(a) For purposes of this rule, the following definitions
apply:
(1) "High-risk patient" means a patient who has a level
3 or 4 classification according to the American Society of Anesthesiologists
Physical Status Classification System (ASA).
(2) "Board-approved education program" means an in-person
or online program provided by a recognized continuing education provider
pursuant to Board rule 22 TAC §104.2 of this title (relating
to Providers) and any subsequent amendments.
(b) For the purposes of this chapter, ASA classifications
are defined as follows:
(1) ASA I: a normal healthy patient.
(2) ASA II: a patient with mild systemic disease.
(3) ASA III: a patient with severe systemic disease.
(4) ASA IV: a patient with severe systemic disease
that is a constant threat to life.
(c) On or after September 1, 2019, a permit holder
may not administer sedation/anesthesia under a level 2, level 3, or
level 4 permit to a high-risk patient unless the permit holder has
completed the requirements of paragraph (1) or (2) of this subsection.
Permit holders must have:
(1) completed a university or hospital-based residency
at least 12 months in length. All permit holders completing a university
or hospital-based residency after September 1, 2019, must confirm
that during the residency, the permit holder completed satisfactory
management of sedation/anesthesia in at least ten (10) cases involving
high-risk patients sedated/anesthetized at the highest level of permit
held. At least five (5) of the cases must involve the hands-on administration
of sedation/anesthesia as the primary provider. No more than five
(5) cases may be observed. The ten (10) cases must involve either
live patients and/or high-fidelity emergency sedation/anesthesia simulations;
or
(2) completed a board-approved education program that
includes a minimum of sixteen (16) hours of didactic training and
instruction in sedation/anesthesia of high-risk patients. The entire
board-approved education program, including all didactic and clinical
requirements, must be completed within a two-year period of beginning
the Board-approved program. Successful completion of the program must
include passing an evaluation to demonstrate satisfactory completion
of the course requirements. Didactic education must include:
(A) pre-anesthetic patient assessment/evaluation for
medically compromised and geriatric patients;
(B) physical evaluation and medical history of high-risk
patients, including obesity, pregnancy, and obstructive sleep apnea
syndrome, cardiovascular disease, metabolic or genetic disorders,
hematologic disorders, and other systemic diseases/conditions affecting
sedation/anesthesia;
(C) high-risk patient anatomical and/or physiological
differences;
(D) medical consultations;
(E) high-risk respiratory assessment, including airway
anatomy, physiology, and management;
(F) informed consent by patient, parent, or guardian;
(G) sedation/anesthesia pharmacology;
(H) sedation/anesthesia management of patients identified
with special health care needs;
(I) high-risk patient monitoring;
(J) peri-operative complications and emergencies;
(K) emergency management of high-risk patients, including
high-risk anesthesia equipment and resuscitation supplies;
(L) sedation/anesthesia technique;
(M) sedation/anesthesia record keeping;
(N) patient recovery and discharge;
(O) appropriate patient selection; and
(P) permit holders shall have completed satisfactory
management of sedation/anesthesia in at least ten (10) cases involving
high-risk patients sedated/anesthetized at the highest level of permit
held. At least five (5) of the cases must involve the hands-on administration
of sedation/anesthesia as the primary provider. No more than five
(5) cases may be observed. The ten (10) cases must involve either
live patients and/or high-fidelity emergency sedation/anesthesia simulations.
All of the cases must be performed and documented under the on-site
instruction and direct supervision of a licensed dentist authorized
to administer sedation/anesthesia to high-risk patients.
(d) A permit holder is authorized to administer sedation/anesthesia
under a level 2, level 3, or level 4 permit to a high-risk patient
if they have completed the requirements above and have requested and
received authorization from the Board to administer sedation/anesthesia
to high-risk patients. Board staff shall promulgate appropriate forms
for permit holders qualifying under subsection (c)(1) and (c)(2) of
section. The permit holder must attest to their advanced training
satisfying the requirements of subsection (c)(1) or (c)(2) of this
section, and will be required to produce proof of completion as part
of a permit inspection or an investigation of a complaint involving
sedation/anesthesia of a high-risk patient.
(e) The education hours described in subsection (c)(2)
of this section can be applied towards the permit holder's continuing
education requirement for maintaining a sedation/anesthesia permit.
(f) If qualifying under subsection (c)(2) of this section,
the didactic and clinical training described in subsection (c)(2)
of this section may not be fulfilled by the same didactic and clinical
training used to fulfill the requirements for initial sedation/anesthesia
permit issuance.
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