(a) Personnel. ECT may be administered only by a licensed physician credentialed by the facility providing the treatment to use ECT, or by a licensed physician in training in an approved residency program under the direct supervision of a fully qualified psychiatrist so trained and credentialed. In specific circumstances a licensed physician who is not a fully qualified psychiatrist but who has demonstrated training and experience in the administration of ECT may administer ECT providing authorization has been provided in writing to the chief executive officer by the hospital or facility medical director. Assistants shall include a recovery nurse and an ECT treatment nurse or assistant trained in ECT procedures.
(b) Equipment. Equipment available in the ECT room shall receive a general inspection on a regular basis. Equipment shall include, but not be limited to, the following:
  (1) an ECT machine of contemporary model which shall be calibrated at least semiannually;
  (2) a respiratory support system including oxygen, endotracheal intubation tray, suction apparatus, and equipment for tracheotomy;
  (3) a cardiac arrest tray with appropriate drugs;
  (4) a cardiac monitor and defibrillator.
(c) Recovery area. A recovery area containing emergency equipment and supplies shall be used, the patients to be therein until adequately recovered and all vital signs are stable. The recovery room will be equipped and staffed to meet commonly accepted standards for postanesthesia units.
(d) Anesthesia. Anesthesia practice shall meet commonly accepted standards for patient evaluation for anesthesia, informed consent, induction, maintenance, monitoring, and documentation of anesthesia.
  (1) General anesthesia shall be administered to all patients as a standard procedure during ECT. In the rare event that general anesthesia is contraindicated, the administering physician shall obtain consultation and written concurrence by two physicians, at least one of whom is a fully qualified psychiatrist.
  (2) Anesthesia shall be administered only by persons credentialed by the medical staff to do so, and who are:
    (A) licensed anesthesiologists;
    (B) licensed physicians credentialed and privileged in anesthesiology for ECT; or
    (C) nurse anesthetists (CRNA).
  (3) At least one person in attendance must be certified in advanced cardiorespiratory life support (ACLS).

Source Note: The provisions of this §405.110 adopted to be effective January 1, 1992, 16 TexReg 7528; amended to be effective December 10, 1993, 18 TexReg 8790