Anesthesiologists want changes to CRNA, dentist collaboration rule
Anesthesiologists asked for changes to a proposed state rule allowing advanced practice nurse prescribers to enter into collaborative agreements with dentists at a Wednesday public hearing.
Current administrative code requires advanced practice nurse prescribers to have an agreement with a physician. The rule would allow them to have that agreement with a dentist or doctor.
The Wisconsin Society of Anesthesiologists doesn’t oppose the rule in concept. But they want it to specify that a certified registered nurse anesthetist, advanced practice nurse prescribers who specialize in anesthesia, limit their practice to match the collaborating dentist’s level of anesthesia certification.
Dr. Christina Diaz, an associate professor at the Medical College of Wisconsin and pediatric anesthesiologist at the Children’s Hospital of Wisconsin, said she was concerned that without changes, the rule would become a “slippery slope.”
There have been several child deaths across the country related to anesthesia at the dental office, she said, citing a case where a 6-year-old child died after receiving general anesthesia.
“If we’re adding an advanced nurse practitioner, but we are not having the dentist at the same level in that collaboration, I’m afraid that we are going to start pushing the patient population that maybe they should not be sedating in an office,” she told members of the Assembly Committee on Health.
Deb Dahlke, a certified registered nurse anesthetist and Wisconsin Association of Nurse Anesthetists legislative committee chair, said that in the dental death cases, there usually weren’t anesthesia providers or certified registered nurse anesthetists present.
She said the certified registered nurse anesthetists already work in dental offices, often having collaborative agreements with doctors that are off site. Nurses have training in advanced life support, she said.
“I’ve worked with plenty of surgeons who did not have those certifications at all,” she said. “I made sure myself and the nurses in those offices were certified. So basically what we’re doing with the change in this rule is codifying what’s taking place. It’s already taking place. There’s no slippery slope here.”
The Wisconsin Dental Association supports the rule. Matt Rossetto, the association’s director of government services, said they’re looking at the anesthesiologists’ requested changes and consulting with other stakeholders.
The Wisconsin Society of Anesthesiologists also wants the Board of Nursing to clarify that existing malpractice insurance requirements for advanced nurse prescribers working with physicians apply to those working with dentists.
Dahlke said they wouldn’t have an issue with the proposed change as certified registered nurse anesthetists are required to have insurance and are part of the state’s Injured Patients and Families Compensation Fund.
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