Frequently Asked Questions

The crash cart must include, at a minimum, the following resuscitative medications:

• Adenosine 6 mg/2 ml x 3
• Albuterol Inhaler
• Amiodarone 150 mg x 2
• Atropine 0.4 mg/ml; 3 ml
• Calcium chloride 10%; 10 ml
• Dextrose 50%; 50 ml
• Diphenhydramine 50 mg
• Dopamine 200 mg minimum
• Epinephrine 1:10,000 dilution; 10 ml
• Epinephrine 1:1000 dilution; 1 ml x 3
• Flumazenil 0.1 mg/ml; 5 ml x 2
• Furosemide 40 mg
• Hydrocortisone or Methylprednisolone or Dexamethasone
• Lidocaine 100 mg
• Magnesium sulfate 1 gm x 2
• Naloxone 0.4 mg/ml; 3 ml
• Propranolol 1 mg x 1
• Sodium bicarbonate 50 mEq/50 ml
• Paralytic agent that is appropriate for use in rapid sequence intubation
• A calcium channel blocker class drug
• Intralipid 20% 500 ml solution (only if non-neuraxial regional blocks are performed)

See Rule 64B8-9.009(4)(b), F.A.C., for more information.

Level II office surgeries require the following equipment:

• Full and current crash cart at the location the anesthetizing is being carried out
• A benzodiazepine must be stocked, but not on the crash cart
• Suction devices, endotracheal tubes, laryngoscopes, etc.
• Positive pressure ventilation device plus an oxygen supply
• Double tourniquet for the Bier block procedure
• Monitors for blood pressure/EKG/oxygen saturation
• Emergency intubation equipment
• Adequate lighting
• Emergency power source able to produce adequate power to run required equipment for a minimum of two hours
• Appropriate sterilization equipment
• IV solution and IV equipment

See Rules 64B8-9.009(2) and 64B8-9.009(4)(b)3., F.A.C., for more information.

Applicable statutes and rules do not specify standard dimensions for the physical plant of an office surgery facility. It is suggested that you contact your local city and county clerk’s office for specific rules and code descriptions and restrictions.

A physician/surgeon must be assisted by a qualified anesthesia provider, or a registered nurse may assist with the anesthesia if the physician/surgeon is ACLS certified. An assisting anesthesia provider cannot function in any other capacity during the procedure. If additional assistance is required due to the specific procedure or patient circumstances, it must be provided by a physician, osteopathic physician, registered nurse, licensed practical nurse, or operating room technician. See Rule 64B8-9.009(4), F.A.C., for more information.

Licensed health care providers are required to monitor the recovery of a patient who has been given anesthesia. A physician, osteopathic physician, physician assistant, or registered nurse with an ACLS certification (for Level II procedures) and post-anesthesia training and experience (for Level III procedures) must be available. See Rule 64B8-9.009(4)(b)4., F.A.C., for Level II office surgeries and see Rule 64B8-9.009(6)(b)4., F.A.C., for Level III office surgeries.

At least two monitors must be in the recovery room at all times, one of whom must be ACLS certified when the patient has undergone a Level II procedure and one of whom must be ACLS certified and have post-anesthesia care training and experience when the patient has undergone a Level III procedure. See Rule 64B8-9.009(2)(h)1., F.A.C., for more information.

Yes, a surgical log is required. Copies of the suggested form are available online at the Board of Medicine website. See Rule 64B8-9.009(2)(c), F.A.C., for more information.

The information required on the surgical log are:

• Confidential patient identifier
• Time of arrival in the procedure room
• Name of the physician who provided medical clearances
• Surgeon’s name
• Diagnosis
• CPT Codes
• Patient ASA classification
• Type of procedure
• Level of surgery
• Anesthesia provider
• Type of anesthesia used
• Duration of the procedure
• Type of postoperative care
• Duration of recovery
• Disposition of the patient upon discharge
• List of medications used during surgery and recovery
• Any adverse incidents as defined in section 458.351, F.S.

See Rule 64B8-9.009(2)(c), F.A.C., for more information.

For purposes of reporting to the Department of Health, an adverse incident is an event over which a physician or other licensee could exercise control and which is associated in whole or in part with a medical intervention, rather than the condition for which such intervention occurred, and which results in the following patient injuries:

• The death of a patient
• Brain or spinal damage to a patient
• The performance of a surgical procedure on the wrong patient
• A procedure to remove unplanned foreign objects remaining from a surgical procedure
• The performance of a wrong-site surgical procedure; the performance of a wrong surgical procedure; or the surgical repair of damage to a patient resulting from a planned surgical procedure where the damage is not a recognized specific risk as disclosed to the patient and documented through the informed-consent process and if one of the listed procedures in this paragraph results in: death; brain or spinal damage; permanent disfigurement not to include the incision scar; fracture or dislocation of bones or joints; a limitation of neurological, physical or sensory function; or any condition that required transfer of the patient
• Any condition that required the transfer or a patient to a hospital licensed under section 395, F.S., from any facility or any office maintained by a physician for the practice of medicine that is not licensed under section 395, F.S.

See Rule 64B9-9.001(1)(a), F.A.C., for more information.

The report must be submitted by every licensee who was involved in the adverse incident. If multiple licensees are involved in the adverse incident, they may meet this requirement by signing off on one report; however, each signee is responsible for the accuracy of the report. See Rule 64B8-9.001(2), F.A.C., for more information.

Adverse incident reports must be postmarked and sent by certified mail or emailed within 15 calendar days after the occurrence of the adverse incident.

You may download and print a copy of the Physician Office Adverse Incident Report form.