Current through Register 1531, September 27, 2024
(1)
Initial Application
Requirements. An applicant shall submit an accurate and complete
application on forms provided by the Board and accompanied by a fee established
annually by the Executive Office of Administration and Finance, and includes
documentation that demonstrates proof the applicant:
(a) Is a dentist licensed under M.G.L. c.
112, § 45 to practice in the Commonwealth;
(b) Has current certification in ACLS or
PALS;
(c) Has successfully
completed an education program accredited by the ADA Commission on Dental
Accreditation that provides comprehensive and appropriate training necessary to
administer and manage moderate sedation commensurate with the ADA
Guidelines for Teaching Pain Control Sedation to Dentists and Dental
Students, 2007, at the time training was commenced; or
(d) Is certified by the American Board of
Oral and Maxillofacial Surgery (ABOMS); or
(e) Is certified as a Fellow and/or has Board
certification in Anesthesia issued by the American Dental Board of
Anesthesiology.
(2)
Auxiliary Personnel Required. A qualified dentist
inducing moderate sedation must have at least two additional individuals
trained in BLS present during the administration of the anesthesia.
(3)
Patient Evaluation
Required. Patients considered for moderate sedation must be
suitably evaluated prior to the start of any sedative procedure. For healthy or
medically stable patients (ASA I, II), this must consist of a review of their
current medical history and medication use. For patients with a significant
medical history (ASA III, IV), consultation with their primary care physician
or consulting medical specialist may be required.
(4)
Pre-operative Preparation
Required. Pre-operative preparation for the administration of
moderate sedation shall include:
(a) The
patient or legal representative shall be advised regarding the procedure
associated with the delivery of any sedative or anesthetic agents and a signed
informed consent shall be obtained pursuant to
234 CMR 5.15(3)(f)
for the proposed sedation/anesthesia
obtained prior to the administration of the anesthesia or sedative
agent(s);
(b) Determination of
adequate oxygen supply and equipment necessary to deliver oxygen under positive
pressure must be completed;
(c)
Baseline vital signs, including blood pressure, respiration, and heart rate,
must be obtained and documented in the patient record. If the patient's
behavior prohibits such determination, this must be documented in the patient
record;
(d) A medical history must
be completed and problem focused physical evaluation must be performed where
deemed appropriate;
(e) Specific
dietary instructions must be provided to the patient based upon the type of
sedative/anesthetic technique prescribed and patient's physical status;
and
(f) Pre-operative verbal and
written instructions must be given to the patient and responsible
person.
(5)
Patient Monitoring and Documentation Required.
(a) A qualified dentist administering
moderate sedation anesthesia must remain in the room with the patient to
monitor the patient continuously until the patient meets the criteria for
recovery and must not leave the facility until the patient meets the criteria
for discharge and is discharged from the facility.
(b) Monitoring and documentation of patient
administered moderate sedation anesthesia shall include, but not be limited to
continuous monitoring and evaluation of:
1.
Color of mucosa, skin or blood (monitoring only);
2. Oxygenation saturation by pulse
oximetry;
3. Level of consciousness
(e.g. responsiveness to verbal command);
4. Chest excursions;
5. Ventilation either by auscultation of
breath sounds, monitoring end-tidal CO2 or by verbal
communication with the patient; and
6. ECG for patients with significant
cardiovascular disease (may be considered).
(c)
Anesthesia
Chart. The Anesthesia Chart shall contain documentation of all
events related to the administration of the sedative or anesthetic agents,
including but not limited to the following:
1.
Time-oriented anesthetic record including the names of all drugs administered,
including local anesthetics, dosages, and monitored physiologic
parameters;
2. Pulse oximetry,
heart rate, respiratory rate, and blood pressure;
3. The duration of the procedure;
and
4. The individuals present
during the procedure.
(6)
Requirements for Management
of Recovery and Discharge of Patients.
(a) The recovery and discharge procedures for
a patient administered moderate sedation anesthesia shall include, but not be
limited to:
1. Immediate availability of
oxygen and suction equipment;
2.
Continuous monitoring and documentation of the patient's blood pressure, heart
rate, oxygenation, and level of consciousness;
3. Determination and documentation that the
level of consciousness, oxygenation, ventilation, and circulation are
satisfactory for discharge; and
4.
Post-operative verbal and written instructions provided.
(b) If a reversal agent is administered
before discharge criteria have been met, the patient must be monitored until
recovery is assured.
(7)
Requirements for Management of pediatric and Special Needs
Patients
. The Board adopts the American Academy of Pediatrics/American
Academy of Pediatric Dentistry's Guidelines for Monitoring and
Management of Pediatric Patients During and After Sedation of Diagnostic and
Therapeutic Procedures and the American Dental Association's guidance
on pediatric and special needs patients as contained in its policy statement on
The Use of Sedation and General Anesthesia by Dentists
(2007).
(8)
Requirements for Emergency Management. The qualified
dentist is responsible for the sedative management, adequacy of the facility
and staff, diagnosis and treatment of emergencies related to the administration
of sedation, providing and maintaining the equipment, drugs and protocol for
patient rescue and conducting and documenting emergency drills. If a patient
enters a deeper level of sedation than the qualified dentist is permitted to
provide, the dentist must stop the dental procedure until the patient returns
to the intended level of sedation.
