Position Paper Anesthesia Assistants

The Canadian Society of Respiratory Therapists (CSRT) is dedicated to promoting the profession of respiratory therapy as being essential to the safe delivery of healthcare in Canada. We believe that the following position, as outlined, serves both the interest of the public as well as the CSRT membership.

BACKGROUND
For several decades, registered respiratory therapists (RRTs), have worked alongside Anesthesiologists in Canadian operating rooms. The traditional role of the operating room respiratory therapist has included providing technical support to the anesthesiologist for the proper use and maintenance of the anesthetic gas machine, in addition to providing airway management. Over the past several years, this role has evolved into a more advanced and specialized practice with increasing responsibilities. In many Canadian hospitals, RRTs have undergone additional training in order to perform these duties, all under the authority of their respective departments of anesthesia. As well, a number of educational institutions have now developed programs supporting the specialization of RRTs for anesthesia support.

The title for this role varies within institutions and jurisdictions across Canada. Although the title of “Anesthesia Assistant” is not a legislated protected title, it is associated with this role in many facilities, as well as having been recognized by the CSRT and the Canadian Anesthesiologists’ Society (CAS). The CSRT has determined that an individual with a diploma and/or degree in respiratory therapy is the most appropriately qualified practitioner to fill the role of anesthesia assistant, that the concept of anesthesia assistant is consistent with an advanced scope of practice RRT and should be able to use registered respiratory therapist (anesthesia assistant), or RRT(AA), as a designation.

POSITION STATEMENT
The CSRT is of the position that the role of respiratory therapist as anesthesia assistant falls within the scope of practice of respiratory therapy. As well, the RRT functioning as an RRT(AA) works within the framework of the team providing the delivery of anesthesia care, under the direction of the attending anesthesiologist. Furthermore, the CSRT believes that RRT(AA)s assuming the role and responsibilities of anesthesia assistant is in the public’s best interest and can improve the safety and efficiency of anesthetic care. As such, the CSRT has supported and will continue to support its members and academic institutions in their endeavors with provincial Ministries of Health and provincial regulatory bodies to recognize and facilitate the role of RRTs as anesthesia assistants in Canada.

As accountable professionals, our members are committed to the delivery of safe and ethical health care. Some employers across Canada have chosen to provide formalized training and certification processes for their RRTs who practice in the area of anesthesia. As well, numerous educational institutions offer or are developing programs specific to training in the specialty of anesthesia assistance. Although the CSRT does not specifically require additional certification or formalized training from its members to carry out or to enhance their practice, the CSRT supports and encourages a consistent and measurable process to advance the skills of its members. Continuing competency and ongoing quality improvement initiatives are supported and encouraged by the CSRT in accordance with provincial licensing bodies in providing excellence in the delivery of respiratory therapy.

Recommendations from the Anesthesia Assistant Task Force

Training and Education of Anesthesia Assistants

In March of 2005 the CSRT hosted a meeting of stakeholders in Ottawa to review and update a proposed curriculum document. At the meeting, the stakeholders, comprised of representatives from several schools involved in, or about to create, anesthesia assistant programs as well as representatives from the regulators and the CSRT, made significant changes to the original curriculum document created in 2003. The schools indicated their willingness to use the revised document for their programs.

Currently there are six schools across Canada providing advanced programs in anesthesia at the post-diploma level. They are; Thompson Rivers University in Kamloops, British Columbia, University of Manitoba in Winnipeg, Manitoba, The Michener Institute in Toronto, Ontario, Algonquin College in Ottawa, Ontario, Fanshawe College in London, Ontario and Dalhousie University in Halifax, Nova Scotia. In addition, the CoARTE accredited schools in Quebec provide additional didactic instruction and clinical exposure to anesthesia practice within their respiratory therapy programs. As more schools express interest in developing a program, it is becoming apparent that the lack of a common foundational knowledge document with which to create a curriculum is resulting in a lack of consistency in the training of anesthesia assistants across Canada. It is imperative therefore, that if we are to develop anesthesia assistants to the level demanded that there be national standards. Given the previous acceptance of theFoundation Knowledge for Assisting in Anesthesia Documentby the schools and the significant amount of work already expended in its creation, it is proposed that this document be again reviewed in order to establish it as the standard to be used in further curriculum development.

Accreditation of Anesthesia Assistant Training Programs

The CSRT, through the Council on Accreditation for Respiratory Therapy Education (CoARTE), provides a national accreditation program for schools offering a respiratory therapy training program. This program has proven itself to be highly successful. As all the schools offering, or planning, an anesthesia assistant training program are also accredited respiratory therapy schools, it is proposed that an accreditation program for anesthesia assistants be piggybacked onto the current CoARTE process. This would eliminate the need to reassess various academic policies and procedures protecting students’ rights and ensuring appropriate documentation which would be common throughout the institution’s educational programs. To facilitate this proposal, it is suggested that CoARTE could add one more content specific expert to the current accreditation review team. The CAS will be approached for a list of suitable interested anesthesiologists. One benefit of this proposal should be the significant reduction in the cost of accreditation over the development, from the ground up, of a new, entirely independent system.

Examination and Certification

The Canadian Board for Respiratory Care (CBRC) currently provides a national registry exam for respiratory therapy based upon the National Competency Profile. With the further development of the Foundation Knowledge for Assisting in Anesthesia Document as the basis of a common curriculum, it is hoped that a national standard for training can be established. Once this has occurred, a profile of the required competencies can be drawn up and used as the matrix for a national exam. With the CBRC’s established expertise in this area, they will be approached to assist in the development of both the competency matrix and an exam. Further, as a means to establish a national standard for anesthesia assistants, Human Resources and Social Development Canada (HRSDC) will be approached to assist in the development of a national job profile.

Scope of practice

The specific job descriptions and duties of AAs may differ according to geographic area and local practice. Provincial legislation or board of medicine regulations or guidelines may further define the job descriptions of AAs. AAs practice under the direction of a qualified anesthesiologist. The CSRT believes that the Canadian Anesthesiologists’ Society statement on the Recommended Scope of Practice of Anesthesia Assistants be adopted. The statement may be found at: http://www.cas.ca

The AA’s functions include, but are not limited to, the following:

Technical Duties
The Anesthesia Assistant shall:

1. Set up, test, calibrate and operate physiologic monitors such as anesthesia workstations, intubation/airway devices, fiberoptic endoscopes, physiologic monitors and infusion devices.

To ensure safety of equipment, perform equipment checks as indicated and maintain records of problems.

Replace and change anesthetic equipment supplies as per routine maintenance schedule.

Maintain stock of drug supplies and equipment at anesthesia workstations.

2. Troubleshoot anesthetic equipment.

Correct problems discovered and/or follow up with Biomedical engineering technicians or service representative.

3. Monitor trace gas pollution levels.

4. Maintain and stock Pediatric, Difficult Intubation, Hemodynamic and Malignant Hyperthermia carts.

5. Participate in the operating room infection control program by performing duties such as maintaining cleanliness in anesthetic equipment in accordance with quality assurance programs. Maintain measures, according to established procedures, to minimize operating room pollution.

Clinical Duties
The Anesthesia Assistant shall:

Assist in the preparation of the patient for surgery and perform pre-operative assessments as requested by the anesthesiologist.
Assist with or perform the insertion of devices such as nasogastric tubes, intravenous, and intra-arterial catheters.
Assist with the insertion of Swan Ganz catheters and central venous catheters.
Assist with regional anesthesia procedures.
Assist with or perform airway management, including insertion of laryngeal masks, tracheal intubation, and mask ventilation.
Assist in the positioning of the patient under the direction of the anesthesiologist
Adjust therapies (e.g., ventilation, temperature control devices, etc.) as directed by the anesthesiologist.
Administer prescribed pharmacological agents to the patient under the direction of the attending anesthesiologist, observing for side effects and efficacy of treatment during anesthesia to ensure the patient responds appropriately.
Assess the patient’s physiological status during anesthesia by performing duties such as monitoring vital signs and anesthetic gases and advising the anesthesiologist of the patient’s status.
Assist at emergence from anesthesia by performing duties such as aspirating secretions from the trachea and pharynx, removing LMAs, and tracheal extubation of the patient. Remove monitoring equipment after surgery.
Assist with the transfer of ventilated and/or anesthetized patients between areas of the hospital as required.
Transfer post-operative patients to the Post Anesthesia Care Unit under the direction of the anesthesiologist.
Monitor patient progress in the Post Anesthesia Care Unit, update anesthesia monitoring records, and report patient status to the anesthesiologist, as requested.
Provide diagnostic data for the anesthesiologist by performing duties such as blood sampling and analysis pulmonary functioning testing, end tidal CO2 monitoring, pulse oximetry, and transcutaneous monitoring.
Prepare fiber-optic bronchoscopes and other equipment as required, and assist the anesthesiologist during bronchoscopy with equipment set-up, preparation of and instillation of medication, and sample procurement.
Assist the anesthesiologist with difficult intubations.
Assist the anesthesiologist with cases in locations out of the operating room.
Respond to cardiac arrests in OR, PACU or other locations according to hospital procedures and policies.

Administrative Duties
The anesthesia assistant shall:

1. Establish and conduct a preventive maintenance program.
2. In conjunction with the Anesthesiology and Biomedical Engineering Departments, maintain a variety of anesthetic equipment by performing duties, such as receiving and assessing equipment, testing and identifying malfunctions and determining whether repairs should be made on-site or equipment returned to vendor. Carry out minor maintenance following manufacturer’s and Canadian Standards Association guidelines and verify vendor repairs to ensure equipment is operating in a safe and effective manner.
3. Where appropriate, meet with medical equipment and pharmacological sales representatives to organize trials and evaluations of new equipment and drugs according to hospital protocol. Gather and collate feedback and participate in purchase decisions.
4. Arrange and co-ordinate servicing and repair of equipment.
5. Communicate with and act as a liaison with supply companies.
6. Remain current with available supplies and equipment and make recommendations for changes/improvements.
7. Maintain supply inventory.
8. Source out supplies and equipment.
9. Assist the department of anesthesia with capital equipment budget by conducting equipment needs assessments and research.
10. Assist in quality assurance activities.

Education and Orientation
The anesthesia assistant shall:

1. Participate in the orientation of new OR and PACU staff and students.
2. Participate in teaching of students.
3. Participate in In-service sessions for nursing staff and physicians on new equipment and supplies.
4. Attend training programs as required.

When developing the CSRT position statement, the authors drew on the expertise of a position statement from the College of Respiratory Therapists of Ontario (CRTO) as well as the position description in the position statement disseminated by the Canadian Anesthesiologists’ Society (CAS).

If you have any questions or comments regarding the role of respiratory therapists as anesthesia assistants, please contact the Canadian Society of Respiratory Therapists in Ottawa, Ontario.

Approved by the CSRT Board of Directors, July, 2008