Current through Supplement No. 394, October, 2024
The rules in this chapter are adopted for the purpose of
defining standards for the administration of anesthesia and sedation by
dentists or a dentist who collaborates with a qualified and licensed anesthesia
or sedation provider. A dentist may not use any form of sedation if the intent
is beyond minimal sedation on any patient unless such dentist has a permit,
currently in effect, issued by the board, and renewable biennially thereafter,
authorizing the use of such general anesthesia, deep sedation, or moderate
sedation. With the administration of anesthesia, the qualified dentist must
have the training, skills, drugs, and equipment immediately available in order
to rapidly identify and manage an adverse occurrence until either emergency
medical assistance arrives or the patient returns to the intended level of
sedation or full recovery without airway, respiratory, or cardiovascular
complications.
1. Administration of
nitrous oxide inhalation analgesia - Requirements. The following standards
apply to the administration of nitrous oxide inhalation analgesia:
a. Inhalation equipment must have a fail-safe
system that is appropriately checked and calibrated. The equipment also must
have either a functioning device that prohibits the delivery of less than
thirty percent oxygen or an appropriately calibrated and functioning in-line
oxygen analyzer with audible alarm. A scavenging system must be available if
gases other than oxygen or air are used.
b. Patient dental records must include the
concentration administered and duration of administration.
c. A dentist may not delegate monitoring of
nitrous oxide inhalation analgesia once the patient has ingested an enteral
drug for the purpose of minimal sedation.
d. Before authorizing a dental hygienist or
registered dental assistant to administer nitrous oxide inhalation analgesia,
the dentist must have provided and documented training in the proper and safe
operation of the nitrous oxide inhalation analgesia equipment.
e. A patient receiving nitrous oxide
inhalation analgesia must be continually monitored by authorized dental staff.
A dental hygienist or a registered dental assistant may terminate or reduce the
amount of nitrous oxide previously administered by the authorized nitrous oxide
inhalation analgesia provider.
f.
The board may issue a permit authorizing the administration of nitrous oxide
inhalation to a dentist or dental hygienist or registered dental assistant if
the following requirements are met:
(1)
Evidence of successful completion of a twelve-hour, board-approved course of
training or course provided by a program accredited by an accrediting body
recognized by the United States department of education, and either:
(a) Completed the course within thirteen
months before application; or
(b)
Completed the course more than thirteen months before application, has legally
administered nitrous oxide inhalation analgesia for a period of time during the
three years preceding application, and provides written documentation from a
dentist that has employed or supervised the applicant, attesting to the current
clinical proficiency of the applicant to administer nitrous oxide inhalation
analgesia.
(2) Evidence
of current certification in basic life support by the American heart
association for the health care provider, or an equivalent program approved by
the board.
2.
Administration of minimal sedation. A dentist administering minimal sedation
shall maintain basic life support certification and comply with the following
standards:
a. An appropriate sedative record
must be maintained and must contain the names and time of all drugs
administered, including local anesthetics and nitrous oxide. The time and
condition of the patient at discharge from the treatment area and facility
requires documentation.
b.
Medications used to produce minimal sedation are limited to a single enteral
drug, administered either singly or in divided doses, by the enteral route to
achieve the desired clinical effect, not to exceed the maximum recommended dose
for unmonitored home use in a single appointment. The administration of enteral
drugs exceeding the maximum recommended dose during a single appointment is
considered to be moderate sedation.
c. Drugs and techniques used must carry a
margin of safety wide enough to render the unintended loss of consciousness
unlikely for minimal sedation, factoring in titration and the patient's age,
comorbidities, weight, body mass index, and ability to metabolize
drugs.
d. Combining two or more
enteral drugs, excluding nitrous oxide, prescribing or administering drugs that
are not recommended for unmonitored home use, or administering any parenteral
drug constitutes moderate sedation and requires that the dentist must hold a
moderate sedation permit.
e.
Facilities and equipment must include:
(1)
Suction equipment capable of aspirating gastric contents from the mouth and
pharynx;
(2) Portable oxygen
delivery system, including full face masks and a bag-valve-mask combination
with appropriate connectors capable of delivering positive pressure, oxygen
enriched ventilation to the patient;
(3) Blood pressure cuff (or sphygmomanometer)
of appropriate size;
(4) Automated
external defibrillator (AED) or defibrillator;
(5) Stethoscope or equivalent monitoring
device; and
(6) The following
emergency drugs must be available and maintained:
(a) Bronchodilator;
(b) Anti-hypoglycemic agent;
(c) Aspirin;
(d) Antihistaminic;
(e) Coronary artery vasodilator;
and
(f) Anti-anaphylactic
agent.
f. A
dentist or qualified dental staff member responsible for patient monitoring
must be continuously in the presence of the patient in the office, operatory,
and recovery area before administration or if the patient self-administered the
sedative agent immediately upon arrival, and throughout recovery until the
patient is discharged by the dentist.
g. A dentist shall ensure any advertisements
related to the availability of antianxiety premedication, or minimal sedation
clearly reflect the level of sedation provided and are not
misleading.
3.
Administration of moderate sedation. Before administering moderate sedation, a
dentist licensed under North Dakota Century Code chapter 43-28 must have a
permit issued by the board, renewable biennially thereafter. An applicant for
an initial permit must submit a completed application and application fee on a
form provided by the board and meet the following requirements:
a. An applicant for an initial moderate
sedation permit must meet the following educational requirements. This section
does not apply to a dentist who has maintained a parenteral sedation permit in
North Dakota and has been administering parenteral sedation in a dental office
before July 1, 2022.
(1) Successfully
completed a comprehensive sixty-hour predoctoral dental school, postgraduate
education or continuing education in moderate sedation with a
participant-faculty ratio of not more than four-to-one. The course must include
courses in enteral and parenteral moderate sedation plus individual management
of twenty live patient clinical case experiences by the intravenous route and
provide certification of competence in rescuing patients from a deeper level of
sedation than intended, including managing the airway, intravascular or
intraosseous access, and reversal medications. The formal training program must
be sponsored by or affiliated with a university, teaching hospital, or other
facility approved by the board or provided by a curriculum of an accredited
dental school and have a provision by course director or faculty of additional
clinical experience if participant competency has not been achieved in allotted
time.
(2) The course must be
directed by a dentist or physician qualified by experience and training with a
minimum of three years of experience, including formal postdoctoral training in
anxiety and pain control. The course director must possess a current permit or
license to administer moderate or deep sedation and general anesthesia in at
least one state.
b. A
dentist utilizing moderate sedation must maintain current certification in
basic life support and advanced cardiac life support if treating adult patients
or pediatric advanced life support if treating pediatric patients and have
present a staff of supervised personnel capable of handling procedures,
complications, and emergency incidents, including at least one qualified dental
staff member as specified in subsection 40 of section
20-01-02-01.
c. A permitholder may not administer or
employ any agents that have a narrow margin for maintaining consciousness,
including ultra-short acting barbiturates, propofol, ketamine, or similarly
acting drugs, agents, or techniques, or any combination thereof that likely
would render a patient deeply sedated, generally anesthetized, or otherwise not
meeting the conditions of moderate sedation.
d. During moderate sedation the adequacy of
ventilation must be evaluated by continual observation of qualitative clinical
signs and monitoring for the presence of exhaled carbon dioxide unless
precluded or invalidated by the nature of the patient, procedure, or
equipment.
e. Successfully
completed the moderate site evaluation required by this chapter. An initial
site evaluation must be completed within sixty days of the approval of the
initial permit application.
f.
Administering intranasal versed or fentanyl, or both, is considered deep
sedation. Rules for deep sedation and general anesthesia site evaluations apply
for administration of intranasal versed or fentanyl, or both.
4. Administration of deep sedation
and general anesthesia. Before administering deep sedation or general
anesthesia, a dentist licensed under North Dakota Century Code chapter 43-28
must have a permit issued by the board and renewable biennially thereafter. An
applicant for an initial permit must submit a completed application and
application fee on a form provided by the board and meet the following
educational requirements:
a. Within the three
years before submitting the permit application, provide evidence the applicant
successfully has completed an advanced education program accredited by the
commission on dental accreditation that provides training in deep sedation and
general anesthesia and formal training in airway management, and completed a
minimum of five months of advanced training in anesthesiology and related
academic subjects beyond the undergraduate dental school level in a training
program approved by the board; or
b. Be, within the three years before
submitting the permit application, a diplomate of the American board of oral
and maxillofacial surgeons or eligible for examination by the American board of
oral and maxillofacial surgeons, a fellow of the American association of oral
and maxillofacial surgeons, a fellow of the American dental society of
anesthesiology, a diplomate of the national dental board of anesthesiology, or
a diplomate of the American dental board of anesthesiology or eligible for
examination by the American dental board of anesthesiology; or
c. For an applicant who completed the
requirements of subdivision a or b more than three years before submitting the
permit application, provide on a form provided by the board, a written
affidavit affirming the applicant has administered general anesthesia to a
minimum of twenty-five patients within the year before submitting the permit
application or seventy-five patients within the last five years before
submitting the permit application and the following documentation:
(1) A copy of the deep sedation and general
anesthesia permit in effect in another jurisdiction or certification of
military training in general anesthesia from the applicant's commanding
officer; and
(2) On a form provided
by the board, a written affidavit affirming the completion of thirty-two hours
of continuing education pertaining to oral and maxillofacial surgery or general
anesthesia taken within three years before application.
d. Successfully completed the general
anesthesia and deep sedation site evaluation required by this chapter. An
initial site evaluation must be completed within sixty days of the approval of
the initial permit application.
e.
A dentist utilizing deep sedation or general anesthesia must maintain current
certification in basic life support and advanced cardiac life support if
treating adult patients or pediatric advanced life support if treating
pediatric patients.
f. A dentist
authorized to provide deep sedation and general anesthesia shall utilize and
have present a staff of supervised personnel capable of handling procedures,
complications, and emergency incidents, including at least two qualified dental
staff members as specified in subsection 40 of section
20-01-02-01.
5. Site evaluations for moderate
sedation, deep sedation, and general anesthesia. A licensed and permitted
dentist or host dentist utilizing moderate sedation, deep sedation, or general
anesthesia is required to have an evaluation of the location where sedation or
anesthesia services are rendered initially and every three years thereafter and
shall maintain a properly equipped facility. A North Dakota licensed anesthesia
or sedation provider authorized by the board shall re-evaluate the credentials,
facilities, equipment, personnel, and procedures of a permitholder within every
three years following a successful initial application or renewal. The purpose
of the evaluation is to assess the patient's anesthetic risk and assess a
site's ability to provide emergency care; therefore, the site evaluation
emphasizes recognition and management of emergencies and complications
associated with office administration of sedation and recordkeeping.
Requirements of the site evaluation are as follows:
a. The applicant is responsible for
scheduling a site evaluation with a board-appointed anesthesia site evaluator.
The host dentist must be present during the site evaluation and submit the site
evaluation form to the site evaluator no less than two weeks before the
scheduled site evaluation and must include the following:
(1) Life support credentials of any qualified
dental staff or medical staff and anesthesia provider or host
dentist;
(2) Copy of license of
qualified dental staff or other attending medical staff, or both;
(3) Copy of current permit to prescribe and
administer controlled substances in this state issued by the United States drug
enforcement administration;
(4)
Copy of patient consent agreement and health history forms;
(5) Copy of a blank sedation monitoring
form;
(6) Preanesthesia sedation
instructions; and
(7) Post care
instructions.
b. The
site evaluator shall submit a completed site evaluation form and documentation
to the board. The dentist's facility where anesthesia and sedation are provided
must meet the requirements of this chapter and maintain the following properly
operating equipment and supplies appropriate for the age and relative size of
the patient during the provision of anesthesia and sedation by the permitholder
or physician anesthesiologist or certified registered nurse anesthetist or
other qualified sedation provider;
(1)
Emergency drugs as required by the board, including:
(a) Vasopressor;
(b) Corticosteroid;
(c) Bronchodilator;
(d) Muscle relaxant;
(e) Intravenous medication for treatment of
cardiopulmonary arrest;
(f)
Narcotic antagonist;
(g)
Benzodiazepine antagonist;
(h)
Antihistamine;
(i)
Antiarrhythmic;
(j)
Anticholinergic;
(k) Coronary
artery vasodilator;
(l)
Antihypertensive;
(m)
Antihypoglycemic agent;
(n)
Antiemetic;
(o) Adenosine, for
general anesthesia and deep sedation sites;
(p) Dantrolene, for general anesthesia and
deep sedation sites, if volatile gases are used; and
(q) Anticonvulsant;
(2) Positive pressure oxygen and supplemental
oxygen delivery system;
(3)
Stethoscope;
(4) Suction equipment,
including tonsillar or pharyngeal and emergency backup medical suction
device;
(5) Oropharyngeal or
nasopharyngeal airways, or both;
(6) Pulse oximeter;
(7) Auxiliary lighting;
(8) Blood pressure monitor with an automated
time determined capability and method for recording the data;
(9) Cardiac defibrillator or automated
external defibrillator (AED);
(10)
End-tidal carbon dioxide monitor;
(11) Electrocardiograph monitor;
(12) Laryngoscope multiple blades, backup
batteries, and backup bulbs;
(13)
Endotracheal tubes and appropriate connectors;
(14) Magill forceps;
(15) Appropriate intravenous setup, including
appropriate supplies and fluids;
(16) Cricothyrotomy equipment;
(17) Thermometer; and
(18) Scale.
c. The operatory where moderate sedation,
deep sedation, or general anesthesia is to be administered must:
(1) Be of adequate size and design to permit
physical access of emergency equipment and personnel and to permit effective
emergency management;
(2) Be
equipped with a chair or table adequate for emergency treatment, including a
chair or cardiopulmonary resuscitation board suitable to administer
cardiopulmonary resuscitation;
(3)
Be equipped with a lighting system to permit the evaluation of the patient's
skin and mucosal color with a backup system to permit the completion of any
operation underway at the time of a general power failure;
(4) Be equipped with suction and backup
suction equipment also including suction catheters and tonsil suction;
and
(5) Be equipped with an oxygen
delivery system and backup system complete with full-face masks and appropriate
connectors, capable of delivering oxygen to the patient under positive
pressure.
d. An
operatory may double as a recovery location. A recovery room must be equipped
with the following:
(1) Suction and backup
suction equipment;
(2) Positive
pressure oxygen;
(3) Sufficient
light to provide emergency treatment;
(4) Be of adequate size and design to allow
emergency access and management; and
(5) Be situated to allow the patient to be
observed by the dentist or a qualified staff member at all times.
e. The applicant or permitholder
shall provide written emergency protocol and written documentation of quarterly
mock codes to the site evaluator and provide training to familiarize office
staff in patient monitoring and the treatment of the following clinical
emergencies:
(1) Laryngospasm;
(2) Bronchospasm;
(3) Emesis and aspiration;
(4) Airway blockage by foreign
body;
(5) Angina
pectoris;
(6) Myocardial
infarction;
(7)
Hypertension/hypotension;
(8)
Hypertensive crisis;
(9)
Hematoma;
(10)
Extravasation;
(11)
Phlebitis;
(12) Intra-arterial
injection;
(13) Syncope;
(14)
Hyperventilation/hypoventilation;
(15) Seizures;
(16) Allergic and toxicity reactions;
and
(17) Malignant hypothermia,
deep sedation and general anesthesia only.
f. Failure to successfully complete the
anesthesia inspection must result in an automatic suspension of anesthesia and
sedation privileges. The applicant shall have thirty days from the date of
inspection to correct documented deficiencies. Once the deficiencies are
corrected and approved by the site evaluator, the permit authorizing sedation
and anesthesia privileges may be reinstated.
g. Effective January 1, 2026, completion of a
board-approved anesthesia simulation course and the completion of anesthesia
simulation training successfully every five years thereafter as required by
section
20-02-01-06.
6. Other anesthesia providers. A
host dentist who intends to use the services of a certified registered nurse
anesthetist, anesthesiologist, or another dentist authorized by permit to
administer moderate sedation, deep sedation, or general anesthesia, shall
notify the board before sedation services are provided and arrange a site
evaluation with the board appointed anesthesia professional. The sedation
provider is responsible for discharge assessment. The host dentist shall run a
mock code quarterly with the sedation team and maintain a record of the mock
code schedule and attendance. The anesthesia provider and the host dentist
shall remain at the facility until the sedated patient is discharged.
7. Renewal of permit and site evaluation. All
sedation and anesthesia permits must be renewed biennially, concurrent with the
dentist's license renewal. The board of dental examiners may renew such permit
biennially provided:
a. Requirements of the
permit have been met;
b.
Application for renewal and renewal fee is received by the board before the
date of expiration of the permit. If the renewal application and renewal fee
have not been received by the expiration of the permit, late fees as determined
by the board must apply; and
c. The
anesthesia site inspection is in good standing with the board of dental
examiners.
8.
Documentation. Dentists administering sedation or anesthesia shall maintain
adequate documentation.
a. For the
administration of local anesthesia, minimal sedation, and analgesia, the
following documentation is required:
(1)
Pertinent medical history, including weight and height;
(2) Medication administered and dosage;
and
(3) Vital signs include heart
rate and blood pressure.
b. For administration of moderate sedation,
deep sedation, or general anesthesia the following documentation is required:
(1) A current and comprehensive medical
history, to include current medications;
(2) Informed consent of the patient for the
administration of anesthesia;
(3)
An anesthesia record, which includes documentation of the following:
(a) Height and weight of the patient to allow
for the calculation of body mass index and dosage of emergency
medications;
(b) American society
of anesthesiologist's physical status classification;
(c) Fasting or nothing by mouth
status;
(d) Dental procedure
performed on the patient;
(e) Time
anesthesia commenced and ended;
(f)
Parenteral access site and method, if utilized;
(g) Medication administered, including
oxygen, dosage, route, and time given;
(h) Vital signs before and after anesthesia
is utilized, to include heart rate, blood pressure, respiratory rate, and
oxygen saturation for all patients;
(i) Intravenous fluids, if
utilized;
(j) Response to
anesthesia, including any complications;
(k) Condition and Aldrete score of patient at
discharge;
(l) Records showing
continuous monitoring of blood pressure, heart rate, and respiration using
electrocardiographic monitoring and pulse oximetry recorded every five minutes,
if utilized;
(m) Emergency
protocols followed in the instance of an adverse event; and
(n) Staff participating in the administration
of anesthesia, treatment, and monitoring.
9. Personnel.
a. During the administration of minimal
sedation, the supervising dentist and at least one other individual who is
experienced in patient monitoring and documentation must be present.
b. During the administration of moderate
sedation, the anesthesia permit provider and at least one other individual who
is experienced in patient monitoring and documentation must be
present.
c. During the
administration of deep sedation or general anesthesia, the anesthesia permit
provider and at least two other individuals meeting the following requirements
must be present:
(1) One individual to assist
the host dentist as necessary.
(2)
One qualified dental staff member solely responsible to assist with observation
and monitoring of the patient.
d. During any sedation or anesthesia
procedure, the anesthesia permit provider retains full accountability, but
delegation to trained dental personnel may occur under:
(1) Direct, continuous, and visual
supervision by the anesthesia permitholder if medication, excluding local
anesthetic, is being administered to a patient in the intraoperative phase of
surgery. A patient under general anesthesia, deep sedation, and moderate
sedation is in the intraoperative phase of surgery from the first
administration of anesthetic medication to:
(a) End of the surgical procedure;
(b) No additional anesthetic medication will
be administered;
(c) Peak effect of
the anesthesia medication has been reached; or
(d) The patient has regained consciousness
with a full return of protective reflexes, including the ability to respond
purposely to physical and verbal commands; or
(2) Direct supervision by the dentist and
anesthesia permitholder if a patient is being monitored in the postoperative
phase of surgery.
e. All
individuals assisting the anesthesia permitholder during sedation or anesthesia
shall maintain current basic life support, advanced cardiovascular life
support, or pediatric advanced life support and shall be appropriately trained
in emergency procedures through updates or drills that must be held at least
quarterly and documented.
10. Standards for patient monitoring.
a. For the administration of local anesthesia
and analgesia, patient monitoring must include the general state of the
patient.
b. For the administration
of minimal sedation, patient monitoring must include the following:
(1) Pre- and post-procedure heart rate and
respiratory rate;
(2) Pre- and
post-procedure blood pressure; and
(3) Level of anesthesia or
sedation.
c. For the
administration of moderate sedation, patient monitoring must include the
following:
(1) Continuous heart rate,
respiratory rate, and oxygen saturation;
(2) Intermittent blood pressure every five
minutes or more frequently;
(3)
Continuous electrocardiograph, if clinically indicated by patient history,
medical condition, or age;
(4)
End-tidal carbon dioxide monitoring (capnography); and
(5) Level of anesthesia or
sedation.
d. For the
administration of deep sedation or general anesthesia, patient monitoring must
include the following:
(1) Continuous heart
rate, respiratory rate, and oxygen saturation;
(2) Continuous ventilatory status
(spontaneous, assisted, controlled) for the administration of general
anesthesia to a patient with an advanced airway in place (e.g. endotracheal
tube or laryngeal mask airway);
(3)
Intermittent blood pressure every five minutes or more frequently;
(4) Continuous electrocardiograph;
(5) Continuous temperature for the
administration of volatile anesthesia gases or medications which are known
triggers of malignant hyperthermia, otherwise the ability to measure
temperature should be readily available;
(6) End-tidal carbon dioxide monitoring;
and
(7) Level of anesthesia or
sedation.
e. Monitoring
equipment must be checked and calibrated in accordance with the manufacturer's
recommendations and documented on an annual basis.
11. Patient evaluation required. The decision
to administer controlled drugs for dental treatment must be based on a
documented evaluation of the health history and current medical condition of
the patient in accordance with the class I through V risk category
classifications of the American society of anesthesiologists. The findings of
the evaluation, the American society of anesthesiologists risk assessment class
assigned, and any special considerations must be recorded in the patient's
record.
12. Informed written
consent. Before administration of any level of sedation or general anesthesia,
the dentist shall discuss the nature and objectives of the planned level of
sedation or general anesthesia along with the risks, benefits, and alternatives
and shall obtain informed, written consent from the patient or other
responsible party for the administration and for the treatment to be provided.
The written consent must be maintained in the patient record.
13. Pediatric patients. Sedating medication
may not be prescribed for or administered to a patient eight years of age or
younger before the patient's arrival at the dentist office or treatment
facility.
14. Emergency management.
The licensed dentist authorized by permit to administer sedation or anesthesia
and staff with patient care duties shall be trained in emergency preparedness.
Written protocols must include training requirements and procedures specific to
the permitholder's equipment and drugs for responding to emergency situations
involving sedation or anesthesia, including information specific to respiratory
emergencies. The permitholder shall document this review of office training or
mock codes. Protocols must include the American heart association's basic life
support or cardiopulmonary resuscitation and advanced cardiac life support, or
pediatric advanced life support for any practitioner administering moderate
sedation, deep sedation, or general anesthesia.
a. If a patient enters a deeper level of
sedation than the dentist is qualified and prepared to provide, the dentist
shall stop the dental procedure until the patient returns to and is stable at
the intended level of sedation.
b.
Quarterly mock codes to simulate office medical emergencies must be documented
and available during a site evaluation.
c. Authorization of duties. A dentist who
authorizes the administration of general anesthesia, deep sedation, or moderate
sedation in the dentist's dental office is responsible for assuring that:
(1) The equipment for administration and
monitoring is readily available and in good working order before performing
dental treatment with anesthesia or sedation. The equipment either must be
maintained by the dentist in the dentist's office or provided by the anesthesia
or sedation provider;
(2) The
person administering the anesthesia or sedation is appropriately
licensed;
(3) The individual
authorized to monitor the patient is qualified;
(4) A physical evaluation and medical history
is taken before administration of general anesthesia or sedation. A dentist
holding a permit shall maintain records of the physical evaluation, medical
history, and general anesthesia or sedation procedures; and
(5) Administration of sedation by another
qualified provider requires the operating dentist to maintain advanced cardiac
life support if the patient is nine years of age or older and pediatric
advanced life support if the patient is eight years old or younger.
d. Reporting. All licensed
dentists in the practice of dentistry in this state shall submit a report
within a period of seven days to the board office of any mortality or other
incident which results in temporary or permanent physical or mental injury
requiring hospitalization of the patient during, or as a result of, minimal
sedation, nitrous oxide inhalation analgesia, moderate sedation, deep sedation,
or general anesthesia.
(1) The report must
include responses to at least the following:
(a) Description of dental
procedure;
(b) Description of
preoperative physical condition of patient;
(c) List of drugs and dosage
administered;
(d) Description, in
detail, of techniques utilized in administering the drugs utilized;
(e) Description of adverse occurrence:
[1] Description, in detail, of symptoms of
any complications, to include onset and type of symptoms in patient.
[2] Treatment instituted on the
patient.
[3] Response of the
patient to the treatment.
(f) Description of the patient's condition on
termination of any procedures undertaken; and
(g) The unique reporting identification
issued by the dental anesthesia incident reporting system, indicating a report
has been submitted to the national database.
(2) Violations. A violation of any provision
of this article constitutes unprofessional conduct and is grounds for the
revocation or suspension of the dentist's permit, license, or both, or the
dentist may be reprimanded or placed on probation.
15. Controlled pharmaceuticals.
a. A dentist must secure and maintain
controlled pharmaceuticals in accordance with the state and federal
guidelines.
b. Used controlled
pharmaceuticals or medications must be discarded immediately with documentation
of disposal in conformance with drug enforcement administration
guidelines.
General Authority: NDCC 43-28-06
Law Implemented: NDCC 43-28-01, 43-28-06,
43-28-15, 43-28-18.1
