Certified Nurse Anesthetist; CRNA

Position Summary

A Certified Registered Nurse Anesthetist (CRNA) is a licensed professional Advanced Practice Nurse responsible and accountable for his/her professional practice. He/she shall be capable of exercising independent judgment within his/her scope of practice.

• Assesses and monitors the client pre-operatively, intra- operatively and post- operatively.
• A pre-anesthetic check list shall be performed before the first case and before each additional case of the day.
• Always evaluates the client's current mental and physical status.
• Always identifies any historical adverse re-action(s) to anesthesia.
• Always reviews anesthetic history to include family's anesthetic history and potential problems.
• Proactively advocates for customers who should not be anesthetized.
• Conducts history and physical assessment as per professional standards.
• Always reviews current diagnosis of the client and proposed surgical procedure.
• Identifies and documents the client's current medications.
• Always reviews all pertinent laboratory data and takes appropriate action.
• Assures informed consent has been obtained from client during interview.
• Always evaluates the client for major system abnormalities.
• Always verify allergies, Anesthetic problems, NPO status and other pertinent information.
• Discusses the proposed anesthetic technique and alternative anesthetic techniques in a calming, patient focused and professional manner.
• Appropriately discusses the risks and complications associated with Anesthesia, including but not limited to reactions, intubation, oral and dental damage and possible death.
• Assembles drugs including emergency and routine anesthetic drugs, labeled and dated. Drugs and dosages are weight and age appropriate.
• Prepares equipment, selecting type of equipment and quantity as per type of procedure, as appropriate for the age and size of the patient, i.e. neonates, pediatrics, adolescents, adults and geriatrics.
• Prepares an appropriate anesthesia plan of care, as observed by Supervisor/random chart audit.
• Continues patient oversight through anesthesia discharge.
• Prepares for and provides anesthesia procedures in remote locations as per established protocols.
• Utilizes disconnect alarm as per established procedures.
• Utilizes carefully considered judgment in deciding which monitoring techniques are to be used on each client, based on physical diagnosis, to verify adequate ventilation and circulation. Utilizes ASA standards for basic intra- operative monitoring.
• Plan of care includes post anesthesia care and completes follow up post op visit and care as needed
• Provides individualized pre-medication, meeting each client's unique requirement and the provider’s preference.
• Client's vital signs and condition upon arrival to the recovery unit using the Par's scoring system.
• Adheres to appropriate safety precautions during all procedures to minimize the risk of fire, explosion, electrical shock and equipment failure.
• Documents presence of a nurse anesthetist during the course of the anesthetic.
• Documents Blood pressure and EKG monitoring on all surgical clients (general, regional and local anesthetics).
• Documents the client’s response (acceptance or refusal) to the explanation of the proposed anesthetic.
• Records Anesthesia plans; utilizes ASA classification, documents appropriate plan and interventions via information system.
• Completes and accurately documents pertinent information on client's record per WRHS policy/procedures.
• For the Induction phase always documents:
  Drugs, dosages and times of administration; technical difficulties during the induction period; and verification of airway control as well as frequency of ventilation in adverse airway situations and Anesthetic technique used.
• For the Intra-operative phase always documents: client's physiological responses to Anesthesia; monitoring modalities; all intra-operative events/problems;
  Communications regarding client's concerns to other health care providers;
  Position changes and pulse verification. Anesthetic techniques and methods of drug administration; total amount of all drugs, fluid/blood loss and replacements.
• For the Emergence phase always documents: reversal…