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(a)A dentist administering nitrous oxide or 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 nitrous oxide or Level 1, 2, 3, or 4 sedation/anesthesia.
The checklist may be paper or electronic.
(b)A dentist delegating the administration of sedation/anesthesia
to another provider in accordance with Section 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 sedation/anesthesia. The checklist may be paper or
electronic.
(c)At a minimum, the preoperative checklist must include
documentation of the following 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 any modifications.
(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)American Society of Anesthesiologists Physical
Status Classification (ASA) classification;
(B)NPO status; and
(C)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
(correct patient and procedure);
(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 subsection (c) of this section.
(d)The information required above may be gathered
at any time, but the dentist administering the sedation/anesthesia
must verify that the information is current and correct prior to the
administration of sedation/anesthesia.
The agency certifies that legal counsel has reviewed
the adoption and found it to be a valid exercise of the agency's
legal
authority.
Filed with the Office
of the Secretary of State on April 20, 2018
TRD-201801753 Tyler Vance
Interim Executive Director
State Board of Dental Examiners
Effective date: May 10, 2018
Proposal publication date: February 2, 2018
For further information, please call: (512) 475-0977
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