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AANA Standards for Nurse Anesthesia Practice
TEXTProfessional · 9 min read
11 standards define the practice. Pre-op assessment through QI + wellness. The framework you're accountable to.
After this lesson you can
4 min read9 sections- Recall AANA Standards for Nurse Anesthesia Practice.
- Apply pre-anesthetic assessment standards.
- Document per AANA standard.
- Identify QI + safety standards.
Standard I — Pre-anesthetic assessment + plan
- history (medical, surgical, anesthetic, family, social)
- physical exam
- medication reconciliation
- allergy assessment
- review of relevant labs + imaging
- ASA Physical Status classification
- airway exam (Mallampati + thyromental + neck mobility + mouth opening)
- risk stratification (RCRI for cardiac, STOP-BANG for OSA, frailty if elderly)
- NPO status verification
- IV access plan
Develop a documented plan addressing technique + monitoring + crisis management + post-op pain.
Re-assess on day of surgery for interval changes (acute illness, new medication, recent meal).
Standard II — Informed consent
- nature of the anesthesia
- alternative techniques (GA vs regional vs MAC)
- material risks (death, brain damage, dental injury, awareness, nerve injury, PONV, sore throat per technique)
- benefits
- the option of no treatment
Patient understanding confirmed by teach-back.
Surrogate consent if patient lacks capacity (state-specific hierarchy).
- DNR reconsideration discussion
- blood product consent if applicable
- off-label use disclosure
- opioid stewardship discussion for chronic pain patients
Standard III — Patient safety + equipment
Pre-use anesthesia machine checkout per ASA/FDA.
Backup equipment immediately available: alternate airway devices (LMA, bougie, video laryngoscope, surgical airway kit), self-inflating bag-valve-mask, emergency medications (succinylcholine, epinephrine, atropine, naloxone, dantrolene per facility policy).
Suction working.
Pulse oximeter with backup.
Two functioning IV access points or plan for two.
Verify identity (patient + procedure + side + site) with surgical team pre-induction (time-out per Joint Commission Universal Protocol).
Standards IV-V — Monitoring + documentation
Continuous monitoring per ASA standards: oxygen analyzer with low-FiO₂ alarm, pulse oximetry, end-tidal CO₂ + capnography waveform, ECG, BP at least every 5 min, temperature when significant changes anticipated, NMB monitor when relaxants used.
Additional invasive monitoring per patient + procedure indication.
CONTEMPORANEOUS documentation throughout case: pre-op assessment + plan + consent, all drugs + doses + times (controlled substances especially), fluids in/out, vital sign trends at least every 5 min, anesthesia events + interventions + responses, complications, total volatile + opioid + NMB given, time of induction + incision + emergence + extubation + handoff.
Legal + clinical record — 'if it isn't charted, it didn't happen.'
Standard VI — Transfer of care + handoff
Receiving provider must be VERIFIED and ready to assume care before anesthesia leaves bedside.
- (SBAR or anesthesia-specific tool): patient identity + procedure
- anesthetic technique + airway
- drugs given (especially long-acting opioids, NMB reversal, antibiotics)
- complications + responses
- fluid + blood product totals
- post-anesthesia plan
- anticipated issues
- pain management plan
- contact information for questions
Receiving team has opportunity to ask questions.
Document handoff time + recipient name in the anesthesia record.
Standards VII-X — QI + wellness + infection control + ethics
- participate in QI activities — peer review
- M&M conferences
- root-cause analysis of adverse events
- practice improvement initiatives
- outcome tracking via AQI NACOR or institutional metrics
- professional wellness — substance use disorder vigilance (anesthesia + ICU professions have elevated risk)
- fatigue management
- burnout awareness + peer support
- fitness for duty
- infection control — hand hygiene before every patient contact + before sterile procedures
- equipment cleaning between cases
- sharps safety
- drug-vial contamination prevention (single-use propofol, scrub-the-hub)
- ethical practice — patient autonomy
- beneficence
- non-maleficence
- justice
- fiduciary relationship
- mandatory reporting of impaired colleagues
Standard XI — Scope of practice + state law
- full anesthesia care: pre-op evaluation
- anesthesia plan
- drug administration including controlled substances
- airway management + line placement
- perioperative management
- crisis response
- postop care
- acute + chronic pain management
Supervision requirements vary by STATE LAW (currently ~24 states/territories have opted out of CMS physician-supervision requirement for CRNAs in hospitals/ASCs) and by FACILITY POLICY (some hospitals require anesthesiologist medical direction regardless of state law).
AANA + state boards of nursing regulate.
Verify your specific state status + facility privileges; do not practice outside them.
Practice models + AANA documentation requirements
All-CRNA practice — common in rural + critical access hospitals + military/VA.
Anesthesiologist-only — rare in modern practice.
Mixed model.
Billing modifier reflects model (QY 1 CRNA medically directed, QK 2-4, QZ CRNA without medical direction, AA anesthesiologist alone).
Documentation must support the billed modifier.
AANA-specific documentation per Standard V is the same regardless of practice model.
Re-certification + continuing education
Every 8 years a CPC Assessment (CPCA, the open-book knowledge assessment).
State licensure renewals: separate requirements per state board of nursing, often coupled with CE hours.
DEA registration renewal q3 yr.
Facility privileges renewal q2 yr typical.
AANA membership optional but recommended for advocacy + resources.
Document all CE — keep records personally; institutional records can be lost.
⚠ Common pitfalls
- Skipping documented pre-anesthetic assessment — Standard 1.
- Inadequate informed-consent documentation — Standard 2.
- Missing equipment checkout in record — Standard 4.
- Failing to document the handoff — Standard 7.
💎 Clinical pearls
- AANA Standards 1-11: assessment, consent, plan, equipment, monitoring, record, handoff, QI, wellness, infection control, post-anesthesia care.
- Anesthesia record is a legal document — accurate, complete, time-stamped.
- Continuing education: 60 hr q-4 yr for NBCRNA recertification (MAC program).
- Practice scope varies by state — know your state's CRNA practice act.
Recap
- AANA Standards 1-11: assessment, consent, plan, equipment, monitoring, record, handoff, QI, wellness, infection control, post-anesthesia care.
- Anesthesia record is a legal document — accurate, complete, time-stamped.
- Continuing education: 60 hr q-4 yr for NBCRNA recertification (MAC program).
- Practice scope varies by state — know your state's CRNA practice act.
Mark each section done to complete the module.