A05 - 8.15.23 _Section B CRNA SOW_BFSU 2023-24.docx

Statement of Work (SOW)

1. PROJECT TITLE: CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) SERVICES

2. BACKGROUND/PURPOSE: The Surgery Department has been critically short staffed for more than two years. This affects the department’s ability to provide continued 24 hour anesthesia coverage for the Blackfeet Service Unit. This includes all anesthesia required for the Emergency Department, Surgery/Operating Room (OR) and Ward.

3. SCOPE: The purpose of the work is to provide 24/7 CRNA coverage for Anesthesia service to the Blackfeet Service Unit. The services include administration of general anesthesia and monitored anesthesia care, accomplished by performing the duties and responsibilities for pre-anesthetic evaluations, preoperative and intra-operative care, and postoperative care, and additional responsibilities which are within the expertise of the CRNA and appropriate and relevant to the Indian Health Service (IHS) and Service Unit facility. These duties are an integral part of the total patient care, continuity of patient care, and patient care evaluation.

4. TASKS: The services are located at the IHS Blackfeet Service Unit, Blackfeet Community Hospital, Browning, Montana and the IHS Crow Service Unit, Crow / Northern Cheyenne Hospital, Crow Agency, Montana. The purpose of the services is to perform Anesthesia services. Anesthesia care is for the OR, Emergency Department, and wards. The CRNA reports to the OR Supervisor or their designee. Expert judgment is required in the evaluation of the physical and psychological status of each patient in order to determine the appropriate anesthetic agent and method of administration. The majority (greater than 80%) of Anesthesia services shall be performed in the area of emergent and non-emergent surgical anesthesia. A minority of anesthesia service (less than 20%) may be performed on functions that directly support anesthesia patient care. This anesthesia direct support services include but are not limited to preoperative clinic, pain management, sedation analgesia program management, infection control, hospital education, process improvement, and nurse anesthesia training.

MAJOR DUTIES: The services provided by the contractor shall be as comprehensive as the IHS supplied facilities, equipment and support services permit. CRNA serves as an Independent Licensed Practitioner and performs to provide Anesthesia service to the Blackfeet Service Unit and Crow Service Unit. CRNA is individually responsible for the anesthesia care delivered. CRNA is accountable for judgments made and actions taken in the practice of nurse anesthesia. Neither physician's orders or institutional policies relieve the CRNA of accountability for actions taken and judgments made relative to the care of the patient. CRNA must be certain that they obtained informed consent from the patient and they rendered safe anesthesia care to the patient.

As an anesthetist, the CRNA shall:

a) Perform pre-op evaluations;

b) Order pertinent diagnostic tests;

c) Develop the anesthetic treatment plan considering such factors as multi-system disease and type of procedure to be performed;

d) Select anesthetics to be used;

e) Coordinate choice and administration of anesthesia during operations;

f) Assess and document the patient’s medical condition continuously during surgery through recovery from anesthesia; and

g) Administer and manage recovery agents use throughout the care period as needed.

Explains information to patients and patients’ families in sufficiently understood lay terms to exchange information, allay fears, and provide psychological support so as to make the patient knowledgeable of what is expected. Correlates clinical history, pertinent clinical data and other ancillary diagnostic examinations to assess situations, define problems, and delineate solutions.

KNOWLEDGE REQUIRED BY THE POSITION: Mastery of professional and advanced nursing policies and procedures related to the preoperative care of surgical patients. Knowledge enables incumbent to provide effective care for patients with complex health problems.

Extensive advanced knowledge of nurse anesthesia, which is gained through graduation from an accredited nurse anesthesia program and/or Master's Degree program. Knowledge includes comprehensive expertise in administering anesthesia and anesthesia-related care in five (5) general categories:

Up to date ACLS and PALS certification are a mandatory requirement.

Duties require application of all knowledge described above in order to establish and maintain complex anesthesia program that provides quality healthcare. The care of increasingly complex patients requires innovative organization to meet the health care needs of our customers, while taking into account cultural sensitivity.

Work involves varied surgical procedures which require different and unrelated processes and methods to apply substantial depth of analysis before and during surgery to develop the anesthetic plan, administer and manage anesthetic agents. Work also involves prolonged surgery; extensive analysis to administer and manage anesthetic agents; and induction, maintenance, and support of life functions during anesthesia to include intubation procedures. Because of the complex procedures, new techniques, information, and criteria are constantly being established. These changes frequently arise from the report of results that are rendered by the nurse anesthetist.

Work requires a comprehensive knowledge of the effects that different diseases and debilities had in changing patient's responses to anesthetic drugs and surgical stress and uses many finely graded administrations made rapidly and continuously during the course of anesthesia to modify anesthesia methods, techniques, and drug doses in order to minimize, avert and resolve anesthesia problems.

The CRNA plays a critical role in the daily operations in the operating room, performing preoperative screenings and interviewing; induction of anesthesia; maintaining anesthesia during procedures; and monitoring and supporting life functions.

Performs administrative functions for BFSU and CSU Department of Anesthesia. The services provided by the Anesthesia Department are extremely important to the overall functioning of an Anesthesia program and directly affect the efficiency and quality of services provided. The CRNA is individually responsible for the anesthesia care delivered. CRNA is accountable for judgments made and actions taken in the practice of nurse anesthesia. Neither physician's orders nor institutional policies relieve the Certified Registered Nurse Anesthetist of accountability for actions taken and judgments made relative to the care of the patient. The CRNA must be certain that informed consent has been obtained and that safe anesthesia care has been rendered to the patient.

Keeps abreast of the new techniques and changing knowledge through reading the latest journals, attends meetings, seminars and conventions at the local, state and national level as required by certifying agency. In a similar manner, keeps abreast of the latest advances in the anesthesia program. Recommends new developments to the OR Supervisor which could improve the operation of the program. meeting with outside organizations, schools of certified registered nurse anesthetist, CRNA organizational leaders to assess situations, define problems, delineate solutions and motivate others to cooperate in achieving program goals and initiatives.

PHYSICAL DEMANDS: Long periods of standing may occur while assisting on surgical procedures during the administration of anesthesia. Assistance in placing IV access, positioning the patient and moving anesthetized patients is required.

WORK ENVIRONMENT: Chronic exposure to anesthetic agents and x-rays may post a health hazard. There is repeated exposure to anesthetic agents now known to cause abortions, birth defects and possibly cancer. Exposure to infections and infectious agents may be hazardous. Exposure during emergency life threatening situations may pose a risk. There is always an inherent risk to potential violent or compromised patients.

5. DELIVERABLES AND DELIVERY SCHEDULE: Provide the qualified personnel to perform services.

6. GOVERNMENT-FURNISHED EQUIPMENT AND INFORMATION: The IHS shall provide all necessary equipment and supplies. The Blackfeet Service Unit and Crow Service Unit will be responsible for getting the Contractor access and clearance to all computer services necessary to carry out their duties.

PLACE OF PERFORMANCE: The work will be performed at the following locations:

A. Blackfeet Community Hospital, 760 Hospital Drive Browning, MT 59417 B. Crow / Northern Cheyenne Hospital, 10110 South, 7650th East, Crow Agency, MT 59022

7. WORK SCHEDULE: An intermittent work schedule to fulfill known periods resulting from scheduled leave of approximately two (2) weeks or in the event of a personnel emergency resulting in a need for contractor coverage within 48-72 hours for a minimum of one (1) week will be required.

a. When reporting for performance as a CRNA, the following weekly work schedule pertains:

Work Hours are 7:00AM to 4:00PM; eight (8) hours per day.

24/7 CRNA Coverage for Surgery Department, includes callback and weekend call.

40 standard hours per week plus pager, estimated 16 hours for callback and weekend call.

PRICE SCHEDULE

(Above 40 hours per week - Call Back, Weekend)

(Above 40 hours per week - Call Back, Weekend)

Grand Total……………………………….………… $____________________

b. An option for additional coverage in the event of a personnel emergency resulting in a need for contractor coverage within 48-72 hours for a minimum of one (1) week for 40 standard hours plus pager, estimated 16 hours callback and weekend.

Any change to the estimated schedule will be communicated no less than 14 days in advance.

8. PERIOD OF PERFORMANCE: The period of performance will for a period of one year from the date of award plus four one-year options if exercised.

9. SECURITY: Pursuant to the Federal Information Security Management Act of 2002 (FISMA), the Contractor will be required to complete a course in Computer Security Awareness Training (CSAT). This training must be completed annually by all employees including all contractors, volunteers, students, and summer extems. The Contractor will be required to comply with the Federal Information Processing Standards Publication (FIPS PUB) Number 201, "Personal Identity Verification of Federal Employees and Contractors" and the associated Office of Management and Budget (OMB) implementation guidance for personal identity verification for all affected contractor and subcontractor personnel.

Access/clearance to all pertinent computer systems, including completing the Security Checklist, Rules of Behavior form, Security training; and if necessary, a Business Partner Interconnection Security Agreement (BPISA), should be coordinated with the Blackfeet Service Unit and Crow Service Unit.

Background Checks / Clearance: As directed by the Contracting Officer, the CRNA shall provide all requested information necessary to perform background checks. The CRNA shall comply with the requirement to obtain security investigations. The CRNA shall work with the IHS to ensure that the pre‐employment screening process includes the appropriate investigation questionnaires and forms to be completed. All completed forms will be reviewed by the CRNA and forwarded to the Government personnel. IHS will immediately remove a Contractor from the position if at any time the investigation receives unfavorable adjudication, or, if other unfavorable information that would affect the investigation becomes known.

Credentialing: CRNAs hall complete the credentialing and clearance requirements at the appropriate level before reporting for work.