71-5-10. Level I permit: enteral conscious sedation or combination inhalation-enteral conscious sedation. (a) To be eligible for issuance of a level I permit, each dentist shall submit the following to the board:
(1) An application on the form provided by the board;
(2) evidence of a current "basic cardiac life support for the health care provider" certificate from the American heart association or a current certificate deemed equivalent by the board from a provider approved by the board;
(3)(A) Evidence of having successfully completed a course or postdoctoral training program in the control of anxiety and pain in dentistry that is approved by the board; or
(B) evidence of performance of 20 clinical cases of conscious sedation over the preceding five years, which shall be evaluated by the board;
(4) the level I permit fee of $100; and
(5) an explanation of any sedation-related mortality or morbidity that occurred to a patient of the applicant during the preceding five years and could have been associated with the administration of a sedative agent.
(b) To be approved by the board, each course or training program specified in paragraph (a)(3)(A) shall meet the following requirements:
(1) Provide comprehensive training in the administration and management of enteral conscious sedation or combination inhalation-enteral conscious sedation;
(2) include training in patient evaluation and selection, use of equipment, personnel requirements, monitoring, documentation, patient medical management, and emergency management; and
(3) include a minimum of 18 hours of education and 20 clinical experiences, which may be simulation or video presentations, or both, but shall include at least one experience in which a patient is deeply sedated and returned to consciousness.
(c)(1) Each level I permit shall be renewed before the expiration of the dentist's license and as part of the biennial license renewal.
(2) To apply for renewal of a level I permit, each dentist shall provide the following to the board:
(A) Evidence of a current "basic cardiac life support for the health care provider" certificate from the American heart association or a current certificate deemed equivalent by the board from a provider approved by the board;
(B) in addition to the continuing education required to renew the dentist's license, proof of six hours of continuing education on sedation; and
(C) the renewal fee of $100.
(d) Before administering enteral conscious sedation or combination inhalation-enteral conscious sedation, each treating dentist shall perform the following:
(1) Review the patient's medical history and current medications;
(2) for all patients with a severe systemic disease, consult with the patient's primary care physician or any consulting medical specialist regarding the potential risks;
(3) document that the patient or guardian received written preoperative instructions, including dietary instructions that are based on the sedation technique to be used and the patient's physical status, and that the patient or guardian reported that the patient complied with the instructions;
(4) obtain from the patient or guardian a signed informed consent form;
(5) evaluate the inhalation equipment for proper operation;
(6) determine that an adequate oxygen supply is available and can be delivered to the patient if an emergency occurs;
(7) obtain the patient's vital signs and perform a patient assessment; and
(8) confirm the time when the patient last took any solid or liquid by mouth.
(e) During the administration of enteral conscious sedation or combination inhalation-enteral conscious sedation, each treating dentist shall ensure that both of the following conditions are met:
(1) At least one additional staff person who has either a current "basic cardiac life support for the health care provider" certificate from the American heart association or a current certificate deemed equivalent by the board from a provider approved by the board is present.
(2) The following equipment is available and in working order:
(A) A pulse oximeter;
(B) a drug kit that includes an agent to reverse the effects of the sedation agent administered, if an agent to reverse the effects of the sedation agent is commercially available;
(C) a bag-valve mask with patient-appropriate masks that have all connections necessary to attach the bag-valve mask to a 100 percent oxygen source or a separate positive-pressure oxygen source; and
(D) oropharyngeal airways in patient-appropriate sizes.
(f) Whenever enteral conscious sedation or combination inhalation-enteral conscious sedation is administered, each treating dentist shall cause the following records to be contemporaneously created. These records shall be maintained, for at least 10 years, as part of each patient's record:
(1) The date, the type of procedure, the personnel present, and the patient's name, address, and date of birth;
(2) documentation of the sedative agents administered, the approximate time when the sedative agents were administered, the amount of each agent administered, and the patient's blood pressure, heart rate, and oxygen saturation readings at the start of sedation and at the end of the surgical or operative procedure and at 15-minute intervals throughout the procedure;
(3) an indication of the extent to which the effects of the sedation had abated at the time of the patient's release;
(4) the gases used, with flow rates expressed in liters per minute or relative percentages, and the amount of time during which each gas was administered;
(5) the full name of the person to whom the patient was released;
(6) a record of all prescriptions written or ordered for the patient; and
(7) each type of monitor used.
(g) During the administration of enteral conscious sedation or combination inhalation-enteral conscious sedation and the recovery phase, the treating dentist shall ensure that all of the following conditions are met:
(1) The patient is continuously observed.
(2) The patient is continuously monitored with a pulse oximeter.
(3) The patient's respiration is continuously confirmed.
(4) The patient's blood pressure, heart rate, and oxygen saturation reading are recorded at least every 15 minutes.
(5) The patient's ability to appropriately respond to physical stimulation or verbal command is documented every 15 minutes.
(h)Following the administration of enteral conscious sedation or combination inhalation-enteral conscious sedation and during the recovery phase, each treating dentist shall ensure that all of the following conditions are met:
(1) Oxygen and suction equipment are immediately available in the recovery area.
(2) The patient is continuously supervised until oxygenation, ventilation, and circulation are stable and until the patient is appropriately responsive for discharge from the facility.
(3) Written and verbal postoperative instructions, including an emergency telephone number to contact the treating dentist, are provided to the patient, guardian, or any escort present at the time of discharge.
(4) The patient meets the discharge criteria established by the treating dentist, including having stable vital signs, before leaving the office.
(i) Whenever enteral conscious sedation or combination inhalation-enteral conscious sedation is administered, each treating dentist shall cause the following information to be entered into a sedation log:
(1) The name of each patient;
(2) the date of administration of each sedative agent; and
(3) the name, strength, and dose of each sedative agent.
Each entry shall be maintained for at least 10 years. (Authorized by K.S.A. 2008 Supp. 65-1444, K.S.A. 2008 Supp. 65-1447, and K.S.A. 74-1406; implementing K.S.A. 2008 Supp. 65-1444 and K.S.A. 2008 Supp. 65-1447; effective Nov. 19, 2010.)
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