201 KAR 8:550. Anesthesia and sedation

Link to law: http://www.lrc.ky.gov/kar/201/008/550.htm
Published: 2015

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      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.)