LAWRENCE J. HOGAN, JR., Governor Ch. 686
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Chapter 686
(House Bill 55)
AN ACT concerning
Health Occupations – Nurse Anesthetists – Drug Authority and Collaboration
FOR the purpose of authorizing a nurse anesthetist to prescribe, order, and administer
drugs, including controlled dangerous substances, without obtaining approval from
a practitioner with whom the nurse anesthetist collaborates, subject to certain
limitations; authorizing a nurse anesthetist to collaborate with a podiatrist; and
generally relating to nurse anesthetists.
BY repealing and reenacting, with amendments,
Article – Health Occupations
Section 8–513, 12–101(b), and 12–102(e)
Annotated Code of Maryland
(2021 Replacement Volume)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
That the Laws of Maryland read as follows:
Article – Health Occupations
8–513.
(a) In this section, “perioperative assessment and management” means the
assessment and management of a patient preoperatively, intraoperatively, and
postoperatively.
(b) (1) A nurse anesthetist may perform the following functions:
(i) Perioperative assessment and management of patients requiring
anesthesia services;
(ii) Administration of anesthetic agents;
(iii) Management of fluids in intravenous therapy; [and]
(iv) Respiratory care; AND
(V) SUBJECT TO PARAGRAPH (4) OF THIS SUBSECTION ,
PRESCRIPTION , ORDERING, AND ADMINISTRATION O F DRUGS, INCLUDING A DRU G
THAT IS CLASSIFIED A S A CONTROLLED DANGE ROUS SUBSTANCE UNDER TITLE 5,
SUBTITLE 4 OF THE CRIMINAL LAW ARTICLE. Ch. 686 2022 LAWS OF MARYLAND
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(2) A nurse anesthetist has the right and obligation to refuse to perform a
delegated act if in the nurse anesthetist’s judgment, the act is:
(i) Unsafe;
(ii) An invalidly prescribed medical act; or
(iii) Beyond the clinical skills of the nurse anesthetist.
(3) Paragraph (1) of this subsection may not be construed to authorize a
nurse anesthetist to:
(i) Diagnose a medical condition;
(ii) Provide care that is not consistent with the scope of practice of
nurse anesthetists; or
(iii) Provide care for which the nurse anesthetist does not have proper
education and experience.
(4) A NURSE ANESTHETIST MA Y PRESCRIBE DRUGS UNDER
PARAGRAPH (1) OF THIS SUBSECTION :
(I) ONLY IN AN AMOUNT THA T DOES NOT EXCEED A 10–DAY
SUPPLY;
(II) ONLY FOR AN INDIVIDUA L WITH WHOM THE NURS E
ANESTHETIST HAS , AT THE TIME OF PRESC RIPTION, ESTABLISHED A CLIENT OR
PATIENT RECORD ; AND
(III) ONLY IN CONNECTION WI TH THE DELIVERY OF A NESTHESIA
SERVICES; AND
(IV) WITHOUT OBTAINING APP ROVAL FROM A PRACTIT IONER
WITH WHOM THE NURSE ANESTHETIST COLLABOR ATES UNDER SUBSECTIO N (C) OF
THIS SECTION.
(c) A nurse anesthetist shall collaborate with an anesthesiologist, a licensed
physician, [or] a dentist, OR A PODIATRIST in the following manner:
(1) An anesthesiologist, a licensed physician, [or] a dentist, OR A
PODIATRIST shall be physically available to the nurse anesthetist for consultation at all
times during the administration of, and recovery from, anesthesia;
LAWRENCE J. HOGAN, JR., Governor Ch. 686
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(2) An anesthesiologist shall be available for consultation to the nurse
anesthetist for other aspects of the practice of nurse anesthesia; and
(3) If an anesthesiologist is not available, a licensed physician [or], dentist,
OR PODIATRIST shall be available to provide this type of consultation.
(d) The nurse anesthetist shall ensure that a qualified anesthesia provider:
(1) Performs a thorough and complete preanesthetic assessment;
(2) Obtains informed consent for the planned anesthetic intervention from
the patient or an individual responsible for the patient; and
(3) Formulates a patient–specific plan for anesthesia care.
(e) The nurse anesthetist as part of the standards of practice shall:
(1) Implement and adjust an anesthesia care plan as needed to adapt to
the patient’s response to the anesthesia;
(2) Monitor a patient’s physiologic condition for untoward identifiable
reactions and initiate appropriate corrective actions as required;
(3) Enter prompt, complete, and accurate documentation of pertinent
information on a patient’s record;
(4) Transfer responsibility for care of a patient to other qualified providers
in a manner that ensures continuity of care and patient safety;
(5) Ensure that appropriate safety precautions are taken to minimize the
risks of fire, explosion, electrical shock, and equipment malfunction;
(6) Maintain appropriate infection control standards;
(7) Evaluate anesthesia care to ensure its quality;
(8) Maintain continual competence in anesthesia practice; and
(9) Respect and maintain the basic rights of patients.
(f) This section may not be construed to require a written collaboration
agreement between a nurse anesthetist and an anesthesiologist, a physician, [or] a dentist,
OR A PODIATRIST .
12–101.
Ch. 686 2022 LAWS OF MARYLAND
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(b) “Authorized prescriber” means any licensed dentist, licensed dental hygienist
with prescriptive authority under § 4–206.4 of this article, licensed physician, licensed
podiatrist, licensed veterinarian, advanced practice nurse with prescriptive authority
under § 8–508 of this article, LICENSED NURSE ANEST HETIST, or other individual
authorized by law to prescribe prescription or nonprescription drugs or devices.
12–102.
(e) (1) This title does not prohibit:
(i) A dentist, physician, or podiatrist from administering a
prescription drug or device in the course of treating a patient; [or]
(ii) A licensed dental hygienist from administering medication under
§ 4–206.4 of this article; OR
(III) A NURSE ANESTHETIST FR OM ADMINISTERING
MEDICATION UNDER § 8–513 OF THIS ARTICLE .
(2) For the purposes of paragraph (1)(i) of this subsection, “administering”
means the direct introduction of a single dosage of a drug or device at a given time, whether
by injection or other means, and whether in liquid, tablet, capsule, or other form.
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shal l take effect
October 1, 2022.
Enacted under Article II, § 17(c) of the Maryland Constitution, May 29, 2022.