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(a)A dentist administering level 1, 2, 3, or 4 sedation/anesthesia
must create and maintain in the patient's dental records required
by rule §108.8, a document titled "preoperative sedation/anesthesia
checklist" that is completed by the dentist prior to commencing a
procedure for which the dentist will administer Level 1, 2, 3, or
4 sedation/anesthesia.
(b)A dentist delegating the administration of sedation/anesthesia
to another provider in accordance with §258.001(4) of the Act,
must maintain in the patient's dental records required by rule §108.8,
a document titled "preoperative sedation/anesthesia checklist" that
is completed by the sedation/anesthesia provider prior to commencing
a procedure for which the dentist has delegated another provider to
administer the Level 1, 2, 3, or 4 sedation/anesthesia.
(c)The checklist must include, at a minimum, documentation
of the following, or documentation of why the item was not recorded,
for each level of sedation/anesthesia:
(1)Medical history, including documentation of the
following:
(A)review of patient medical history;
(B)review of patient allergies;
(C)review of patient surgical and/or anesthesia history;
(D)review of family surgical and/or anesthesia history;
and
(E)review of patient medications and date and time
last taken
(2)Confirmation that written and verbal preoperative
and post-operative instructions were delivered to the patient, parent,
legal guardian, or care-giver;
(3) Medical consults, as needed;
(4)Physical examination, including documentation of
the following:
(A)Body mass index;
(B)American Society of Anesthesiologists Physical
Status Classification (ASA) classification;
(C)NPO status; and
(D)Preoperative vitals, including height, weight,
blood pressure, pulse rate, and respiration rate;
(5)Anesthesia-specific physical examination including
documentation of the following:
(A)Airway assessment, including Mallampati score and/or
Brodsky score; and
(B)Auscultation;
(6)Confirmation of pre-procedure equipment readiness
check;
(7)Confirmation of pre-procedure treatment review;
(8)Special preoperative considerations as indicated
for sedation/anesthesia administered to pediatric or high risk patients;
and
(9)Documentation of reason for omission of any item
required by this subsection.
The agency certifies that legal counsel has
reviewed the proposal and found it to be within the state agency's
legal authority to adopt.
Filed with the Office
of the Secretary of State on September
29, 2017
TRD-201703953 Kelly Parker
Executive Director
State Board of Dental Examiners
Earliest possible date of adoption: November 12, 2017
For further information, please call: (512) 475-0977
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