Podiatry

Practice Guidelines

Law, rules and regulations, not Guidelines, specify the requirements for practice and violating them constitutes professional misconduct. Not adhering to this Guideline may be interpreted as professional misconduct only if the conduct also violates pertinent law, rules and regulations, some citations of which are listed at the end of this Guideline.

Office-Based Surgery and Conscious Sedation

• A podiatrist performing office-based surgery is responsible for all aspects of the sedation procedure including life support procedures, monitoring, recovery and record-keeping and should adhere to the following:
  
  
  1. You may not administer conscious sedation to more than one patient at a time and should ensure that you or a licensed physician, a registered professional nurse, or a licensed practical nurse personally monitors the patient's recovery.
  2. A minimum of two individuals should be present in the operatory during administration of conscious sedation, including the use of nitrous oxide-you or a licensed physician qualified to administer the anesthetic drugs or agents and one additional individual who is also competent to perform cardiopulmonary resuscitation.
  3. Unlicensed personnel may not be assigned duties or responsibilities that require professional licensure. It is unprofessional conduct for a licensee to delegate professional responsibilities to a person who is not licensed to perform these functions.
  4. You should monitor and document vital signs, including:
     
     
     • Blood pressure;
     • Pulse;
     • Respiration; and
     • Oxygen saturation continuously with a pulse oximeter or an equivalent device when administering conscious sedation.
  
  
• Podiatrists may provide narcotics, local anesthesia and conscious sedation for therapeutic purposes in office-based settings. Conscious sedation is described as a minimally depressed level of consciousness in which the patient can independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal commands. Podiatrists may employ nitrous oxide (N₂0₂) when it is used to induce conscious sedation.
• Podiatrists may not provide general anesthesia, but they may treat patients who are receiving general anesthesia administered by an authorized person. For podiatric surgery performed in an office-based setting, only authorized licensed physicians with certification in anesthesiology are authorized to provide general anesthesia.
• Appropriate oral and written instructions should be provided to the patient or the patient's family or guardian based on the techniques used and the patient's physical state.
• Appropriate emergency supplies, equipment and medications should be available and commensurate with the scope of surgical and anesthesia services provided at the podiatrist's office. The podiatrist and at least one additional staff member should be competent to perform cardiopulmonary resuscitation. You should also develop an emergency care plan for your practice that includes provisions for safe and timely transfer of patients to a nearby hospital when hospitalization is indicated.
• You should have a plan in place for regular maintenance and inspection of all surgical and anesthesia equipment and machines in your practice such as the autoclave, pulse oximeter and nitrous oxide machine. The maintenance and inspection procedures should be consistent with the manufacturer's recommendations and a maintenance record should be maintained.
• You should develop and implement a procedure and schedule for cleaning, disinfecting and sterilizing equipment and patient care items in your practice. Personnel should also be trained in infection control practices and in the implementation of universal precautions.