Current through Register Vol. 43, No. 52, December 26, 2024
(a) To be eligible for issuance of a level I permit, each
dentist shall submit the following to the board:
(1) An application on the form provided by the board;
(2) evidence of a current "basic cardiac life support for the
health care provider" certificate from the American heart association or a
current certificate deemed equivalent by the board from a provider approved by
the board;
(3)
(A) Evidence of having successfully completed a course or
postdoctoral training program in the control of anxiety and pain in dentistry
that is approved by the board; or
(B) evidence of performance of 20 clinical cases of conscious
sedation over the preceding five years, which shall be evaluated by the
board;
(4) the level I permit fee of $100; and
(5) an explanation of any sedation-related mortality or
morbidity that occurred to a patient of the applicant during the preceding five
years and could have been associated with the administration of a sedative
agent.
(b) To be approved by the board, each course or training
program specified in paragraph (a)(3)(A) shall meet the following
requirements:
(1) Provide comprehensive training in the administration and
management of enteral conscious sedation or combination inhalation-enteral
conscious sedation;
(2) include training in patient evaluation and selection, use
of equipment, personnel requirements, monitoring, documentation, patient
medical management, and emergency management; and
(3) include a minimum of 18 hours of education and 20 clinical
experiences, which may be simulation or video presentations, or both, but shall
include at least one experience in which a patient is deeply sedated and
returned to consciousness.
(c)
(1) Each level I permit shall be renewed before the
expiration of the dentist's license and as part of the biennial license
renewal.
(2) To apply for renewal of a level I permit, each dentist
shall provide the following to the board:
(A) Evidence of a current "basic cardiac life support for the
health care provider" certificate from the American heart association or a
current certificate deemed equivalent by the board from a provider approved by
the board;
(B) in addition to the continuing education required to renew
the dentist's license, proof of six hours of continuing education on sedation;
and
(C) the renewal fee of $100.
(d) Before administering enteral conscious sedation or
combination inhalation-enteral conscious sedation, each treating dentist shall
perform the following:
(1) Review the patient's medical history and current
medications;
(2) for all patients with a severe systemic disease, consult
with the patient's primary care physician or any consulting medical specialist
regarding the potential risks;
(3) document that the patient or guardian received written
preoperative instructions, including dietary instructions that are based on the
sedation technique to be used and the patient's physical status, and that the
patient or guardian reported that the patient complied with the
instructions;
(4) obtain from the patient or guardian a signed informed
consent form;
(5) evaluate the inhalation equipment for proper
operation;
(6) determine that an adequate oxygen supply is available and
can be delivered to the patient if an emergency occurs;
(7) obtain the patient's vital signs and perform a patient
assessment; and
(8) confirm the time when the patient last took any solid or
liquid by mouth.
(e) During the administration of enteral conscious sedation or
combination inhalation-enteral conscious sedation, each treating dentist shall
ensure that both of the following conditions are met:
(1) At least one additional staff person who has either a
current "basic cardiac life support for the health care provider" certificate
from the American heart association or a current certificate deemed equivalent
by the board from a provider approved by the board is present.
(2) The following equipment is available and in working
order:
(B) a drug kit that includes an agent to reverse the effects of
the sedation agent administered, if an agent to reverse the effects of the
sedation agent is commercially available;
(C) a bag-valve mask with patient-appropriate masks that have
all connections necessary to attach the bag-valve mask to a 100 percent oxygen
source or a separate positive-pressure oxygen source; and
(D) oropharyngeal airways in patient-appropriate sizes.
(f) Whenever enteral conscious sedation or combination
inhalation-enteral conscious sedation is administered, each treating dentist
shall cause the following records to be contemporaneously created. These
records shall be maintained, for at least 10 years, as part of each patient's
record:
(1) The date, the type of procedure, the personnel present, and
the patient's name, address, and date of birth;
(2) documentation of the sedative agents administered, the
approximate time when the sedative agents were administered, the amount of each
agent administered, and the patient's blood pressure, heart rate, and oxygen
saturation readings at the start of sedation and at the end of the surgical or
operative procedure and at 15-minute intervals throughout the procedure;
(3) an indication of the extent to which the effects of the
sedation had abated at the time of the patient's release;
(4) the gases used, with flow rates expressed in liters per
minute or relative percentages, and the amount of time during which each gas
was administered;
(5) the full name of the person to whom the patient was
released;
(6) a record of all prescriptions written or ordered for the
patient; and
(7) each type of monitor used.
(g) During the administration of enteral conscious sedation or
combination inhalation-enteral conscious sedation and the recovery phase, the
treating dentist shall ensure that all of the following conditions are
met:
(1) The patient is continuously observed.
(2) The patient is continuously monitored with a pulse
oximeter.
(3) The patient's respiration is continuously confirmed.
(4) The patient's blood pressure, heart rate, and oxygen
saturation reading are recorded at least every 15 minutes.
(5) The patient's ability to appropriately respond to physical
stimulation or verbal command is documented every 15 minutes.
(h) Following the administration of enteral conscious sedation
or combination inhalation-enteral conscious sedation and during the recovery
phase, each treating dentist shall ensure that all of the following conditions
are met:
(1) Oxygen and suction equipment are immediately available in
the recovery area.
(2) The patient is continuously supervised until oxy-genation,
ventilation, and circulation are stable and until the patient is appropriately
responsive for discharge from the facility.
(3) Written and verbal postoperative instructions, including an
emergency telephone number to contact the treating dentist, are provided to the
patient, guardian, or any escort present at the time of discharge.
(4) The patient meets the discharge criteria established by the
treating dentist, including having stable vital signs, before leaving the
office.
(i) Whenever enteral conscious sedation or combination
inhalation-enteral conscious sedation is administered, each treating dentist
shall cause the following information to be entered into a sedation log:
(1) The name of each patient;
(2) the date of administration of each sedative agent;
and
(3) the name, strength, and dose of each sedative agent. Each
entry shall be maintained for at least 10 years.