section .0300 - PARENTERAL CONSCIOUS SEDATION

 

21 NCAC 16Q .0301          CREDENTIALS

AND PERMITS FOR MODERATE CONSCIOUS SEDATION, MODERATE PEDIATRIC CONSCIOUS

SEDATION AND MODERATE CONSCIOUS SEDATION LIMITED TO ORAL ROUTES OF

ADMINISTRATION AND NITROUS OXIDE

(a)  Before a dentist licensed to practice in North Carolina

may administer or supervise a certified registered nurse anesthetist (CRNA) to

administer moderate conscious sedation, moderate pediatric conscious sedation

or moderate conscious sedation limited to oral routes of administration and

nitrous oxide to dental patients on an outpatient basis, the dentist shall

obtain a permit from the Board by completing an application form provided by

the Board and paying a fee of one hundred dollars ($100.00).  Such permit shall

be renewed annually and shall be displayed with the current renewal at all

times in a conspicuous place in the facility of the permit holder.

(b)  For a dentist to employ a certified registered nurse

anesthetist to administer moderate conscious sedation, moderate conscious

sedation limited to oral routes and nitrous oxide or moderate pediatric

conscious sedation, the dentist must demonstrate through the permitting process

that he or she is capable of performing all duties and procedures to be delegated

to the CRNA.  The dentist must not delegate said CRNA to perform procedures

outside of the scope of the technique and purpose of moderate conscious

sedation, moderate pediatric conscious sedation or moderate conscious sedation

limited to oral routes and nitrous oxide as defined in Rule .0101 of this

Subchapter.

(c)  A dentist applying for a permit to administer moderate

conscious sedation or moderate pediatric conscious sedation must meet at least

one of the following criteria:

(1)           Satisfactory completion of a minimum of 60

hours of didactic training, including PALS (Pediatric Advanced Life Support),

and instruction in intravenous conscious sedation and satisfactory management

of a minimum of 10 patients, under supervision, using intravenous sedation; or

(2)           Satisfactory completion of a pre-doctoral

dental or postgraduate program which included intravenous conscious sedation

training equivalent to that defined in Subparagraph (c)(1) of this Rule; or

(3)           Satisfactory completion of an internship or

residency which included intravenous conscious sedation training equivalent to

that defined in Subparagraph (c)(1) of this Rule.

(d)  Notwithstanding the foregoing, a dentist may also

qualify for a permit to administer moderate pediatric conscious sedation by documenting,

with patient names and dates of completion, at least 100 cases of moderate

pediatric sedation procedures successfully completed between July 3, 2006 and

July 3, 2009.  A dentist who obtains a pediatric conscious sedation permit

pursuant to this Paragraph may not administer sedation intravenously and such

limitation shall be noted on the dentist's permit.

(e)  A dentist may modify his or her moderate conscious

sedation permit to include the privilege of moderate pediatric conscious

sedation by completing a Board approved pediatric dental degree or pediatric

dental residency program or obtaining the equivalent hours of continuing

education program in pediatric dental anesthesia.  If said qualifications are

satisfied, it shall be so designated on the dentist's moderate conscious

sedation permit and will be subject to the renewal requirements stated in Rule

.0501(d) of this Subchapter.

(f)  To be eligible for a moderate conscious sedation

permit, moderate conscious sedation limited to oral routes and nitrous oxide

inhalation permit or moderate pediatric conscious sedation permit, a dentist

must operate within a facility which includes the capability of delivering

positive pressure oxygen, and is staffed with supervised auxiliary personnel

for each procedure performed.  The dentist shall ensure that auxiliary

personnel document annual, successful completion of basic life support (BLS)

training and are capable of assisting with procedures, problems and emergencies

incident thereto.

(g)  Prior to issuance of a moderate conscious sedation

permit, moderate conscious pediatric sedation permit or moderate conscious

sedation permit limited to oral routes and nitrous oxide inhalation permit, the

applicant shall undergo an evaluation which includes a facility inspection. 

The Board shall direct an evaluator to perform this evaluation.  The applicant

shall be notified in writing that an evaluation and facility inspection is

required and provided with the name of the evaluator who shall perform the

evaluation and facility inspection.  The applicant shall be responsible for

successful completion of the evaluation and inspection of his or her facility

within three months of notification.  An extension of no more than 90 days

shall be granted if the designated evaluator or applicant requests one.

(h)  The evaluator shall assign a grade of pass or fail and

shall report his recommendation to the Board, setting out the basis for his

conclusion.  The Board is not bound by the evaluator's recommendation and shall

make a final determination regarding whether the applicant has passed the

evaluation.  The applicant shall be notified of the Board's decision in

writing.

(i)  A dentist who holds a moderate conscious sedation,

moderate conscious sedation limited to oral routes and nitrous oxide inhalation

or moderate pediatric conscious sedation permit shall not intentionally

administer deep sedation although deep sedation may occur briefly and

unintentionally.

(j)  A dentist may obtain a moderate conscious sedation

permit limited to oral routes of administration  and nitrous oxide inhalation,

including the ability to add supplemental dosing to the techniques set out in

Rule .0101(23) of this Subchapter upon compliance with the following

requirements:

(1)           successfully complete 24 hours of didactic

training and manage at least 10 adult case experiences, including at least

three live clinical dental experiences.  The live clinical cases shall not be

handled by groups with more than five student participants.  The remaining

cases may include simulations, video presentations or both, but must include

one experience in returning/rescuing a patient from deep to moderate sedation;

or

(2)           document, with patient names and dates of

completion, at least 100 cases of oral moderate conscious sedation procedures

successfully completed within one year preceding June 3, 2008; and fulfill all

the requirements listed in Rule .0401 of this Subchapter for minimal conscious

sedation.

(k)  A dentist who is qualified to administer general

anesthesia, moderate conscious sedation or moderate pediatric conscious

sedation and holds a general anesthesia, moderate conscious sedation permit or

a moderate pediatric conscious sedation permit may administer minimal conscious

sedation without obtaining a separate minimal conscious sedation permit.

(l)  Any dentist who holds an active parenteral conscious

sedation permit as of October 1, 2007 shall be deemed to hold an active

moderate conscious sedation permit.  Such permits shall be subject to the

renewal requirements set out in Rule .0501 of this Subchapter.

 

History Note:        Authority G.S. 90-28; 90-30.1;

Eff. February 1, 1990;

Amended Eff. April 1, 2001; August 1, 2000; January 1,

1994;

Temporary Amendment Eff. December 11, 2002;

Amended Eff. July 1, 2010, July 3, 2008; August 1, 2004.