Horace Well and William Morton
Dentist who used anesthesia
Crawford Long 1842
Used Ether to remove a cyst but didn’t report the finding. One of the first ppl to use anesthesia.
Massachusetts general hospital
Did surgery 1846 with ether In the ether dome..
He tried to patent ether..
Ether was difficult when pt went under they fought.. so they remember
rapid induction no ether frolic
After 3 deaths they stopped using it.
Greener unfortunate pt
Pt took breaths and died really quickly!!
Problem with anesthesia
Occasional anesthetist - ppl didn’t know how to use it. Physicians didn’t want to do it. So they used interns to give ether. Interns wouldn’t pay attention to pt and pts. would die.
Father of neurosurgery
When he was a student he gave anesthesia and the pt died. He was told not to worry about it. He never forgot to!!
A nurse in the service provided anesthesia for the wounded during civil war. She wrote a book. She felt it was important job and nurses were stepping up to do it.
Sister Mary Bernard
Sisters Of St. Joseph
1877 St Vincent’s Hospital in Erie, PA
1878 took over anesthesia duties of the hospital
Sister Mary Erhard
Maui Hawaii 1886
Administered anesthesia for 42 years
Sister St. Francis
1889 St. Mary’s Hospital Mayo Clinic
Trained Alice Magaw “The Mother of Anesthesia” trained really hard. Was a standout
Lakeside Hospital late became Cleveland clinic
1908 personal anesthetist of Dr George Crile
She founded the American Association of Nurse Anesthetist
Established anesthesiology service at Mayo Clinic
Taught practitioners all over the world.
Published several different papers but physician presented them because women weren’t allowed.
Reported 14000 cases with on complications
PA hospital hired her as an anesthetist
Salaried and on call for the hospital
Jewish Hospital Philadelphia 1915
Their first anesthetist
Chosen by Dr. William Teller because of her Pugnacity”
Introduce gas anesthesia nitrous oxide gas mix
Served with Dr. Crile In World War 1 France
I’m 1915 Set up the first organized school of nurse anesthesia In Cleveland at Lakeside Hospital
Physicians stated challenging nurses giving anesthesia without a physician
1st AANA PRESIDENT standardized education
Sophie Gran Winton
Awarded medals for heroism she was a civilian nor an office during ww1
Trained in Minneapolis
Appointed to Yale Medical School 1922
Wrote Anesthesia principles and practice 1946 first nurse Anesthetist to publish a book
She taught at the medical school
Performed the first successful pneumonectomy anesthetic in 1929
Dr. Graham got credit for it.
Established a school at Barnes Hospital in St. Louis.
Collaborated with Dr Richard Von fOregger for 20 years on an anesthesia machine..
2 applications were approved for African American nurse anesthetist
Called for protection of the community’s interest
2nd AANA president
Called for approval mechanism for schools
Wanted the school to only admit well trained nurses
Organize the profession to protect against outside threats
Wanted certification for grads!
Council on Accreditation
Standards guidelines and criteria for programs accredits educational programs and helps Anesthesia schools improve
Council on Certification of Nurse Anesthetist
Protecting and serving the public by assuring that practicing CRNA’s have met qualifications or standards for providing anesthesia services..
Council on Public Interest no longer exist.
Student of Gertrude FIfe
Sole anesthesia provider for many rural history
Education director of VA hospital school of anesthesia
Wrote text on Regional anesthesia
Tax Equity and Fiscal Responsibility Act of 1982
7 conditions an anesthesiologist must satisfy with regard to a procedure for medical direction is CRNA’s to her Medicare reimbursement
- Perform preanesthesia eval
- Prescribe the anesthesia plan
- Personally participate in induction and emergence
- Monitor course is anesthesia at frequent intervals
- Be physically available for diagnosis and tx in emergencies
- Provide post anesthesia care
- Refrain from personally performing an anesthesia procedure when engaged in medical direction..up to 4 CRNA’s
AANA standards of practice for Nurse Anesthetist
Standards that describe the rules and responsibilities anesthetist are held accountable. What is expected 8 or 9 standards
AANA Vision Statement
Preeminent professional association. For healthcare and patient safety
AANA mission Statement
Advancing patient safety practice excellence and its members profession
AANA Core Values
Quality Professionalism Compassion Collaboration Wellness Diversity
Safe and effective anesthesia care.
Boards and recertification very 8 years we retest
Medicare part A
Medicare part B
The Joint Commission
National Practitioner Data Bank
Department of Health and Human Services
Department of education
Department of Justice
State board of Nursing
To protect society from harm
Fraudulent filing of insurance and Medicare claims
Practice without license
Employ someone without license
Misuse is controlled substance
Private rights and remedies
Area of most concern for CRNAs
Intentional torts- assault, battery, false imprisonment
Unintentional tort - malpractice negligence
Something bad happened
Non criminal cases
Goal is Tort Law
To restore the party who has suffered a damage to a condition that existed before the damage. For the plaintiff to be made whole.
-there has to be proof of damage
- Duty a legal responsibility to provide service and to receive payment
2.Breach of duty- they have to prove —————-commission do something wrong
—————Omission not do something you were suppose to do.
- Cause—would damage have occurred if there was no breach of duty? Has to show a relationship
- Damage- prove damage
Burden of Proof
Criminal beyond a reasonable doubt
Civil clear and convincing evidence
More likely than not preponderance is evidence
Res Ipsa Loquitur
Defendant has to prove or wasn’t them.
Obvious negligence occurred or else it wouldn’t have happened. Foot drop
The act speaks for itself
Circumstantial evidence is allowable in this!
- Doesn’t usually happen
- Has to be under the control of the defendant
- Can’t be no fault of the pt.
Assumption of Risks
Can’t be held accountable for things that we explained were a possibility of the procedure.
Defenses to protect yourself
- Do no harm
- Communicate with pt and family
- Informed consent
- Accurate documentation
- Contributory negligence plaintiff contributed to issue
- Comparative negligence- shared fault each pays their percent
- Statue ofLimitations— 2 years unless you try to alter evidence then it can be extended..
Occurrence policy- more preferred policy Anything that occurs while you have that policy is covered. In that time period.
Claims made policy is only enforced while you have the policy..
Tail coverage/ extended reporting period endorsement can be added if a claims made policy has ended and someone sues you after it the policy ended.
Captain of the ship
Once surgeon assumes responsibility they are accepting responsibility for everyone. Not follows anymore
Doctor is responsible for anyone they direct ie. nurse
Not followed anymore
Master is responsible for servants actions
Not practices anymore
Anesthesiologist is vicariously responsible for what we do even if they aren’t in the room..