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) Under a dentist’s direct supervision and direct orders, a dental assistant may administer nitrous oxide.

      (b) If a dental assistant administers nitrous oxide, the dental assistant shall administer the level prescribed by the 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 KAR8:520;

      (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. 8-5-11.)