201 KAR 8:550. Anesthesia and sedation.
RELATES TO: KRS 313.035
STATUTORY AUTHORITY: KRS 313.035(1)
NECESSITY, FUNCTION AND CONFORMITY: KRS
313.035(1) requires the board to promulgate administrative regulations related
to conscious anesthesia and sedation permits. This administrative regulation
establishes requirements for permits to perform conscious sedation or anesthesia.
Section 1. Definitions. (1)
"Advanced Cardiac Life Support" or "ACLS" means a
certification that an individual has successfully completed an advanced cardiac
life support course that meets or exceeds the standards established by the
American Heart Association and incorporated by reference in 201 KAR 8:532.
(2) "Anesthesia" means an
artificially induced insensibility to pain usually achieved by the administration
of gases or drugs.
(3) "Anesthesia and sedation"
means:
(a) Minimal sedation;
(b) Moderate sedation;
(c) Deep sedation; and
(d) General anesthesia.
(4) "Board" means the Kentucky
Board of Dentistry.
(5) "Certified registered nurse
anesthetist" means a registered nurse who is currently certified to
practice nurse anesthesia in Kentucky.
(6) "Conscious sedation permit"
means a permit that was issued by the board prior to February 1, 2011, that
authorized the dentist to whom the permit was issued to administer parenteral
sedation for the practice of dentistry.
(7) "Deep sedation" means a
drug-induced depression of consciousness during which patients cannot be easily
aroused but respond purposefully following repeated or painful stimulation. The
ability to independently maintain ventilatory function may be impaired.
Cardiovascular function is usually maintained.
(8) "Enteral" means a technique
of administration in which the agent is absorbed through the gastrointestinal
(GI) tract or oral mucosa (oral, rectal, or sublingual).
(9) "Facility" means a location
in which anesthesia or sedation is administered for the practice of dentistry.
(10) "Facility inspection"
means an on-site inspection by the board or its designee to determine if a
facility where the applicant proposes to provide anesthesia and sedation is
adequately supplied, equipped, staffed, and maintained in a condition to
support the provision of anesthesia and sedation services in a manner that
meets the requirements of this administrative regulation.
(11) "General anesthesia" means
a drug-induced loss of consciousness during which patients are not arousable
even by painful stimulation. The ability to independently maintain ventilatory
function is often impaired. Patients often require assistance in maintaining a
patent airway, and positive pressure ventilation may be required because of
depressed spontaneous ventilation, drug-induced depression, or changes in
neuromuscular function. Cardiovascular function may be impaired.
(12) "General anesthesia
permit" means a permit that was issued by the board prior to February 1,
2011, that authorized the dentist to whom the permit was issued to administer
general anesthesia for the practice of dentistry.
(13) "Incident" means dental
treatment performed on a patient under minimal sedation, moderate sedation,
deep sedation, or general anesthesia with unforeseen complications.
(14) "Incremental dosing" means
administration of multiple doses of a drug until a desired effect is reached.
(15) "Minimal sedation" means a
drug-induced state, with or without nitrous oxide to decrease anxiety, in which
patients respond normally to tactile stimulation and verbal commands. Although
cognitive function and coordination may be impaired, ventilatory and
cardiovascular functions are maintained and do not require assistance.
(16) "Moderate enteral
sedation" means a drug-induced depression of consciousness through the
gastrointestinal tract or oral mucosa during which patients respond purposefully
to verbal commands, either alone or accompanied by light tactile stimulation. Intervention
is not required to maintain a patent airway, and spontaneous ventilation is
adequate. Cardiovascular function is usually maintained.
(17) "Moderate parenteral
sedation" means a drug-induced depression of consciousness that bypasses
the gastrointestinal tract or oral mucosa during which patients respond
purposefully to verbal commands, either alone or accompanied by light tactile
stimulation. Intervention is not required to maintain a patent airway and spontaneous
ventilation is adequate. Cardiovascular function is usually maintained.
(18) "Moderate sedation" means
a drug-induced depression of consciousness during which patients respond
purposefully to verbal commands, either alone or accompanied by light tactile
stimulation. Intervention is not required to maintain a patent airway, and
spontaneous ventilation is adequate. Cardiovascular function is usually
maintained.
(19) "Nitrous oxide sedation"
means a technique of inhalation sedation with nitrous oxide and oxygen.
(20) "Parenteral" means a
technique of administration in which the drug bypasses the gastrointestinal
tract, that is, through an intramuscular, intravenous, intranasal, submucosal,
subcutaneous, or intraosseous technique.
(21) "Pediatric Advanced Life
Support" or "PALS" means a certification that an individual has
successfully completed a pediatric advanced life support course that meets or
exceeds the standards established by the American Heart Association and
incorporated by reference in 201 KAR 8:532.
(22) "Sedation" means the
reduction of stress or excitement by the administration of a drug that has a
soothing, calming, or tranquilizing effect.
Section 2. Nitrous Oxide Sedation. (1)
Nitrous oxide sedation may be used by a Kentucky-licensed dentist without a
specific sedation permit or by a Kentucky-licensed dental hygienist certified
to administer block and infiltration anesthesia and nitrous oxide analgesia.
(2) Equipment used in the administration
of nitrous oxide sedation shall have functional safeguard measures that:
(a) Limit the minimum oxygen
concentration to thirty (30) percent; and
(b) Provide for scavenger elimination of
nitrous oxide gas.
(3) The dentist shall:
(a) Insure that a patient receiving
nitrous oxide is constantly monitored; and
(b) Be present in the office while
nitrous oxide is being used.
(4) A dental assistant may only deliver
nitrous oxide at a rate specified by direct orders of a dentist.
Section 3. Minimal Sedation Without a
Permit. (1) A permit shall not be required for a dentist to administer minimal
enteral sedation for patients age thirteen (13) and older.
(2) A dentist who intends to administer
minimal sedation shall indicate the intent to administer minimal sedation in
the patient’s record.
(3) Medication used to produce minimal
sedation shall not exceed the manufacturer’s recommended dose (MRD) for unmonitored
use by the individual. Additional dosing shall be within the MRD limits.
(4) A dentist who administers minimal sedation
shall maintain a margin of safety and a level of consciousness that does not approach
moderate sedation and other deeper states of sedation and general anesthesia.
(5) Nitrous oxide may be combined with an
oral medication. If nitrous oxide is combined with an oral medication, the
level of sedation shall be maintained at the level of minimal sedation.
Section 4. Permit and Location
Certificate Required. (1) A dentist shall not administer an anesthetic
technique in order to attain a level beyond minimal sedation for the practice
of dentistry unless:
(a) The dentist holds an appropriate
Minimal Pediatric Sedation, Moderate Enteral Sedation, Moderate Parenteral
Sedation, Moderate Pediatric Sedation, or Deep Sedation or General Anesthesia
permit issued by the board; or
(b) The dentist holds a conscious
sedation or general anesthesia permit that shall be converted to a Minimal
Pediatric Sedation, Moderate Enteral Sedation, Moderate Parenteral Sedation,
Moderate Pediatric Sedation, or Deep Sedation or General Anesthesia permit at
the next license renewal.
(2) A dentist shall not administer an
anesthetic technique under a Minimal Pediatric Sedation, Moderate Enteral
Sedation, Moderate Parenteral Sedation, Moderate Pediatric Sedation, Deep Sedation
or General Anesthesia, conscious sedation, or general anesthesia permit issued
by the board at a facility unless:
(a) The facility has a current Anesthesia
and Sedation Facility Certificate issued by the board; or
(b) The facility passed an inspection by
the board for the purpose of issuing a conscious sedation or general anesthesia
permit.
(3) A treating dentist who does not hold
an anesthesia and sedation permit shall not allow a physician anesthesiologist,
another dentist who holds an anesthesia and sedation permit, or a certified
registered nurse anesthetist to administer an anesthetic technique in order to
attain a level beyond minimal sedation for the practice of dentistry at a
facility owned or operated by the treating dentist unless:
(a) The facility has a current Anesthesia
and Sedation Facility Certificate issued by the board; or
(b) The facility passed an inspection by
the board for the purpose of issuing a conscious sedation or general anesthesia
permit.
Section 5. Classifications of Anesthesia
and Sedation Permits. The following permits shall be issued by the board to a
qualified licensed dentist:
(1) Minimal Pediatric Sedation permit
that authorizes a dentist to use minimal enteral sedation for patients age five
(5) to twelve (12) Medication or medications used to produce minimal sedation
shall not exceed the manufacturer’s recommended dose (MRD) for unmonitored use
by the individual. Incremental dosing shall be prohibited. All dosing shall be
administered in the dental office. A dentist who administers minimal sedation
shall maintain a margin of safety and a level of consciousness that does not
approach moderate sedation and other deeper states of sedation and general
anesthesia. Nitrous oxide may be combined with an oral medication. If nitrous
oxide is combined with an oral medication, the level of sedation shall be
maintained at the level of minimal sedation;
(2) Moderate Enteral Sedation permit that
authorizes a dentist to use moderate enteral sedation for patients age thirteen
(13) and older;
(3) Moderate Parenteral Sedation permit
that authorizes a dentist to use moderate parenteral sedation for patients age
thirteen (13) and older;
(4) Moderate Pediatric Sedation permit
that authorizes a dentist to use moderate sedation by any route of
administration for patients age twelve (12) and under; and
(5) Deep Sedation or General Anesthesia
permit that authorizes a dentist to use:
(a) General anesthesia; or
(b) Deep sedation.
Section 6. Qualifications for Obtaining a
Minimal Pediatric Sedation Permit. To qualify for a Minimal Pediatric Sedation
permit, an applicant shall:
(1) Submit an Application for Sedation or
Anesthesia Permit;
(2) Pay the fee required by 201 KAR
8:520;
(3) Hold current certification in either
ACLS or PALS or successfully complete a six (6) hour board-approved course that
provides instruction on medical emergencies and airway management; and
(4) Provide proof of successful
completion of:
(a) a Commission on Dental Accreditation
(CODA) accredited postdoctoral training program that affords comprehensive and
appropriate training necessary to administer and manage minimal sedation; or
(b) Provide proof of successful
completion of a board-approved course that shall consist of a minimum of
twenty-four (24) hours of didactic instruction on pediatric minimal sedation by
the enteral route or the combination enteral and nitrous oxide route.
Section 7. Qualifications for Obtaining a
Moderate Enteral Sedation Permit. To qualify for a Moderate Enteral Sedation
permit, an applicant shall:
(1) Submit an Application for Sedation or
Anesthesia Permit;
(2) Pay the fee required by 201 KAR
8:520;
(3) Hold current certification in either
ACLS or PALS or successfully complete a six (6) hour board-approved course that
provides instruction on medical emergencies and airway management; and
(4) Provide proof of successful
completion of:
(a) A Commission on Dental Accreditation
(CODA) accredited postdoctoral training program that affords comprehensive and
appropriate training necessary to administer and manage moderate sedation; or
(b) Provide proof of successful
completion of a board-approved course that shall consist of a minimum of
twenty-four (24) hours of didactic instruction plus management of at least ten
(10) adult case experiences by the enteral route or the combination enteral and
nitrous oxide route. These ten (10) cases shall include at least three (3) live
(on sight) clinical dental experiences managed by participants in groups that
shall not exceed five (5) individuals. These three (3) live (on-sight) experiences
may be obtained by observing a permit level dentist in his or her office, and
the remaining cases may include simulations and video presentations and shall
include at least one (1) experience in returning a patient from deep to moderate
sedation.
Section 8. Qualifications for Obtaining a
Moderate Parenteral Sedation Permit. To qualify for a Moderate Parenteral
Sedation permit, an applicant shall:
(1) Submit an Application for Sedation or
Anesthesia Permit;
(2) Pay the fee required by 201 KAR 8:520;
(3) Hold current certification in either
ACLS or PALS or successfully complete a six (6) hour board-approved course that
provides instruction on medical emergencies and airway management; and
(4) Provide proof of successful
completion of:
(a) A CODA-accredited postdoctoral
training program that affords comprehensive and appropriate training necessary
to administer and manage moderate parenteral sedation; or
(b) Provide proof of successful completion
of a board-approved course that shall consist of a minimum of sixty (60) hours
of didactic instruction plus management of at least twenty (20) patients per
course participant in moderate parenteral sedation techniques.
Section 9. Qualifications for Obtaining a
Moderate Pediatric Sedation Permit. To qualify for a Moderate Pediatric
Sedation permit, an applicant shall:
(1) Submit an Application for Sedation or
Anesthesia Permit;
(2) Pay the fee required by
administrative regulation;
(3) Hold current certification in either
ACLS or PALS or successfully complete a six (6) hour board-approved course that
provides instruction on medical emergencies and airway management; and
(4) Provide proof of successful
completion of a CODA-accredited postdoctoral training program that affords
comprehensive and appropriate training necessary to administer and manage moderate
sedation for patients age twelve (12) and under.
Section 10. Qualifications for Obtaining
a Deep Sedation or General Anesthesia Permit. To qualify for a Deep Sedation or
General Anesthesia permit, an applicant shall:
(1) Submit an Application for Sedation or
Anesthesia Permit;
(2) Pay the fee required by
administrative regulation;
(3) Hold current certification in either
ACLS or PALS; and
(4) Provide proof of successful
completion of:
(a) A board-approved Accreditation
Council for Graduate Medical Education (ACGME) accredited post doctoral
training program in anesthesiology which affords comprehensive and appropriate
training necessary to administer deep sedation and general anesthesia;
(b) A board-approved nurse anesthesia program
accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs
that affords comprehensive and appropriate training necessary to administer
deep sedation and general anesthesia;
(c) Successful completion of a minimum of
two (2) years advanced clinical training in anesthesiology from a Joint
Commission on Accreditation of Healthcare Organization (JCAHO) accredited
institution that meets the objectives set forth in part two (2) of the American
Dental Association’s Guidelines for Teaching the Comprehensive Control of
Anxiety and Pain in Dentistry; or
(d) Provide proof of successful
completion of a CODA-accredited postdoctoral training program that affords
comprehensive and appropriate training necessary to administer and manage deep
sedation and general anesthesia.
Section 11. Multiple Application Levels
Permitted. Dentists with education and training for more than one (1) level of
sedation may mark their levels of qualification on the Application for Sedation
or Anesthesia Permit, based on the requirements of Sections 6 through 10 of
this administrative regulation.
Section 12. Location Requirement. A
dentist holding a Minimal Pediatric Sedation, Moderate Enteral Sedation,
Moderate Parenteral Sedation, Moderate Pediatric Sedation, Deep Sedation or
General Anesthesia, conscious sedation, or general anesthesia permit shall
advise the board of the name and address of each facility where the dentist intends
to or has ceased to administer anesthesia and sedation by submitting the
Anesthesia and Sedation Permit Location Notification Form within ten (10)
business days of the change.
Section 13. Anesthesia and Sedation
Facility Certificates. (1) The owner or operator of a facility shall obtain an
Anesthesia and Sedation Facility Certificate from the board for any location at
which:
(a) A dentist holding a Minimal Pediatric
Sedation, Moderate Enteral Sedation, Moderate Parenteral Sedation, Moderate
Pediatric Sedation, Deep Sedation or General Anesthesia, conscious sedation, or
general anesthesia permit may administer anesthesia and sedation under the
permit; or
(b) The treating dentist may allow a
physician anesthesiologist, another dentist who holds an anesthesia and
sedation permit, or a certified registered nurse anesthetist to administer an
anesthetic technique in order to attain a level beyond minimal sedation for the
practice of dentistry.
(2) A facility owner or operator desiring
to obtain an Anesthesia and Sedation Facility Certificate shall:
(a) Submit an Application for an
Anesthesia and Sedation Facility Certificate;
(b) Pay the fee required by 201 KAR
8:520; and
(c) Successfully pass a facility
inspection as outlined in Section 14 of this administration.
(3) A dentist currently in an advanced
training course for sedation may request the Board of Dentistry complete a
Sedation Facility Inspection prior to completion of the course.
(4) The owner or operator of a facility
shall not allow an individual to administer anesthesia or sedation unless the
individual is permitted to do so under this administrative regulation.
(5) The owner or operator of a facility
shall maintain for five (5) years for inspection by the board the name and
license number of each dentist, physician anesthesiologist, or certified registered
nurse anesthetist who has administered anesthesia or sedation at that location.
(6) The owner or operator of a facility
shall ensure that the facility:
(a) Remains properly equipped in accordance
with Section 14 of this administrative regulation; and
(b) Remains properly staffed in
accordance with Section 15 of this administrative regulation.
(7) In addition to the requirements
contained in subsection (6) of this section, the owner or operator of a
facility shall ensure that the facility has appropriate nonexpired emergency
and sedation medications.
Section 14. Facility Inspection Criteria.
(1) To qualify for an Anesthesia and Sedation Facility Certificate, the
facility shall pass an evaluation of facility equipment, medications, and
clinical records.
(a) The following shall be provided by
the facility to qualify:
1. Oxygen and gas delivery system, backup
system fail-safe;
2. Gas storage facility;
3. Safety indexed gas system;
4. Suction and backup system;
5. Auxiliary lighting system;
6. Suitability of operating room to
include:
a. Size, which shall be at a minimum ten
(10) feet by eight (8) feet or eighty (80) square feet;
b. Operating primary light source and
secondary portable back-up source, unless back-up generator is available; and
c. Accessibility by emergency medical
staff;
7. Recovery area, including oxygen,
suction, and visual and electronic monitoring, which may include the operating
room;
8. Preoperative medical history and
physical evaluation form; and
9. Anesthesia and monitoring equipment
checked to insure proper working order.
(b) The following shall be provided by
the facility or by an individual listed in Section 22 of this administrative
regulation:
1. Appropriate drugs for each procedure,
all of which shall be unexpired, including reversal agents and emergency
medications;
2. Appropriate devices to maintain an
airway with positive pressure ventilation;
3. Anesthesia records, including
monitoring and discharge records and a check sheet.
a. The check sheet shall be signed by the
provider and the dentist and placed in each record.
b. If the dentist is the provider, only
the dentist's signature shall be required;
4. Monitoring equipment, including pulse oximeter
and blood pressure monitoring;
5. Electrocardiogram (EKG):
a. May be present for use by Minimal
Pediatric Sedation, Moderate Enteral Sedation, Moderate Parenteral Sedation,
and Moderate Pediatric Sedation permit holders for patients with significant
cardiac history; and
b. Shall be present for use by Deep
Sedation or General Anesthesia permit holders;
6. Defibrillator or automated external
defibrillator (AED) for moderate and Deep Sedation or General Anesthesia
permits; and
7. For deep sedation or general
anesthesia in pediatric patients:
a. A precordial stethoscope; or
b. A pretracheal stethoscope.
(2) During a facility inspection,
inspectors shall:
(a) Examine the facility’s equipment to
determine if it is in proper working order;
(b) Determine if appropriate emergency
drugs are present; and
(c) Determine if emergency drugs are
nonexpired.
Section 15. Inducing a Level of Sedation
for a Patient. (1) Administration of minimal pediatric sedation, moderate
enteral sedation, moderate parenteral sedation, moderate pediatric sedation,
deep sedation, or general anesthesia to a patient requires at least the
following appropriately trained individuals:
(a) The treating dentist;
(b) An individual trained and competent
in basic life support (BLS) or its equivalent to assist the treating dentist;
and
(c) Another individual trained and
competent in BLS or its equivalent in close proximity to assist if needed.
(2) A dentist administering minimal
pediatric sedation, moderate enteral sedation, moderate parenteral sedation,
moderate pediatric sedation, deep sedation, or general anesthesia to a patient
shall not leave the site until the patient:
(a) Is conscious;
(b) Is spontaneously breathing;
(c) Has stable vital signs;
(d) Is ambulatory with assistance; and
(e) Is under the care of a responsible
adult.
(3) A treating dentist who allows a
physician, another dentist, or certified registered nurse anesthetist to
administer minimal pediatric sedation, moderate enteral sedation, moderate
parenteral sedation, moderate pediatric sedation, deep sedation, or general
anesthesia under Section 22 of this administrative regulation shall ensure that
the physician, dentist, or certified registered nurse anesthetist shall not
leave the site until the patient:
(a) Is conscious;
(b) Is spontaneously breathing;
(c) Has stable vital signs;
(d) Is ambulatory with assistance; and
(e) Is under the care of a responsible
adult.
Section 16. Conscious Sedation Permits
and General Anesthesia permits. (1) A dentist who holds a current general
anesthesia permit may continue to administer anesthesia and sedation consistent
with a Deep Sedation or General Anesthesia permit until the expiration date of
the permit.
(2) A dentist who holds a current
conscious sedation permit and meets the requirements of Section 9(4) of this
administrative regulation may continue to administer anesthesia and sedation consistent
with a Moderate Pediatric Sedation permit until the expiration date of the
permit.
(3) A dentist who holds a current
conscious sedation permit and meets the requirements of Section 8 of this
administrative regulation may continue to administer anesthesia and sedation
consistent with a Moderate Parenteral Sedation permit until the expiration date
of the permit.
(4) During the license renewal process,
current general anesthesia permit holders shall convert the permit to a Deep
Sedation or General Anesthesia permit.
(5) During the license renewal process,
current conscious sedation permit holders shall convert the permit to a minimal
pediatric sedation, moderate enteral sedation, moderate parenteral sedation, or
moderate pediatric sedation permit.
(6) A dentist who currently practices
enteral sedation without a permit may continue without a permit until January
1, 2012 and shall receive a Moderate Enteral Sedation permit by the submission
of:
(a) Twenty-four (24) hours of didactic
education plus twenty (20) sedation records documenting their experience; and
(b) Satisfactory completion of an on-site
inspection as outlined in Section 14 of this administrative regulation.
Section 17. Issuance and Expiration of
Minimal Pediatric Sedation, Moderate Enteral Sedation, Moderate Parenteral
Sedation, Moderate Pediatric Sedation and Deep Sedation or General Anesthesia
Permits.
(1) Once an applicant has met the
qualifications for obtaining a Minimal Pediatric Sedation, Moderate Enteral
Sedation, Moderate Parenteral Sedation, Moderate Pediatric Sedation, or Deep
Sedation or General Anesthesia permit the board shall issue a permit in
sequential numerical order.
(2) Each permit issued under this
administrative regulation shall expire on the same date as the permit holder’s
license to practice dentistry.
Section 18. Renewal of Minimal Pediatric
Sedation, Moderate Enteral Sedation, Moderate Parenteral Sedation, Moderate
Pediatric Sedation, and Deep Sedation or General Anesthesia Permits. An
individual desiring renewal of an active Minimal Pediatric Sedation, Moderate
Enteral Sedation, Moderate Parenteral Sedation, Moderate Pediatric Sedation,
and Deep Sedation or General Anesthesia permits shall:
(1) Submit a completed and signed
Application for Renewal of Sedation or Anesthesia Permit;
(2) Pay the fee required by 201 KAR
8:520; and
(3) Provide evidence to the board that
the applicant meets the continuing education requirements outlined in Section
19 of this administrative regulation.
Section 19. Continuing Education
Requirements for Renewal of a Minimal Pediatric Sedation, Moderate Enteral
Sedation, Moderate Parenteral Sedation, Moderate Pediatric Sedation, or Deep
Sedation or General Anesthesia Permit. (1) An individual desiring renewal of an
active Minimal Pediatric Sedation, Moderate Enteral Sedation, Moderate
Parenteral Sedation, or Moderate Pediatric Sedation permit shall:
(a) Complete at least six (6) hours of
clinical continuing education related to sedation or anesthesia in a classroom
setting that includes hands-on airway management during the two (2) year term
of the permit; or
(b) Maintain ACLS or PALS certification.
(2) An individual desiring renewal of an
active Deep Sedation or General Anesthesia permit shall:
(a) Complete not less than four (4) hours
of on-sight clinical continuing education related to sedation or anesthesia
during the two (2) year term of the permit; and
(b) Maintain ACLS or PALS certification.
(3) Continuing education required by this
administrative regulation shall:
(a) Not be used to satisfy other
continuing education requirements; and
(b) Be in addition to other continuing
education requirements of 201 KAR 8:532.
Section 20. Facilities Inspected Prior to
February 1, 2011. A facility owner or operator desiring to obtain an Anesthesia
and Sedation Facility Certificate for a facility which passed an inspection by
the board prior to February 1, 2011 shall provide proof to the board of having
passed a facility inspection for the purpose of issuing a conscious sedation or
general anesthesia.
Section 21. Issuance of an Anesthesia and
Sedation Facility Certificate. Once an applicant has met the qualifications for
obtaining an Anesthesia and Sedation Facility Certificate the board shall issue
a certificate in sequential numerical order.
Section 22. Administration by a Physician
Anesthesiologist, Dentist, or Certified Registered Nurse Anesthetist at the
Facility of a Treating Dentist. (1) A treating dentist may allow at his or her
dental facility, administration of sedation or anesthesia by a:
(a) Kentucky-licensed physician
anesthesiologist or a Kentucky-licensed Certified Registered Nurse Anesthetist;
or
(b) Dentist who holds an anesthesia and
sedation permit.
(2) Administration by an individual
listed in subsection (1)(a) of this section shall:
(a) Comply with this administrative
regulation; and
(b) Not require board review.
(3) Nothing in this section shall
preclude a dentist from working with a Kentucky-licensed physician
anesthesiologist or a Kentucky-licensed Certified Registered Nurse Anesthetist
in an ambulatory care center or hospital.
Section 23. Morbidity and Mortality
Incident Reports. (1) A dentist shall report to the board, in writing, any
death caused by or resulting from the dentist's administration of minimal
sedation, moderate sedation, deep sedation, or general anesthesia within seven
(7) days after its occurrence.
(2) A dentist shall report to the board,
in writing, any incident that resulted in hospital in-patient admission caused
by or resulting from the dentist's administration of minimal sedation, moderate
sedation, deep sedation, or general anesthesia within thirty (30) days after
its occurrence.
(3) The written report to the board
required in subsections (1) and (2) of this section shall include:
(a) The date of the incident;
(b) The name, age, and address of the
patient;
(c) The patient's original complete
dental records;
(d) The name and license number of the
licensee and the name and address of all other persons present during the incident;
(e) The address where the incident took
place;
(f) The preoperative physical condition
of the patient;
(g) The type of anesthesia and dosages of
drugs administered to the patient;
(h) The techniques used in administering
the drugs;
(i) Any adverse occurrence including:
1. The patient's signs and symptoms;
2. The treatment instituted in response
to adverse occurrences;
3. The patient's response to the
treatment; and
4. The patient's condition on termination
of any procedures undertaken; and
(j) A narrative description of the
incident including approximate times and evolution of symptoms.
(4) The duties outlined in this section
shall apply to every dentist who administers any type of sedation or anesthesia.
Section 24. Registered Dental Assistant
Duties permitted when working with Sedation Permit holders: (1) A registered
dental assistant working with Minimal Pediatric Sedation, Moderate Enteral Sedation,
Moderate Parenteral Sedation, Moderate Pediatric Sedation and Deep Sedation or
General Anesthesia permit holders may, under direct supervision:
(a) Apply noninvasive monitors;
(b) Perform continuous observation of patients
and noninvasive monitors appropriate to the level of sedation, during the
pre-operative, intra-operative and post-operative (recovery) phases of treatment;
(c) Report monitoring parameters to the
operating dentist on a periodic basis and when changes in monitored parameters
occur;
(d) Record vital sign measurements in the
sedation record; and
(e) Remove IV lines (Moderate Parenteral
Sedation, Moderate Pediatric Sedation and Deep Sedation or General Anesthesia
Permit holders only).
(2) A registered dental assistant working
with Minimal Pediatric Sedation, Moderate Enteral Sedation, Moderate Parenteral
Sedation, Moderate Pediatric Sedation and Deep Sedation or General Anesthesia
Permit holders, may under direct supervision assist in the management of emergencies.
(3) A registered dental assistant working
with Moderate Parenteral Sedation, Moderate Pediatric Sedation and Deep
Sedation or General Anesthesia Permit holders may, under direct supervision:
(a) Administer medications into an
existing IV line upon the verbal order and direct supervision of a dentist with
a Moderate Parenteral Sedation, Moderate Pediatric or Deep Sedation or General
Anesthesia permit; and
(b) Establish an IV line under direct
supervision if they have completed a course approved by the Board of Dentistry
in intravenous access.
Section 25. Incorporation by Reference.
(1) The following material is incorporated by reference:
(a) "Application for Sedation or
Anesthesia Permit", February 2011;
(b) "Application for Sedation or
Anesthesia Facility Certificate", February 2011; and
(c) "Sedation of Anesthesia Permit
Location Notification Form", February 2011.
(2) This material may be inspected,
copied, or obtained, subject to applicable copyright law, at the Kentucky Board
of Dentistry, 312 Whittington Parkway, Suite 101, Louisville, Kentucky 40222,
Monday through Friday 8 a.m. through 4:30 p.m. This material is also available
on the board’s Web site at http://dentistry.ky.gov. (37 Ky.R. 2308; 2876;
eff. 8-5-2011; 40 Ky.R. 2596; 41 Ky.R. 56; eff. 9-5-2014.)
