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This thread only applies to hospital based pain programs, but any others feel free to comment:
There was an issue brought to light recently at my hospital-based pain facility. Apparently, there is a movement to classify all procedures as "Invasive" vs. "Non-Invasive" to require performance in an Operating Room or Procedure Room. These guidelines are published in Facility Guidelines Institute 2014 recommendations for classification of hospital and ambulatory facilities. Apparently, Joint Commission utilizes these regulations to approve accreditation.
In a nutshell, it implies that all "Invasive Procedures" (penetrates protective surface of body, eg. Pain) should be performed in an operating room, and "Non-Invasive" should be performed in procedure rooms (percutaneous I.V.'s etc)
This move has significant implications, as it basically indicates that all pain procedures are considered "Invasive" and should be done in an OR, vs. the traditional Procedure Room/Fluoro Suite. I find it hard to believe that a facet nerve block and SI joint injection requires a full surgical prep and gown and be completed in an operating room? Do any other hospital based pain physicians have input regarding this issue?
Excerpt from Facility Guidelines Institute 2014 manual:
“Invasive procedure” is a broad term often used to describe procedures from a simple injection to a major surgical operation. For the purposes of the Guidelines, however, an invasive procedure is defined as a procedure that penetrates the protective surfaces of a patient’s body (e.g., skin or mucous membranes), is performed in an aseptic surgical field, generally requires entry into a body cavity, and may involve insertion of an indwelling foreign body. Such procedures must be performed in an operating room suitable to the technical requirements of the procedure with consideration of infection prevention and anesthetic risks and goals. The intent is to provide a safe environment for procedures that carry a high risk of infection, either by exposure of a usually sterile body cavity to the external environment or by implantation of a foreign object(s) into a normally sterile site. Procedures performed through orifices normally colonized with bacteria and percutaneous procedures that do not involve an incision deeper than skin are not included in this definition.
A "procedure room" is defined as a room for the performance of procedures that do not require an aseptic field but may require use of sterile instruments or supplies. Procedure rooms are considered unrestricted areas. Local anesthesia and minimal and moderate sedation may be administered in a procedure room, but anesthetic agents used in procedure rooms must not require special ventilation or scavenging equipment.
An "operating room (OR)" is defined as a room in the surgical suite that meets the requirements of a restricted area and is designated and equipped for performing surgical operations or other invasive procedures that require an aseptic field. Any form of anesthesia may be administered in an OR as long as appropriate anesthesia gas administration devices and exhaust systems are provided.
Any thoughts? Thx
There was an issue brought to light recently at my hospital-based pain facility. Apparently, there is a movement to classify all procedures as "Invasive" vs. "Non-Invasive" to require performance in an Operating Room or Procedure Room. These guidelines are published in Facility Guidelines Institute 2014 recommendations for classification of hospital and ambulatory facilities. Apparently, Joint Commission utilizes these regulations to approve accreditation.
In a nutshell, it implies that all "Invasive Procedures" (penetrates protective surface of body, eg. Pain) should be performed in an operating room, and "Non-Invasive" should be performed in procedure rooms (percutaneous I.V.'s etc)
This move has significant implications, as it basically indicates that all pain procedures are considered "Invasive" and should be done in an OR, vs. the traditional Procedure Room/Fluoro Suite. I find it hard to believe that a facet nerve block and SI joint injection requires a full surgical prep and gown and be completed in an operating room? Do any other hospital based pain physicians have input regarding this issue?
Excerpt from Facility Guidelines Institute 2014 manual:
“Invasive procedure” is a broad term often used to describe procedures from a simple injection to a major surgical operation. For the purposes of the Guidelines, however, an invasive procedure is defined as a procedure that penetrates the protective surfaces of a patient’s body (e.g., skin or mucous membranes), is performed in an aseptic surgical field, generally requires entry into a body cavity, and may involve insertion of an indwelling foreign body. Such procedures must be performed in an operating room suitable to the technical requirements of the procedure with consideration of infection prevention and anesthetic risks and goals. The intent is to provide a safe environment for procedures that carry a high risk of infection, either by exposure of a usually sterile body cavity to the external environment or by implantation of a foreign object(s) into a normally sterile site. Procedures performed through orifices normally colonized with bacteria and percutaneous procedures that do not involve an incision deeper than skin are not included in this definition.
A "procedure room" is defined as a room for the performance of procedures that do not require an aseptic field but may require use of sterile instruments or supplies. Procedure rooms are considered unrestricted areas. Local anesthesia and minimal and moderate sedation may be administered in a procedure room, but anesthetic agents used in procedure rooms must not require special ventilation or scavenging equipment.
An "operating room (OR)" is defined as a room in the surgical suite that meets the requirements of a restricted area and is designated and equipped for performing surgical operations or other invasive procedures that require an aseptic field. Any form of anesthesia may be administered in an OR as long as appropriate anesthesia gas administration devices and exhaust systems are provided.
Any thoughts? Thx
