18 Va. Admin. Code § 60-21-280 - Administration of minimal sedation
A. Education and
training requirements. A dentist who utilizes minimal sedation shall have
training in and knowledge of:
1. The
medications used, the appropriate dosages, the potential complications of
administration, the indicators for complications, and the interventions to
address the complications.
2. The
physiological effects of minimal sedation, the potential complications of
administration, the indicators for complications, and the interventions to
address the complications.
3. The
use and maintenance of the equipment required in subsection D of this
section.
B. No sedating
medication shall be prescribed for administration to a patient 12 years of age
or younger prior to the patient's arrival at the dental office or treatment
facility.
C. Delegation of
administration.
1. A qualified dentist may
administer or use the services of the following personnel to administer minimal
sedation:
a. A dentist;
b. An anesthesiologist;
c. A certified registered nurse anesthetist
under the dentist's medical direction and indirect supervision;
d. A dental hygienist with the training
required by
18VAC60-25-100 B
only for administration of nitrous oxide/oxygen under indirect supervision;
or
e. A registered nurse upon the
dentist's direct instruction and under immediate
supervision.
2. Preceding
the administration of minimal sedation, a dentist may use the services of the
following personnel working under indirect supervision to administer local
anesthesia to numb an injection or treatment site:
a. A dental hygienist with the training
required by
18VAC60-25-100 C
to parenterally administer Schedule VI local anesthesia to persons 18 years of
age or older; or
b. A dental
hygienist, dental assistant, registered nurse, or licensed practical nurse to
administer Schedule VI topical oral anesthetics.
D. Equipment requirements. A dentist who
utilizes minimal sedation or who directs the administration by another licensed
health professional as permitted in subsection C of this section shall maintain
the following equipment in working order and immediately available to the areas
where patients will be sedated and treated and will recover:
1. Blood pressure monitoring
equipment;
2. Source of delivery of
oxygen under controlled positive pressure;
3. Mechanical (hand) respiratory
bag;
4. Suction apparatus;
and
5. Pulse
oximeter.
E. Required
staffing. The treatment team for minimal sedation shall consist of the dentist
and a second person in the operatory with the patient to assist the dentist and
monitor the patient. The second person shall be a licensed health care
professional or a person qualified in accordance with
18VAC60-21-260 I.
F. Monitoring requirements.
1. Baseline vital signs, to include
temperature and oxygen saturation, shall be taken and recorded prior to
administration of sedation.
2.
Blood pressure, oxygen saturation, respiratory rate, and pulse shall be
monitored continually during the procedure unless extenuating circumstances
exist and are documented in the patient's record.
3. Once the administration of minimal
sedation has begun by any route of administration, the dentist shall ensure
that a licensed health care professional or a person qualified in accordance
with 18VAC60-21-260 I
monitors the patient at all times until discharged as required in subsection G
of this section.
4. Nitrous
oxide/oxygen may be used with one other pharmacological agent in the
recommended dosage for minimal sedation. If deeper levels of sedation are
produced, the regulations for the induced level shall be followed.
5. Monitoring shall include making the proper
adjustments of nitrous oxide/oxygen machines at the request of or by the
dentist or by another qualified licensed health professional identified in
subsection C of this section. Only the dentist or another qualified licensed
health professional identified in subsection C of this section may turn the
nitrous oxide/oxygen machines on or off.
6. If any other pharmacological agent is used
in addition to nitrous oxide/oxygen and a local anesthetic, requirements for
the induced level of sedation must be met.
G. Discharge requirements.
1. The dentist shall not discharge a patient
until the patient exhibits baseline responses in a post-operative evaluation of
the level of consciousness. Vital signs, to include oxygen saturation, shall be
taken and recorded prior to discharge unless extenuating circumstances exist
and are documented in the patient's record.
2. Post-operative instructions shall be given
verbally and in writing and documented in the patient's chart. The written
instructions shall include a 24-hour emergency telephone number.
3. Pediatric patients shall be discharged
with a responsible adult who has been instructed with regard to the patient's
care.
Notes
Statutory Authority: § 54.1-2400 of the Code of Virginia.
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