VHA Handbook 1123 establishes the programmatic structure, policies and procedures that are to be used for the practice of anesthesia in the Veterans Health Administration. 

The updated Handbook was issued March 7, 2007.

Changes include:

1.  Recognition of different levels of complexity of anesthesia care in the VA which involve different practice models.

2.  Where multiple provider types exist, a team care approach is required.

3.  Clarification that in facilities with Nurse Anesthetists, but not Anesthesiologists, the Nurse Anesthetist is responsible for choosing the intraoperative anesthesia and that for authentication purposes, only the Nurse Anesthetist needs to sign the anesthesia record.

4.  Clarification that a State license defines the maximum breadth of practice allowable for a provider and that the local facility, based on their needs, may specify privileges or scopes of practice that are narrower than those established in the State license.

5.  Clarification, through an expanded listing, of the types of Allied Health Professionals that may be part of the Anesthesia Care Team.  The Allied Health Professionals list includes: medical instrument technicians, health technicians, electronics technicians, biomedical engineering technicians, physician’s assistants, Anesthesiologist Assistants (AAs), registered nurses, nurse practitioners, administrative assistants, secretaries, and others as determined locally.

VHA Handbook 1123, Anesthesia Service   (PDF file)