Pennsylvania Code › Title 49 - PROFESSIONAL AND VOCATIONAL STANDARDS › Part I - DEPARTMENT OF STATE › Subpart A - PROFESSIONAL AND OCCUPATIONAL AFFAIRS › Chapter 33 - STATE BOARD OF DENTISTRY › Subchapter E - ADMINISTRATION OF GENERAL ANESTHESIA, DEEP SEDATION, CONSCIOUS SEDATION AND NITROUS OXIDE/OXYGEN ANALGESIA › Section 33.340a - Duties of dentists who are restricted permit I holders

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A dentist who possesses a restricted
					 permit I issued under this subchapter shall ensure that:
(1) Prior to the administration of conscious
					 sedation or nitrous oxide/oxygen analgesia, the permitholder takes or updates a
					 patient medical history and gives the patient a physical evaluation sufficient
					 to determine the patient's suitability to receive conscious sedation or nitrous
					 oxide/oxygen analgesia.
(2) The
					 dental office in which the permitholder administers conscious sedation or
					 nitrous oxide/oxygen analgesia on an outpatient basis contains the following:
(i) An operating room.
(ii) An operating table or chair.
(iii) A lighting system.
(iv) Suction equipment commensurate with the
					 patient's age, size and condition.
(v) Oxygen and supplemental gas delivery
					 systems, including primary and back-up sources and a fail-safe control
					 mechanism.
(vi) A sterilization
					 area.
(vii) A recovery
					 area.
(viii) A gas storage area and
					 scavenger system.
(ix) Emergency
					 airway equipment and medications, including intravenous emergency
					 equipment.
(x) Communications
					 equipment.
(xi) Patient transport
					 equipment.
(xii) Monitoring
					 equipment, procedures and documentation to conform to the age, size and
					 condition of the patient and the AAOMS Manual and AAOMS Guidelines for adult
					 and pediatric patients (OMS); the ADA Guidelines for adult patients (general
					 dentists); and the AAPD Guidelines for pediatric patients (general
					 dentists.)
(xiii) Pulse
					 oximeter.
(xiv) ECG.
(xv) Blood pressure monitoring
					 device.
(xvi)
					 Defibrillator.
(xvii) Results of
					 patient medical history and patient physical evaluation, and identification of
					 anesthesia procedures to be utilized, prior to the administration of conscious
					 sedation or nitrous oxide/oxygen analgesia.
(xviii) Signed, written, informed patient
					 consent, prior to the administration of conscious sedation or nitrous
					 oxide/oxygen analgesia, which includes a description of the procedure, its
					 risks and possible alternative treatments. Consent for a minor patient shall be
					 obtained from the minor's parent or guardian.
(xix) Stethoscope.
(3) Auxiliary personnel who assist the
					 permitholder in the administration of conscious sedation:
(i) Are trained to perform the duties that
					 the permitholder delegates to them, if the duties do not require the
					 professional judgment and skill of the permitholder and do not involve the
					 actual administration of conscious sedation.
(ii) Perform their duties under the direct
					 on-premises supervision of the permitholder, who shall assume full
					 responsibility for the performance of the duties.
(iii) Do not render assistance in areas that
					 are beyond the scope of the permitholder's authority.
(iv) Are currently certified in
					 BLS.
(4) CRNAs who are
					 delegated the duties of administering conscious sedation:
(i) Perform their duties under the direct
					 on-premises supervision of the permitholder, who shall assume full
					 responsibility for the performance of the duties.
(ii) Do not perform duties that are beyond
					 the scope of the permitholder's authority.
(iii) Are currently certified in
					 ACLS.
(5) The dentist
					 possesses a current certification in ACLS for adult patients and PALS for
					 pediatric patients.
(6) The Board
					 receives a complete report of a death or incident requiring medical care and
					 resulting in physical or mental injury that directly resulted from the
					 administration of conscious sedation or nitrous oxide/oxygen analgesia by the
					 permitholder or by a CRNA working under the supervision of the permitholder.
					 The permitholder shall submit the report within 30 days of the death or
					 incident.
(7) The Board receives
					 prior notice of the first time that a dental office of the permitholder will be
					 used for the administration of conscious sedation or nitrous oxide/oxygen
					 analgesia.
(8) Monitoring equipment
					 and equipment used to administer conscious sedation and nitrous oxide/oxygen
					 analgesia is installed, maintained and calibrated according to the equipment
					 manufacturer's guidelines, contains a fail-safe system and is in proper working
					 condition prior to the administration of conscious sedation or nitrous
					 oxide/oxygen analgesia.
(9) If the
					 permitholder travels to the offices of non-permitholders for the purpose of
					 administering conscious sedation or nitrous oxide/oxygen analgesia, the
					 permitholder shall satisfactorily complete a clinical evaluation and the
					 equipment transported to a non-permitholder dentist's office for the
					 administration of conscious sedation or nitrous/oxide oxygen analgesia by a
					 permitholder must satisfactorily complete an inspection conducted by an
					 approved peer evaluation organization under §
												33.336b(a)
					 (relating to approved peer evaluation organizations for administering clinical
					 evaluations and office inspections) in accordance with the requirements of the
					 AAOMS Manual and AAOMS Guidelines, the ADA Guidelines or the AAPD Guidelines,
					 as applicable. As part of that clinical evaluation and inspection, the
					 permitholder shall certify that each office location in which conscious
					 sedation or nitrous oxide/oxygen analgesia is administered has the equipment
					 required by paragraph (2) and that the staff is properly trained to handle
					 anesthesia-related emergencies.
(10) Conscious sedation and nitrous
					 oxide/oxygen analgesia is administered to adult and pediatric patients in
					 accordance with the AAOMS Guidelines and AAOMS Manual (OMSs) or to adult
					 patients in accordance with the ADA Guidelines (general dentists) or to
					 pediatric patients in accordance with the AAPD Guidelines (general dentists).
					 Conflicts between the AAOMS Guidelines, the AAOMS Manual, the ADA Guidelines,
					 or the AAPD Guidelines and this subchapter shall be resolved in favor of this
					 subchapter.
(11) Patient records
					 are prepared, maintained and retained in accordance with §
												33.209 (relating to preparing,
					 maintaining and retaining patient records).