172 Neb. Admin. Code, ch. 56, § 009

Current through June 17, 2024

Section 172-56-009 - INITIAL ANESTHESIA OR SEDATION PERMIT

To receive a permit to administer general anesthesia or deep sedation, moderate sedation or minimal sedation at a location, an individual must submit a complete application for each location and meet all statutory requirements and the requirements in this chapter.

009.01EDUCATION. An applicant must demonstrate the following:

(A) For a general anesthesia or deep sedation permit:

(i) Fellowship in the American Dental Society of Anesthesiology; or

(ii) Successful completion of an advanced education program that is equivalent to that required for obtaining a fellowship as approved by the Board.

(B) For a moderate sedation permit:

(i) Fellowship in the American Dental Society of Anesthesiology; or

(ii) Successful completion of an advance education program approved by the Board that has at least 60 combined didactic and clinical hours of comprehensive and appropriate training necessary to administer and manage moderate sedation.

(C) For a minimal sedation permit:

(i) Successful completion of an advanced education program approved by the Board that has at least 16 hours of comprehensive and appropriate training necessary to administer and manage minimal sedation;

(ii) Training to the level of competency in minimal sedation consistent with the standards set by the American Dental Association for providing such sedation or approved by the board as substantially equivalent to such training; or

(iii) A comprehensive training program in minimal sedation approved by the Board.

009.02CERTIFICATION. An applicant must demonstrate the following:

(A) For a general anesthesia or deep sedation permit:

(i) Current certification in basic life-support skills for health care providers from the American Heart Association or from a substantially equivalent course as approved by the Board and

(ii) Current certification in a hands on advanced cardiac life support from the American Heart Association; or

(iii) Successful completion of an emergency management course for anesthesia and dental sedation approved by the Board as substantially equivalent to the course in this chapter.

(B) For a moderate sedation permit:

(i) Current certification in basic life-support skills for health care providers from the American Heart Association or from a substantially equivalent course as approved by the Board; and

(ii) Current certification in a hands on advanced cardiac life support from the American Heart Association; or

(iii) Successful completion of an emergency management course for anesthesia and dental sedation approved by the Board as substantially equivalent to the course in this chapter.

(C) For a minimal sedation permit:

(i) Meet the requirements set out in this chapter; and

(ii) If sedation will be provided to individuals 12 years of age and under, have current certification in pediatric advanced life support from the American Heart Association or from a substantially equivalent course as approved by the Board.

009.03FACILITY REQUIREMENTS. An applicant must demonstrate the following:

(A) For a general anesthesia or deep sedation permit or for a moderate sedation permit, each location must have the following:

(i) An operating room large enough to accommodate a patient on a table or in an operating chair and to allow an operating team consisting of at least 3 individuals to freely move about the patient;

(ii) An operating table or chair which permits a patient to be positioned so the operating team can maintain an airway, quickly alter a patient's position in an emergency and provide a firm platform for the management of cardiopulmonary resuscitation (CPR);

(iii) A lighting system which permits evaluation of a patient's skin and mucosal color and a backup lighting system which is battery powered or on-site generator powered and of an intensity to permit completion of any operation underway at the time of a general power failure;

(iv) Suction equipment which permits aspiration of the oral and pharyngeal cavities. A backup suction device must be available;

(v) An oxygen delivery system with full face masks and connectors that is capable of delivering 100% oxygen to a patient under positive pressure, together with a backup system;

(vi) A recovery area that has oxygen, lighting, suction, and electrical outlets. The recovery area can be the operating room. A member of the staff must be able to observe the patient at all times during the recovery period;

(vii) Ancillary equipment, which includes the following:

(1) Laryngoscope complete with selection of blades and spare batteries and bulb;

(2) Endotracheal tubes and connectors;

(3) Oral airways;

(4) Endotracheal tube forceps;

(5) Pulse oximeter;

(6) Carbon Dioxide (CO2) monitor (general anesthesia or deep sedation and either (6) or (7) for moderate sedation);

(7) Precordial stethoscope (general anesthesia or deep sedation and either (6) or (7) for moderate sedation; and

(8) Electrocardiogram (EKG) (general anesthesia and deep sedation only);

(viii) Drugs with current dates available for treatment of the following medical emergencies:

(1) Laryngospasm and myocardial infarction (general anesthesia or deep sedation only);

(2) Bronchospasm;

(3) Angina pectoris;

(4) Hypotension;

(5) Hypertension;

(6) Cardiac arrest (general anesthesia or deep sedation only);

(7) Convulsions; and

(8) Respiratory arrest;

(ix) Drugs for the reversal of anesthesia or sedation agents; and

(x) Written procedures for the following:

(1) Preoperative evaluation of patients:

(2) Management of medical at-risk patients;

(3) Technique and method of administration of general anesthesia or deep sedation or moderate sedation, as applicable; and

(4) Management of emergencies; and

(B) For a minimal sedation permit, each location must:

(i) Have an operating room large enough to accommodate a patient on a table or in an operating chair and to permit an operating team consisting of at least 2 individuals to freely move about the patient;

(ii) An oxygen delivery system with full face masks and connectors that is capable of delivering 100% oxygen to a patient under positive pressure, together with a backup system;

(iii) A recovery area that has oxygen, lighting, suction, and electrical outlets. The recovery area can be the operating room. A member of the staff must be able to observe the patient at all times during the recovery period;

(iv)Meet the requirements of this chapter and have oral pharyngeal airway(s), sphygmomanometer, pulse oximeter and a stethoscope; and

(v) Written procedures for the following:

(1) Preoperative evaluation of patients;

(2) Management of medical at-risk patients; and

(3) Management of emergencies.

009.04STANDARDS OF OPERATION, CARE, AND TREATMENT. The permit holder for each location has the responsibility for the total operation of the location and administration of anesthesia. The permit holder responsibilities include:

(A) Ensuring compliance with all applicable state statutes and relevant rules and regulations;

(B) Verifying the current licensure, certification, registration, or other credentials of staff prior to the staff assuming job responsibilities and must have implement procedures for verifying that such credentials are maintained;

(C) Ensuring that each location maintains compliance with the requirements of this chapter, as applicable to the type of permit held;

(D) Ensuring all sedation medications are administered per manufacturers labeled instructions; and

(E) Ensuring the following documentation is kept:

(i) For a general anesthesia or deep sedation permit or for a moderate sedation permit, each location must maintain records which include the following;

(1) Medical history and physical evaluation records for each patient;

(2) Anesthesia records for each patient, which must include blood pressure, pulse, drugs and amounts administered, length of the procedure, and any complications of anesthesia;

(3) Name of and documentation verifying any person who assists a dentist in the administration of general or deep sedation or moderate sedation for each procedure; and

(4) Documentation that each staff member assisting the permit holder during a procedure has a current certification in basic life-support for health care providers and the permit-holder performing a procedure has current certification in either advanced cardiac life support or has successfully completed an approved emergency management course for anesthesia and dental sedation.

(ii) For a minimal sedation permit, each location must maintain records which include the following:

(1) Medical history prior to the administration of minimal sedation and physical evaluation records for each patient;

(2) Documentation of the medication and dosage administered for each patient;

(3) Name of the permit holder and any person who assists the permit holder after the administration of minimal sedation for each procedure; and

(4) Documentation verifying that the permit holder and any person who assists the permit holder after the administration of minimal sedation has a current certification as set out in this chapter, as applicable.

172 Neb. Admin. Code, ch. 56, § 009

Amended effective 12/23/2020

Amended effective 6/2/2024