Current through Register Vol. 6, March 22, 2024
(1)
Minimum standards for monitoring patients for deep sedation/general anesthesia
shall include the following:
(a)
preoperative:
(i) vital signs - to include
blood pressure, heart rate, pulse, and oximetry results. Temperature may be
necessary; and
(ii) electrocardiac
monitoring.
(b)
intraoperative:
(i) vital signs - to include
blood pressure, heart rate, pulse, and oximetry results to be taken and
recorded at least every five minutes;
(ii) precordial or pretracheal stethoscope
and capnography used to monitor respiratory rate;
(iii) continuous electrocardiac monitoring;
(iv) an intravenous line;
(v) continuous monitoring of skin
and mucosal color;
(vi) end tidal
CO2 monitoring must be utilized for intubated patients under general
anesthesia; and
(vii) additional
monitoring devices as indicated.
(c) postoperative:
(i) vital signs - to include blood pressure,
pulse, and oximetry results recorded at the completion of the procedure and
prior to discharge with associated times; and
(ii) the patient must not leave the recovery
area until the cardiovascular, respiratory stability, and absence of nausea and
vomiting are assured, and the patient is awake and oriented.
(d) Food and Drug Administration
approved medical devices or manual sphygmomanometer stethoscope for monitoring
blood pressure shall be used during the sedation procedure.
(2) The minimum standards for
monitoring moderate sedation patients shall include the following:
(a) preoperative:
(i) vital signs to include blood pressure,
pulse, respiratory rate, and oximetry results; and
(ii) blood pressure monitoring for pediatric
patients as indicated, unless unable to obtain.
(b) intraoperative:
(i) continuous electrocardiac on American
Society of Anesthesiologists (ASA) Class 2 and greater patients;
(ii) all vital signs - to include blood
pressure, heart rate, pulse, and oximetry results to be monitored and recorded
at least every five minutes. Only appropriate blood pressure and oximetry
results monitoring for pediatric patients need be recorded, unless unable to
obtain;
(iii) a precordial or
pretracheal stethoscope and capnography used to continually monitor
respiration; and
(iv) continuous
monitoring skin and mucosal color.
(c) postoperative:
(i) vital signs, blood pressure, heart rate,
pulse, and oximetry results should be taken at completion of the procedure and
prior to discharge;
(ii) only
appropriate blood pressure and oximetry results monitoring for pediatric
patients need be recorded. When these parameters are unable to be obtained,
other documentation should be evident, verifying adequate respiratory and
cardiovascular function; and
(iii)
prior to discharge, cardiovascular and respiratory systems must be adequate,
with the absence of nausea and vomiting.
(d) Food and Drug Administration approved
medical devices or manual sphygmomanometer stethoscope for monitoring blood
pressure shall be used during the sedation procedure.
(3) Minimum standards for monitoring minimal
sedation patients shall include the following:
(a) pre-op:
(i) vital signs, blood pressure, and heart
rate; or
(ii) for pediatric
patients, all vital signs, unless unable to obtain.
(b) when the dentist who administers the
nitrous oxide/oxygen and/or is not in the operatory, there must be a dental
auxiliary who remains with the patient and provides direct observation. The
dental auxiliary must have specific instruction in the observation of nitrous
oxide/oxygen sedated patients and shall monitor the patient until discharged.
(4) During dental
procedures, the facility must be staffed by supervised monitoring personnel,
all of whom are capable of handling procedures, problems, and emergency
incidents, and have successfully completed the American Heart Association's
Basic Life Support for Healthcare Providers, or its equivalent.
(a) With respect to a deep sedation/general
anesthesia facility, in addition to the dentist and dental assistant, there
must be at least one person present to monitor vital signs. That person must
be:
(i) a physician anesthesiologist licensed
to practice medicine in Montana;
(ii) a certified registered nurse anesthetist
recognized in that specialty by the Montana Board of Nursing;
(iii) a dentist who has successfully
completed an accredited advanced dental education program in dental
anesthesiology;
(iv) an oral and
maxillofacial surgeon who has successfully completed an accredited oral and
maxillofacial training program; or
(v) a trained healthcare professional.
(b) When moderate
sedation is used, the dentist shall be qualified and permitted to administer
the drugs and appropriately monitor the patient, and have successfully
completed a course in advanced cardiac life support. In addition to the
dentist, at least one other person on staff and present in the office must have
successfully completed the American Heart Association Basic Life Support for
Healthcare Providers, or its equivalent.
AUTH:
37-1-131,
37-4-205,
37-4-408,
MCA; IMP:
37-1-131,
37-4-101,
37-4-205,
37-4-408,
37-4-511,
MCA