitability of the patient to undergo the procedure in the OHP setting in accordance with the Patient Selection Standard
   1. For patients with significant co-morbidities, physicians must undertake appropriate consultation (for example, discussion with an anesthesiologist or other specialists) as required, prior to making a decision to proceed with the procedure in the OHP setting.

Pre-Procedure Requirements

6. Physicians must provide appropriate pre-procedure instructions to patients including any fasting instructions, and whether they will require adult accompaniment upon discharge from the OHP.
7. The physician performing the procedure must undertake an appropriate pre-procedure assessment and ensure a baseline history and physical has been taken.
8. Where anesthesia or sedation will be administered, the physician administering the anesthesia or sedation must, on the day of the procedure, undertake a pre-anesthetic assessment.
9. Physicians must ensure informed consent has been obtained for the procedure, including the use of anesthesia or sedation where applicable, in accordance with CPSO’s Consent to Treatment.

Intra-Procedure Care for Mild and Moderate Sedation and Regional Anesthesia

10. If the physician administering the regional anesthesia or sedation is also performing the procedure⁴, the physician must ensure the patient is attended by a second individual⁵ who is solely responsible for actively monitoring the patient and is appropriately qualified, in accordance with Appendix A of the Medical Director Standard, to monitor patients undergoing regional anesthesia or sedation.

Post-Procedure Patient Care

11. A physician must remain on site until the patient has met discharge criteria for the most acute phase of recovery, in accordance with the National Association of PeriAnesthesia Nurses of Canada Standards for Practice.

Extended and Overnight Stays⁶

12. Medical Directors must ensure that where there is an extended stay at an OHP, all of the following conditions are met:
    1. The extended stay takes place on the premises and patients are not transferred to another location pre-discharge, unless it is necessary to transfer the patient to a hospital;
    2. A physician, appropriately qualified in accordance with Appendix A of the Medical Director Standard, is immediately available by telephone and can be available onsite at the premises within thirty minutes for urgent medical matters;
    3. A minimum of two nurses appropriately qualified to monitor and recover patients from anesthesia or sedation are on premises;
    4. Necessary monitoring equipment and equipment and drugs to respond to urgent or emergency situations, in accordance with the Drugs and Equipment Standard are immediately available;
    5. The patient is continuously and appropriately monitored until they meet discharge criteria;
    6. An appropriate post-operative diet is available for the patient; and
    7. The patient has access to a washroom.
13. Medical Directors must ensure that no patient remains in an OHP longer than 24 hours. Should a patient need continued monitoring or be unable to meet discharge criteria after 24 hours in an OHP, the physician who performed the procedure or who administered the anesthesia must ensure the patient is transferred to hospital.

Patient Discharge After Anesthesia or Sedation

14. When a patient is being discharged, a physician must:
    1. write the discharge order for a patient, and
    2. direct that a summary of the care provided be distributed to the patient’s primary care provider (e.g., an operative or procedural note), if there is one and, the patient has provided consent.
15. Recovery area staff must ensure that patients are:
    1. provided with appropriate written discharge instructions⁷;
    2. accompanied by an adult when leaving the OHP, and are advised to have an adult stay with the patient during the postoperative period (most commonly 24 hours);
    3. informed that they need to notify the OHP of any unexpected admission to a hospital within 10 days of the procedure.

Endnotes

^1. Where this standard uses the term “physician” the expectation can be fulfilled by either the physician performing the procedure, or the physician administering the anesthesia or sedation. Expectations that must be fulfilled by a specific physician state this explicitly.

^2. For more information on appropriate documentation, please see the Advice to the Profession document.

^3. While this resource may refer to hospitals, the expectations will equally apply in an OHP setting.

^4. This may occur in certain scenarios, such as for surgical abortion or circumcisions.

^5. Such as a physician, respiratory therapist, registered nurse, or anesthesia assistant.

^6. An extended or overnight stay is where a patient has not met discharge criteria and is required to stay in the OHP beyond normal operating hours.

^7. For example, no driving for 24 hours, who to contact for routine and emergency follow-up, and instructions for pain management, wound care, and activity.