(a) In this section, “perioperative assessment and management” means the assessment and management of a patient preoperatively, intraoperatively, and postoperatively.
(b) (1) A nurse anesthetist may perform the following functions:
(i) Perioperative assessment and management of patients requiring anesthesia services;
(ii) Administration of anesthetic agents;
(iii) Management of fluids in intravenous therapy;
(iv) Respiratory care; and
(v) Subject to paragraph (4) of this subsection, prescription, ordering, and administration of drugs, including a drug that is classified as a controlled dangerous substance under Title 5, Subtitle 4 of the Criminal Law Article.
(2) A nurse anesthetist has the right and obligation to refuse to perform a delegated act if in the nurse anesthetist’s judgment, the act is:
(i) Unsafe;
(ii) An invalidly prescribed medical act; or
(iii) Beyond the clinical skills of the nurse anesthetist.
(3) Paragraph (1) of this subsection may not be construed to authorize a nurse anesthetist to:
(i) Diagnose a medical condition;
(ii) Provide care that is not consistent with the scope of practice of nurse anesthetists; or
(iii) Provide care for which the nurse anesthetist does not have proper education and experience.
(4) A nurse anesthetist may prescribe drugs under paragraph (1) of this subsection:
(i) Only in an amount that does not exceed a 10–day supply;
(ii) Only for an individual with whom the nurse anesthetist has, at the time of prescription, established a client or patient record; and
(iii) Only in connection with the delivery of anesthesia services.
(c) A nurse anesthetist shall collaborate with an anesthesiologist, a licensed physician, or a dentist in the following manner:
(1) An anesthesiologist, a licensed physician, or a dentist shall be physically available to the nurse anesthetist for consultation at all times during the administration of, and recovery from, anesthesia;
(2) An anesthesiologist shall be available for consultation to the nurse anesthetist for other aspects of the practice of nurse anesthesia; and
(3) If an anesthesiologist is not available, a licensed physician or dentist shall be available to provide this type of consultation.
(d) The nurse anesthetist shall ensure that a qualified anesthesia provider:
(1) Performs a thorough and complete preanesthetic assessment;
(2) Obtains informed consent for the planned anesthetic intervention from the patient or an individual responsible for the patient; and
(3) Formulates a patient–specific plan for anesthesia care.
(e) The nurse anesthetist as part of the standards of practice shall:
(1) Implement and adjust an anesthesia care plan as needed to adapt to the patient’s response to the anesthesia;
(2) Monitor a patient’s physiologic condition for untoward identifiable reactions and initiate appropriate corrective actions as required;
(3) Enter prompt, complete, and accurate documentation of pertinent information on a patient’s record;
(4) Transfer responsibility for care of a patient to other qualified providers in a manner that ensures continuity of care and patient safety;
(5) Ensure that appropriate safety precautions are taken to minimize the risks of fire, explosion, electrical shock, and equipment malfunction;
(6) Maintain appropriate infection control standards;
(7) Evaluate anesthesia care to ensure its quality;
(8) Maintain continual competence in anesthesia practice; and
(9) Respect and maintain the basic rights of patients.
(f) This section may not be construed to require a written collaboration agreement between a nurse anesthetist and an anesthesiologist, a physician, or a dentist.