Current through Register Vol. 48, No. 38, September 20, 2024
a) Moderate
sedation (conscious sedation) includes the prescription or administration of
pharmacologic agents to be used for the purposes of moderate sedation. Moderate
sedation (conscious sedation) must be administered by an individual qualified
under this Section. (See Appendix D for characteristics of levels of
anesthesia.) The drugs and/or techniques used must carry a margin of safety
wide enough to render unintended loss of consciousness unlikely.
b) A licensed dentist seeking a Permit A for
moderate sedation (conscious sedation) administration privileges shall file an
application with the Division, on forms provided by the Division, that shall
include:
1) Certification of completion of an
anesthesiology training program that meets the following requirements:
A) Include a minimum of 75 hours of didactic
and clinical study that includes training in moderate sedation (conscious
sedation), physical evaluation, venipuncture, advanced airway management,
technical administration, recognition and management of complications and
emergencies, and monitoring with additionally supervised experience in
providing moderate sedation to 20 or more patients; and
B) Be an organized sequence of study operated
by one entity and completed in less than one calendar year;
2) A signed affidavit certifying
that:
A) the dentist will practice in a
facility properly equipped in accordance with subsection (g) for the
administration of moderate sedation (conscious sedation);
B) the facility will be staffed with a team,
supervised by the applicant, that will remain in the treatment room. For each
patient, the anesthesia team will consist of at least:
i) the dentist who holds the Permit
A;
ii) one dental hygienist or
dental assistant who has completed the training prescribed in Section
1220.240(f) or
1220.245(c)(2)
and is capable of assisting with procedures, problems and emergencies incident
to the administration of sedation; and
iii) one additional hygienist or dental
assistant;
C) the
dentist permit holder will remain immediately available to the patient after
being treated under moderate sedation. A dental hygienist or dental assistant
trained to monitor a patient under moderate sedation will remain with the
sedated patient until the patient is no longer sedated;
D) all members of the anesthesia team are
capable of assisting with procedures, problems and emergencies incident to the
administration of sedation and will maintain current certification in BLS;
and
E) for the dentist permit
holder, the BLS certification is in addition to the required 9 sedation
technique CE hours (see subsection (k)) required per renewal cycle;
3) Proof of current ACLS
certification or PALS certification; and
4) The required fee set forth in Section
1220.415.
c) Dentists who have a current valid permit
for moderate sedation (conscious sedation) issued by the Division shall be
permitted to administer without additional application.
d) In accordance with the standards set forth
in this Section, the Division will:
1) Issue
a moderate sedation (conscious sedation) permit (Permit A).
2) Re-issue a moderate sedation (conscious
sedation) permit to Permit A holders who attest to completing continuing
education.
e) Licensees
qualified to administer deep sedation (Permit B) pursuant to Section
1220.520 may administer moderate
sedation (conscious sedation) without a Permit A.
f) If the accuracy, relevance or sufficiency
of any submitted documentation is questioned by the Division or the Board,
because of discrepancies or conflicts in information, needing further
clarification, and/or missing information, additional documentation may be
required and/or an on-site evaluation of the facilities, equipment and
personnel may be conducted by the Division or a member of the Board's
Anesthesia Review Panel.
g) A
properly equipped facility for the administration of moderation sedation
(conscious sedation) shall include at minimum:
1) Sphygmomanometer and
stethoscope;
2) An oxygen delivery
system with full face masks and connectors appropriate to the patient
population being served that is capable of delivering oxygen to the patient
under positive pressure, with an emergency backup system;
3) Emergency drugs and equipment appropriate
to the medications administered;
4)
Suction equipment, including an emergency backup suction system;
5) An emergency backup lighting system that
will permit the completion of any operation underway;
6) A pulse oximeter;
7) Laryngoscope complete with selection of
blades and spare batteries and bulbs in sizes appropriate to the patient
population being served;
8)
Advanced airway devices that would isolate the trachea and facilitate positive
pressure oxygen administration in sizes appropriate for the patient population
being served (e.g., endotracheal tubes or laryngeal mask airway);
9) Tonsillar or pharyngeal suction tips
adaptable to all office outlets;
10) Nasal and oral airways in sizes
appropriate to the patient population being served;
11) Defibrillator (an automated external
defibrillator is an acceptable defibrillator);
12) Equipment for the establishment of an
intravenous infusion;
13) An
operating table or an operating chair that permits appropriate access to the
patient and provides a firm platform for the management of cardiopulmonary
resuscitation; and
14) A recovery
area that has available oxygen, lighting, suction and electrical outlets. The
Permit A holder shall remain with the patient until the patient retains the
ability to independently and consciously maintain an airway and respond
appropriately to physical stimulation and oral commands. The recovery area may
be the operating theatre.
h) The following records shall be kept during
the administration of moderate sedation (conscious sedation):
1) Medical history of the patient and consent
for administration of anesthesia prior to the performance of any
procedure;
2) Preoperative,
intraoperative and pre-discharge monitoring of blood pressure, pulse,
respiration and oxygen saturation. A time based record shall be entered into
the patient's chart;
3) Drugs and
dosages of these drugs used during the operative procedure, including the
identification of the person administering drugs and times of their
administration over the course of the procedure.
i) The dentist who holds the Permit A shall
report adverse occurrences to the Division and the Board as required by Section
1220.405.
j) A licensed dentist shall hold Permit A in
order to perform dentistry while a licensed certified nurse anesthetist
administers moderate sedation (conscious sedation). A nurse anesthetist for
purposes of this Section is a licensed certified nurse anesthetist who holds a
license as an advanced practice nurse under the Nurse Practice Act [225 ILCS 65
]. The dentist shall enter into a written collaborative agreement with the
nurse anesthetist consisting of the requirements of this section as follows: A
certified registered nurse anesthetist who provides anesthesia services in a
dental office shall enter into a written collaborative agreement with the
operating dentist performing the procedure. The agreement shall describe the
working relationship of the nurse anesthetist and the operating dentist and
shall authorize the categories of care, treatment, or procedures to be
performed by the nurse anesthetist. In a collaborating dentist office, the
nurse anesthetist may only provide those services that the operating dentist
with the appropriate permit is authorized to provide as found in 68 Ill. Adm.
Code 1220.510 and 1220.520. For
anesthesia services, the operating dentist shall approve the anesthesia plan
prepared by the nurse anesthetist and shall remain physically present and be
available on the premises during the delivery of anesthesia services for
diagnosis, consultation, and treatment of emergency medical conditions. The
nurse anesthetist may select, order, and administer medications, including
controlled substances, and apply appropriate medical devices for delivery of
anesthesia services under the anesthesia plan agreed with by the operating
dentist.
k) Proof of 9 hours of
continuing education per renewal cycle in sedation techniques, including
medications and recognition and management of complications and emergencies, is
required for renewal of Permit A.
l) A treating dentist does not need to hold
Permit A to perform dentistry when another dentist, who holds Permit A or
Permit B, or a physician or dental anesthesiologist assists the treating
dentist by administering moderate sedation (conscious sedation). Physician for
purposes of this Section means a physician who is licensed to practice medicine
in all of its branches under the Medical Practice Act of 1987 [225 ILCS 60 ]
and is authorized to provide anesthesia services in a licensed hospital or
licensed ambulatory surgical treatment center or is a Board-certified
anesthesiologist.
1) The treating dentist
shall be prepared to provide affidavits to the following if requested by the
Division:
A) That the facility used for
sedation meets the criteria of subsection (g) of this Section;
B) That the dentist shall staff the facility
with a team, supervised by the permit holder or physician, that includes a
minimum of 3 individuals per patient. The team shall be composed of either:
i) One dental hygienist or dental assistant;
the treating dentist; and the dentist who holds a Permit A or B providing the
anesthesia services; or
ii) One
dental hygienist or dental assistant; the treating dentist; and a dental
anesthesiologist or physician performing the anesthesia services.
C) That the permit holder or
physician will remain immediately available to the patient after being treated
under moderate sedation. A dental hygienist or dental assistant trained to
monitor a patient under moderate sedation will remain with the sedated patient
until the patient is no longer sedated.
2) All members of the team, including the
treating dentist (non-permit holder) must maintain current BLS certification or
its equivalent.
3) In addition, the
dentist (non-permit holder) shall report adverse occurrences to the Division as
set forth in Section 1220.405 and accept the
responsibility to verify the certification and licensure of any licensed
provider present during the moderate sedation (conscious sedation) of a patient
who is receiving dental care.
m) A dentist holding a Permit A shall
maintain current ACLS or PALS certification. ACLS or PALS certification shall
be in addition to the required 9 hours of anesthesia CE per renewal
cycle.
n) A dentist holding a
Permit A shall maintain a logbook indicating the sedation cases performed. The
log shall include the patient name, date, route of sedation administration,
drug name and dosage, and the names of anesthesia team members assisting. This
information shall be supplied to the Division upon request.
o) A dentist holding a Permit A must also
hold an active Illinois Controlled Substances License and current federal Drug
Enforcement Administration registration.
