The Center for Medicare & Medicaid Services released an Interpretive Guideline on Anesthetic Use for Hospital Procedures. This guideline restricts injection of intravenous sedatives for procedures (including emergency intubation) to “qualified” practitioners, a definition that does not include critical care and emergency medicine nurses. The Critical Care Society Collaborative (CCSC) was concerned about this wording, as the intensivist may be the only qualified individual in the hospital at night. As such, he/she cannot delay intubation to wait for another practitioner and cannot effectively monitor sedation while preparing to perform the procedure.
The Critical Care Societies Collaborative sent a letter in August 2010 to the Centers for Medicare & Medicaid Services (CMS) to express concern about guidelines governing anesthesia service. The Collaborative is urging CMS to clarify these guidelines, as they have been broadly interpreted to include administration of sedatives for procedures such as emergent intubation for mechanical ventilation.