Circular No. 13/2012/TT-BYT on Anesthesia and Resuscitation Services

 

CIRCULAR

GUIDELINES FOR ANESTHESIA AND POSTOPERATIVE CARE WORK

Decree No. Pursuant to Decree No. 188/2007/NĐ-CP dated December 27, 2007 and Decree No. 22/2010/NĐ-CP dated March 9, 2010 of the Government stipulating the functions, tasks, powers, and organizational structure of the Ministry of Health;

At the proposal of the Director of the Department of Medical Examination and Treatment and the Head of the Legal Department;

The Minister of Health issues this Circular guiding anesthesia and postoperative care work.

PART I
GENERAL PROVISIONS

Article 1. Scope of Regulation

This Circular guides the functions, tasks, organizational structure, material infrastructure, equipment, and activities related to anesthesia and postoperative care in medical facilities permitted to perform surgeries and procedures requiring anesthesia and postoperative care.

Article 2. Interpretation of Terms

In this Circular, the following terms are understood as follows:

1. Anesthesia is a method that helps patients not feel pain at different levels of consciousness to maintain stable vital functions during surgery (operation) or procedures.

2. Recovery is the stage when the patient comes out of the effects of anesthesia.

3. Postoperative Care includes diagnostic and treatment measures for surgical patients (before, during, and after surgery and certain procedures) aimed at maintaining, stabilizing, and improving their vital functions.

4. Anesthesia and Postoperative Care involves performing some or all of the activities in pre-anesthesia examination, anesthesia, recovery, postoperative care, and pain management.

Article 3. Principles of Legal Application

Organizations and individuals involved in anesthesia and postoperative care work must comply with the provisions of this Circular and also apply the provisions of the Law on Medical Examination and Treatment 2009, Decree No. 87/2011/NĐ-CP dated September 27, 2011 detailing and guiding the implementation of certain articles of the Law on Medical Examination and Treatment, Decree No. 96/2011/NĐ-CP dated October 21, 2011 of the Government on administrative penalties for medical examination and treatment, Circular No. 41/2011/TT-BYT dated November 14, 2011 of the Ministry of Health guiding the issuance of practice certificates for healthcare practitioners and permits for medical examination and treatment facilities, other relevant legal documents concerning medical examination and treatment, and professional and technical regulations in medical examination and treatment.

Chapter II
ORGANIZATIONAL STRUCTURE AND STAFFING

Article 4. Organizational Structure

1. A complete anesthesia and postoperative care department consists of the following units:

a) Administrative;

b) Pre-anesthesia examination;

c) Surgery;

d) Recovery;

đ) Postoperative care;

e) Pain management.

2. Special class hospitals and Class I hospitals must organize a complete anesthesia and postoperative care department according to the provisions of Clause 1 of this Article.

3. Class II hospitals must organize an anesthesia and postoperative care department with a minimum of four units as specified in Points a, c, d, and đ of Clause 1 of this Article.

4. Class III, Class IV hospitals, or ungraded hospitals without an anesthesia and postoperative care department must arrange a minimum of two units specified in Points c and đ of Clause 1 of this Article within a clinical department that performs surgeries and procedures.

5. Other medical examination and treatment facilities outside the provisions of Clauses 2, 3, and 4 of this Article, if permitted to perform surgeries and procedures, must ensure anesthesia and postoperative care activities in accordance with the professional and technical regulations stipulated in this Circular.

Article 5. Professional Positions for Anesthesia and Postoperative Care Work

1. Anesthesiologist-Postoperative Care Specialist is a physician who has been trained in anesthesiology-postoperative care for at least 18 months and holds a practice certificate in accordance with the law on medical examination and treatment.

2. Anesthesiologist-Postoperative Care Nurse is a nurse with a specialized degree in anesthesiology-postoperative care and holds a practice certificate in accordance with the law on medical examination and treatment.

3. Anesthesiologist-Postoperative Care Technician is a technician with a specialized degree in anesthesiology-postoperative care and holds a practice certificate in accordance with the law on medical examination and treatment.

4. Surgical Ward Nurse is a nurse with a confirmation certificate indicating training in surgical nursing and holds a practice certificate in accordance with the law on medical examination and treatment.

Article 6. Staff Allocation

The staff of the Anesthesia - Intensive Care Department shall be allocated to the following units as follows:

1. Administrative: including the head nurse of the department and administrative staff. The number of administrative staff shall be decided by the director of the medical examination and treatment facility based on the proposal of the head of the Anesthesia - Intensive Care Department.

2. Pre-anesthesia Examination: at least comprising 01 (one) anesthesiologist - intensive care physician, 01 (one) anesthesia - intensive care nurse, and 01 (one) attendant.

3. Surgery: for each surgery, at least comprising 01 (one) anesthesiologist - intensive care physician, 01 (one) anesthesia - intensive care nurse, 01 (one) surgical instrument nurse, 01 (one) circulating nurse, and 01 (one) attendant.

4. Post-Anesthesia Recovery: at least comprising 01 (one) anesthesiologist - intensive care physician, nurses (the number of nurses depending on the number of recovery beds with a ratio of 02 (two) nurses responsible for 05 beds), and 01 (one) attendant.

5. Post-Surgical Intensive Care: at least comprising 01 (one) anesthesiologist - intensive care physician responsible for 03 beds, 1.5 nurses responsible for 01 bed, and 01 (one) attendant.

6. Pain Management: at least comprising 01 (one) anesthesiologist - intensive care physician, nurses (the number of nurses depending on the number of beds with a ratio of 01 (one) nurse responsible for 02 beds), and 01 (one) attendant.

7. The above positions may concurrently work in different units based on the actual staffing of the medical examination and treatment facility but must be consistent with their medical practice certificates.

Chapter III
FUNCTIONS, TASKS, AND POWERS

Article 7. Functions and Duties of the Anesthesia - Intensive Care Department

1. Functions:

The Anesthesia - Intensive Care Department is a clinical department with the function of performing pre-, intra-, and post-operative anesthesia and resuscitation procedures, as well as certain procedures for patients in accordance with the technical regulations stipulated in this Circular.

2. Tasks:

a) Implementing the approved professional anesthesia and resuscitation procedures;

b) Training, participating in training, conducting scientific research, directing lower-level facilities, and international cooperation in the field of anesthesia and resuscitation;

c) Participating in economic management in the unit;

d) Performing other tasks assigned by the head of the medical examination and treatment facility.

Article 8. Tasks of Units within the Anesthesia - Intensive Care Department

1. Administrative:

a) Monitoring, statistics, compiling, and reporting on professional activities;

b) Monitoring, statistics, compiling, and reporting on the issuance, use of equipment, consumables, medicines, and chemicals;

c) Monitoring staff and other administrative tasks in the department.

2. Pre-Anesthesia Examination:

a) Conducting pre-anesthesia examinations to prepare patients before surgery or procedures;

b) Pre-anesthesia examinations are conducted by anesthesiologists - intensive care physicians either in the pre-anesthesia examination unit, in the operating room, or in the ward where the patient needs surgery or procedures, depending on the conditions of the medical examination and treatment facility and the patient's condition;

c) Pre-anesthesia examinations are performed within a period from 01 to 07 days prior to surgery or procedures (except in emergency cases);

d) The pre-anesthesia physician has the right to request additional tests or organize consultations and must record all necessary information in the patient's medical records;

đ) The pre-anesthesia physician is responsible for informing and discussing with the surgeon, the person who will perform anesthesia - resuscitation about potential risks and complications related to anesthesia - resuscitation; explaining the risks and benefits related to anesthesia - resuscitation to the patient or the patient's legal representative before signing the consent form for anesthesia - resuscitation, surgery, or procedure.

3. Surgery:

a) Preparing staff, operating table, equipment, medications, and medical consumables adequately and ready for surgery or procedures;

b) Receiving and checking the patient's medical records, condition, and mandatory preparation requirements to ensure correct identification and accurate anatomical location for surgery or procedures;

c) Implementing appropriate anesthesia and resuscitation methods during surgery or procedures with the participation of anesthesiologists - intensive care physicians, anesthesia - intensive care nurses, surgical nurses, and other personnel as required by the anesthesiologist - intensive care physician;

d) Implementing infection control measures as prescribed.

4. Post-Anesthesia Recovery:

a) Receiving and assessing the patient's condition;

b) Managing and treating actively to help the patient recover quickly;

c) Treating post-surgery or procedure pain;

d) Monitoring, identifying, and managing complications or abnormalities if they occur for the patient;

đ) Evaluating the patient's condition to transfer them to the post-surgical intensive care unit or to other relevant departments.

5. Post-Surgical Intensive Care:

a) Receiving patients from the post-anesthesia recovery unit or from other transferred units;

b) Monitoring, diagnosing, actively treating, and providing comprehensive care to the patient;

c) Evaluating the patient's condition to transfer them back to the clinical department or another unit or for hospital discharge.

6. Pain Management:

a) Examining, advising, and managing pain relief for patients before surgery, after surgery, and for other acute and chronic postoperative pain cases;

b) Before implementing pain management techniques, informing and explaining to the patient or the patient's legal representative about the technique and method of pain management to be implemented;

c) Monitoring and managing any complications or adverse effects of the pain management method or technique if they occur.

7. In addition to the tasks specified above, units within the Anesthesia - Intensive Care Department must also perform other tasks assigned by the head of the department.

Article 9. Duties and Authorities of the Head of the Anesthesia and Intensive Care Department

Fulfill the duties and authorities of the department head and clinical department head as prescribed, and the following specific duties and authorities:

1. Manage and direct the activities of the Anesthesia and Intensive Care Department; organize for the components of the department to work effectively together, ensure quality, and be responsible to the head of the medical examination and treatment facility regarding the department's activities;

2. Develop plans for managing and utilizing human resources, equipment, medicines, and consumables of the department to submit to the head of the medical examination and treatment facility for approval and implement the plan after approval;

3. Assign anesthesiologists, nursing staff, and other personnel to participate in surgical teams;

4. Organize monitoring and caring for patients from reception until transfer back to the clinical department;

5. Report on the department's activities according to the regulations of the head of the medical examination and treatment facility;

6. Organize the implementation of hospital infection control and occupational safety measures;

7. Implement quality management activities within the department and participate in hospital-wide quality management activities.

Article 10. Duties and Authorities of the Anesthesiologist

Fulfill general functions and duties assigned by the department head, with specific functions and duties at each section as follows:

1. Duties of the doctor in the pre-anesthesia consultation section:

a) Conduct pre-anesthesia consultations according to procedures, assess, and develop anesthesia protocols for patients;

b) Record all contents in the pre-anesthesia consultation form and attach it to the patient's medical record;

c) Request surgeons to postpone surgery or procedures if the patient does not meet safety conditions, and this must be recorded in the medical record. If there is no agreement with the surgeon, report to the department head for resolution;

d) Explain anesthesia methods to patients, advise, and guide patients and their families on how to prepare for pre-anesthesia requirements;

đ) Participate in scientific activities, update professional knowledge, and engage in training, guidance, and emergency care outside the hospital when assigned;

2. Duties of the doctor in the operating room section:

a) Organize and be professionally responsible for anesthesia and intensive care as assigned by the department head;

b) In cases exceeding professional capacity or where complications occur, promptly report to the department head;

c) Supervise, inspect, and remind surgeons, nurses, healthcare workers, and other individuals present in the operating room (if permitted by the operating room doctor) to ensure infection control in the operating room;

d) Check patients and anesthesia-intensive care medical records before and after surgery; all documents must be fully, accurately, and truthfully recorded;

đ) Always be present during anesthesia and intensive care for patients, except when another anesthesiologist has taken over after a full handover;

e) Closely coordinate with related departments and surgical teams to complete tasks, implement surgical plans, and monitor and care for patients before, during, and after surgery;

g) Participate in reviewing surgeries, procedures, and pre-anesthesia examinations to evaluate, explain, supplement tests or treatments, convene consultations if necessary, and plan anesthesia and intensive care;

h) Re-examine patients in the ward one to seven days before scheduled surgery or procedures. Perform pre-, intra-, or post-emergency surgery examinations based on the urgency of the intervention;

i) Assign and supervise the professional activities of anesthesia recovery nursing staff;

k) Re-check anesthesia and intensive care equipment and medications prepared by anesthesia recovery nursing staff. Independently verify the patient's name, position, and medical record. Perform difficult techniques such as tracheal intubation, pleural drainage, central venous puncture, regional anesthesia, and difficult endotracheal intubation;

l) Conduct pre-transfusion checks on blood and blood products according to the Blood Transfusion Regulations issued with Decision No. 06/QĐ-BYT dated January 19, 2007, by the Minister of Health;

m) One anesthesiologist may simultaneously be responsible for up to two adjacent operating tables provided that they are ready for immediate intervention and anesthesia recovery nursing staff are present to monitor the patient. Special cases requiring responsibility for more than two operating tables must have the agreement and responsibility of the department head;

n) In case of severe complications or adverse events, report to the department head and mobilize assistance in terms of manpower, equipment, and medications;

o) In emergency situations, cooperate with surgeons and anesthesia recovery nursing staff to execute direct orders in the operating room, then fully record them in the medical record according to regulations;

p) Be responsible for anesthesia and intensive care until the patient is no longer under the effects of anesthesia and sedative drugs. Be responsible for orders transferring the patient out of the operating room, from the recovery unit to the intensive care unit, other wards, or discharge. For high-risk patients (unstable circulation, respiratory failure, mechanical ventilation, vasopressor use, or other critical conditions), arrange adequately trained personnel to transport the patient for timely intervention;

3. Duties of the doctor in the recovery section:

a) Receive and assess the condition of patients transferred in to make appropriate decisions;

b) Implement pain relief techniques and methods for patients;

c) Monitor, detect, and manage complications and abnormalities in patients;

d) Direct recovery nursing staff to carry out treatment orders and care for patients;

đ) Determine when patients meet the criteria to be transferred to the postoperative intensive care unit, inpatient ward, outpatient treatment, or discharged.

e) Cooperate with other doctors to handle critically ill patients requiring resuscitation and retention in the recovery unit.

4. Duties of doctors at the surgical intensive care unit:

a) Coordinate with other departments to decide on the admission and transfer of patients;

b) Monitor, diagnose, treat, and perform specialized procedures in accordance with regulations;

c) Report and seek opinions from the head of the department in special cases that require consultation for appropriate treatment decisions;

d) Hand over patients and medical orders between shifts must be complete, accurate, and recorded in handover logs, with patient records checked before transferring or discharging patients.

5. Duties of doctors at the pain management unit:

a) Examine and provide pain management advice to patients before and after surgery;

b) Inform and explain to patients or their representatives about the techniques and methods to be implemented;

c) Organize the implementation of pain management measures;

d) Supervise the results of implementation;

đ) Monitor and manage complications and unwanted effects of pain management methods.

Article 11. Duties and responsibilities of the head nurse of the anesthesia-recovery ward

The duties and responsibilities of the head nurse of the ward are carried out according to the provisions set forth in Appendix IV of Circular No. 07/2011/TT-BYT dated January 26, 2011, issued by the Minister of Health guiding nursing work in caring for patients in hospitals.

Article 12. Duties and responsibilities of the anesthesia-recovery nurse and attendant

The duties and responsibilities of the anesthesia-recovery nurse and attendant are carried out according to the provisions of Circular No. 07/2011/TT-BYT dated January 26, 2011, issued by the Ministry of Health guiding nursing work in caring for patients in hospitals; Decision No. 41/2005/QĐ-BNV dated April 22, 2005, issued by the Ministry of Home Affairs regarding the issuance of vocational standards for health personnel positions; Circular No. 23/2009/TT-BYT dated December 1, 2009, issued by the Ministry of Health regarding the issuance of vocational standards for technical health personnel positions. In addition, the anesthesia-recovery nurse and attendant have specific duties and responsibilities as follows:

1. Anesthesia-recovery nurse at the pre-anesthesia examination unit:

a) Prepare all equipment and supplies for the pre-anesthesia examination doctor;

b) After completing the pre-anesthesia examination, replenish consumable materials according to the specified quantity, store tools properly, and hand over fully, recording clearly in the logbooks.

2. Anesthesia-recovery nurse at the surgery unit:

a) The anesthesia-recovery nurse performs some tasks of the anesthesiologist-recovery doctor but must meet the necessary conditions, be suitable for their professional capacity, and be accepted and responsible by the head of the healthcare facility based on the proposal of the department head. The anesthesia-recovery nurse only performs some tasks of the anesthesiologist-recovery doctor when there is no anesthesiologist-recovery doctor in the department.

b) Directly follow the professional guidance of the anesthesiologist-recovery doctor;

c) Notify the anesthesiologist-recovery doctor and the head nurse of the department when issues need to be resolved;

d) Prepare anesthesia-recovery medications and equipment, check the patient's name, age, and surgical position, establish peripheral access, draw blood for testing, check blood type, monitor the patient, record according to the anesthesia-recovery form and other relevant documents related to the surgery or procedure;

đ) Check before transfusing blood and blood products according to the Blood Transfusion Regulations issued together with Decision No. 06/QĐ-BYT dated January 19, 2007, by the Minister of Health;

e) In emergency situations where there is no or yet no anesthesiologist-recovery doctor, the anesthesia-recovery nurse must immediately implement necessary resuscitation measures and promptly request assistance from doctors and colleagues;

g) Carry out direct medical orders and record them fully in the patient's medical record upon request by the doctor during surgery;

h) Each anesthesia-recovery nurse can only assist one operating table at the same time or assist an additional operating table in case of manpower shortage, and must be permitted by the anesthesiologist-recovery doctor and the surgical team.

3. Instrument nurse and circulating nurse:

a) General duties:

- Prepare and inspect instruments, equipment, and medications required for each surgery;

- Verify the patient, medical record, type of surgery, surgical position, and prepare the patient before surgery;

- Closely cooperate in counting gauze, needles, threads, and surgical instruments before and after surgery for each case to prevent foreign objects from being left inside the patient's body. The count report must be kept in the medical record and signed by the main surgeon, instrument nurse, and circulating nurse;

- Perform dressing of the surgical wound and postoperative hygiene for the patient;

b) Instrument nurse:

- Assist the surgeon in performing the surgery, prepare and arrange instruments adequately, pass instruments to the surgeon according to the correct movements and timing of the surgery;

- Process used surgical instruments, medical equipment, and consumables according to the regulations of the surgery department;

- Do not leave without the surgeon's consent;

c) Circulating nurse:

- Collaborate with the surgical team to position the patient, place the grounding pad of the electrosurgical unit, and protect pressure points of the patient;

- Supplement surgical instruments, consumables, and other equipment needed for surgery;

- Support the surgical and anesthesia-recovery teams in controlling devices such as electrosurgical units, suction machines, endoscopes, and tremor control devices;

- Record accurately all consumables used for surgery, including remaining quantities and damaged items;

- Help transport the patient to a bed or stretcher;

- Collect blood or blood products when requested and hand them directly to the nurse or anesthesiologist-recovery doctor who requested them.

4. Nurse at the recovery unit:

a) Monitor patients, identify and provide initial emergency treatment for complications within permitted scope, prepare beds, equipment, and consumable supplies to receive post-operative patients;

b) Assist anesthesiologists-revivalists in examining and treating patients in the recovery unit;

c) Evaluate patient conditions according to specified scales;

d) Observe and accurately, truthfully record patient developments and medical orders on monitoring charts and nursing records.

5. Operating room recovery nurses:

a) Receive, monitor patients, identify and provide initial emergency treatment for complications within permitted scope, prepare beds, equipment, and consumable supplies to receive post-operative patients;

b) Observe and accurately, truthfully record patient developments and medical orders on monitoring charts and nursing records for nurses;

c) Report immediately to doctors and head nurses when patients show abnormal developments or difficulties in executing medical orders and patient care;

d) Prepare and provide nutrition for patients according to doctors' instructions and adhere to established nursing care plans.

6. Anesthesia-revival nurses at the pain management department:

Monitor and evaluate pain reduction effectiveness in patients, report immediately to doctors when there are unusual developments for appropriate handling.

7. Attendants:

a) Implement hygiene and aseptic regulations of the anesthesia-revival department according to hospital infection control guidelines;

b) Clean wards and surrounding areas of the anesthesia-revival department as assigned;

c) Manage linen;

d) Collect, sort, transport, and process waste according to regulations.

Chapter IV
INFRASTRUCTURE AND EQUIPMENT OF THE ANESTHESIA-REVIVAL DEPARTMENT

Article 13. General Requirements for Infrastructure

The content of construction works and design solutions of the Anesthesia-Revival Department shall comply with Point 5.8.2 Clause 5 Section of the Anesthesia-Revival Surgery Department of Technical Code VN 365: 2007 "General Hospital - Design Guidelines" issued together with Decision No. 18/2007/QD-BXD dated May 15, 2007 by the Minister of Construction.

Article 14. Equipment, Medicines, and Consumable Supplies

1. Operating Room:

a) The operating room must have a minimum of two operating rooms.

b) Each operating room must ensure the following equipment:

- Adequate anesthesia-revival equipment, technical means, and medicines as per the approved surgical and procedural catalog;

- A multi-position operating table;

- A surgical instrument table;

- Appropriate surgical instruments;

- Oxygen, compressed air, and vacuum system;

- One anesthesia machine with a vaporizer for inhalation anesthetics (preferably a closed anesthesia system);

- A five-parameter monitor (ECG, non-invasive blood pressure, SpO2, respiration rate, temperature) or a multi-parameter monitor including invasive blood pressure, EtCO2, anesthetic gas analysis, and other advanced hemodynamic monitoring for critically ill patients or specialized surgeries;

- At least one electric syringe pump with battery backup;

- Consumable supplies and emergency respiratory and circulatory equipment;

- Means to warm fluids and administer rapid infusions;

- Patient warming devices.

c) Common equipment for the operating area includes a tremor-resistant device, difficult intubation kits, various sizes of laryngeal mask airways, flexible bronchoscopes;

d) Areas requiring anesthesia-revival (outside the operating room) must also have equipment, medicines, and consumable supplies for sedation, anesthesia, local anesthesia, emergency respiratory and circulatory support.

2. Recovery Unit:

a) The recovery unit should be adjacent to the operating room, with a minimum of 1.5 times the number of operating tables in beds;

b) Office equipment;

c) Medical equipment:

- Medical gases (oxygen, compressed air);

- Vacuum pumps;

- ECG and blood pressure monitors;

- SpO2 monitoring equipment;

- Temperature monitoring equipment;

- Patient warming devices;

- Blood and fluid warming devices;

- Ventilators and airway emergency equipment;

- Tremor-resistant devices;

- Pain relief equipment;

- Essential medications and consumable supplies.

3. Post-Operative Intensive Care Unit:

The post-operative intensive care unit must meet the following requirements:

- Multi-position beds with non-radiolucent pads for bedside X-ray;

- Each bed equipped with a multi-parameter monitor, ventilator, infusion pump, and electric syringe pump, with medical gas outlets (two oxygen outlets, one compressed air outlet, two vacuum outlets). Encourage each room to have only one bed with suitable design;

- Isolation rooms for prevention and infection control as needed;

- Adequate stock of medications and consumable supplies as required;

- Bedside procedure equipment: defibrillator, ECG recorder, bedside X-ray machine, monitor, and ventilator;

- Patient warming devices;

- Blood and fluid warming devices;

- Pain relief equipment;

- Ultrasound and rapid point-of-care testing equipment;

- For post-operative intensive care units in Class I and Special hospitals, additional equipment includes patient weighing devices, extracorporeal kidney dialysis machines, cardiac output monitors, bedside transesophageal echocardiography, central monitoring systems;

- Instrument washing and sterilization area;

- Equipment storage area;

- Medication and consumable medical supply storage area;

- Patient meal preparation area;

- Visitor reception area;

- Workrooms for healthcare staff, on-call restrooms, dining rooms, changing rooms, and sanitation facilities.

4. Pain Management Department:

Depending on conditions and pain treatment methods, healthcare facilities must have basic equipment such as:

a) Medications, equipment, and consumable supplies for pain relief and managing complications;

b) Pain assessment tools;

c) Communication means between patients and healthcare staff.

5. Pre-Anesthesia Examination Department:

a) Infrastructure meeting general outpatient clinic standards;

b) Medical equipment, medications, and consumable supplies meeting specialized anesthesia and revival examination requirements.

6. Administrative Department:

a) Arrange conference room, patient reception area, staff room, on-call room;

b) Necessary office equipment.

Chapter V
RESPONSIBILITIES FOR COOPERATION BETWEEN THE ANESTHESIA AND RECOVERY DEPARTMENT AND RELATED UNITS

Article 15. Cooperation with surgical departments

1. The responsibilities of surgical departments include:

- Preparing medical records, conducting examinations, and performing necessary tests or procedures to diagnose and determine the surgical method.

- Organizing the transfer of patients scheduled for surgery to the anesthesia and recovery department for preoperative examination. In cases of critically ill patients or emergency situations, notify the anesthesia and recovery department to send a doctor for examination.

- Planning the surgery and informing the anesthesia and recovery department of all relevant information: patient's name, age, gender, ward number, diagnosis, planned surgical method and time, names of surgeons, file tracking code (if managed on a computer system).

- The surgeon is responsible for monitoring, examining, implementing treatment protocols, and addressing any abnormalities related to the performed surgery.

2. The responsibilities of the anesthesia and recovery department include:

- Conducting preoperative examinations, issuing additional treatment orders before surgery (if necessary);

- Deciding on appropriate anesthesia methods for each patient;

- Scheduling surgeries according to the priority level suitable for the patient's condition.

- Coordinating with related departments to arrange appropriate anesthesia and surgical teams;

- The head of the anesthesia and recovery team has the right to refuse anesthesia if the above principles are not followed and in cases where anesthesia poses a threat to safety, and bears responsibility for their decision.

3. When there is no agreement between the surgeon and the anesthesia and recovery doctor before and during surgery, a consultation must be organized as prescribed.

4. In urgent emergency situations, decisions and medical orders can be directly communicated and completed in writing after the patient is stabilized. Important decisions must have a third party witness to ensure objectivity.

Article 16. Cooperation with related departments within the hospital

1. Meeting the requirements for anesthesia and recovery of the surgical team;

2. Closely coordinating the reception and transfer of patients;

3. Cooperating with related departments to explain and advise patients;

4. In cases where patients deteriorate in the anesthesia and recovery department, cooperation with related departments must be established to provide timely emergency care and treatment. At the same time, inform the patient's family or legal representative about the current health status of the patient.

Article 17. Cooperation in transportation and out-of-hospital emergency care

1. When there is a request for support in anesthesia and recovery from other levels, the department head is responsible for assigning staff with appropriate expertise to participate in implementation.

2. Critically ill patients must be provided with appropriate escort, monitoring, and treatment measures during transportation.

3. When an external patient needs to be transferred to another level, the responsible anesthesia and recovery doctor has the duty:

a) To seek the opinion of the head of the anesthesia and recovery department regarding the transfer of the patient to another level (if necessary);

b) To inform the patient's legal representative of the risks and benefits of transferring to another level and obtain their written consent (the patient's legal representative signs the agreement to transfer in the medical record);

c) To notify the receiving facility to prepare for the patient's arrival;

d) To check the patient's condition before transfer, prepare monitoring and emergency equipment for the patient during transportation. Transfer should not occur when the patient is near death or at high risk of death during transportation;

e) To assign the completion of necessary procedures and record them fully in the transfer file.

4. The anesthesia and recovery doctor receiving the transferred patient has the duty:

a) To prepare medications, medical equipment, means, and personnel to immediately implement appropriate emergency measures;

b) To seek the opinion of the head of the anesthesia and recovery department regarding the handling and emergency care of the patient (if necessary);

c) To assign staff to guide the escort and the patient's legal representative to complete necessary hospital admission procedures;

d) To notify in writing the hospital from which the patient was transferred about the treatment results and issues requiring lessons learned.

Chapter VI
IMPLEMENTATION

Article 18. Allocation of Responsibilities

1. The Director of the Department of Medical Examination and Treatment shall take the lead and coordinate with relevant units in directing, organizing, and inspecting the implementation of this Circular for medical examination and treatment establishments.

2. The Heads of Health Departments of provinces and centrally governed cities, and the Heads of Health of Ministries and sectors shall be responsible for directing, organizing, and inspecting the implementation of this Circular for medical examination and treatment establishments under their jurisdiction.

3. The Directors of medical examination and treatment establishments permitted to perform surgeries and procedures requiring anesthesia-recovery must develop plans for recruitment, allocation of human resources, investment, and upgrading of infrastructure and medical equipment to meet the conditions stipulated in this Circular before January 1, 2018.

Article 19. Ensuring Human Resources in Anesthesia-Recovery Specialization

1. The Head of the Science and Training Department shall take the lead and coordinate with the Director of the Department of Medical Examination and Treatment and relevant units to develop training plans for the anesthesia-recovery specialization, submit them for approval by the competent authority, and direct universities, colleges, and health vocational schools and other institutions with the function of training in the medical and pharmaceutical specializations to organize various levels of training in the anesthesia-recovery specialization.

2. The Head of the Cadre and Civil Servant Organization Department shall take the lead and coordinate with the Director of the Department of Medical Examination and Treatment and relevant units to develop policies and mechanisms to ensure human resources in the anesthesia-recovery specialization for medical examination and treatment establishments according to regulations, submit them for approval by the competent authority.

3. The Directors of hospitals with anesthesia-recovery departments and training centers shall organize continuous training, supplementary training, and certification for nursing assistants performing instrument handling duties, peripheral nursing assistants, and operating room attendants.

Article 20. Line Guidance

The Directors of medical examination and treatment establishments shall be responsible for implementing specialized line guidance in anesthesia-recovery according to Decision No. 4026/QD-BYT dated October 20, 2010, issued by the Ministry of Health on the allocation of tasks for line guidance in the field of medical examination and treatment.

Article 21. Coordination with the Vietnam Society of Anesthesiology and Intensive Care Medicine

Departments, Bureaus, and General Departments under the Ministry of Health, based on their assigned functions and responsibilities, shall be responsible for coordinating with the Vietnam Society of Anesthesiology and Intensive Care Medicine in advising the Minister of Health on policies, systems, and development plans for the anesthesia-recovery specialization, particularly in training human resources to meet the increasing demand for medical examination and treatment services from the public.

Chapter VII
IMPLEMENTING PROVISIONS

Article 22. Cross-References

In cases where referenced documents in this Circular are replaced or amended, they shall be applied according to the replacing or amending documents.

Article 23. Effectiveness of Implementation

1. This Circular takes effect from October 10, 2012.

2. Abolished: Clause 12 regarding the Anesthesia-Surgery Department in Part V of the Regulations on the Work of Certain Departments, Clause 31 regarding the Head of the Anesthesia-Surgery Department, and Clause 53 regarding Anesthesiologists in Part II of the Regulations on Duties, Rights, and Individual Responsibilities as stipulated in the Hospital Regulations issued together with Decision No. 1895/1997/BYT-QĐ dated September 19, 1997, of the Minister of Health, from the date this Circular takes effect.

During the implementation process, if there are difficulties or obstacles, localities and units shall promptly report to the Ministry of Health (Department of Medical Examination and Treatment) for guidance and resolution./.