N.J. Admin. Code § 13:30-8.2

Current through Register Vol. 56, No. 21, November 4, 2024

Section 13:30-8.2 - Parenteral conscious sedation

(a) No dentist shall administer parenteral conscious sedation ("PCS") unless the minimum standards of training and procedure set forth in this section are satisfied.

(b) PCS is defined as a depressed level of consciousness produced by the parenteral administration of pharmacologic substances that allows the patient to retain the ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command. This modality includes administration of medications via all parenteral routes, that is, intravenous, intra-muscular, subcutaneous, submucosal, or inhalation, but does not include nitrous-oxide inhalation analgesia.

(c) No dentist shall use PCS for dental patients unless such dentist possesses a PCS permit issued by the State Board of Dentistry for a specified practice location, which shall be renewed biennially. A dentist shall obtain a separate PCS permit for each practice location at which PCS is administered, except as set forth at (l) below.

(d) A dentist applying for a Board permit to administer PCS shall complete an application as provided by the Board. The dentist shall submit as part of a completed application a certification from an accredited university, teaching hospital, or other training institution or facility approved pursuant to N.J.S.A. 45:6-2, establishing that the applicant has completed formal training in the administration of PCS. Such formal training shall consist of, at a minimum, 40 hours in didactic instruction and 40 hours of supervised clinical training in the administration of PCS. Such formal training shall have been completed within three years preceding the date of application. Supervised clinical training shall consist of, at a minimum, delivering intravenous, intramuscular, subcutaneous, submucosal and inhalation medications, monitoring patient activity, and managing patient care for 20 PCS patients. As part of the dentist's PCS permit application, the institution shall certify the applicant is competent to:

1. Evaluate the medical status of patients and perform risk management assessments according to American Society of Anesthesiology (ASA) Classification by use of patient histories, physical examinations, vital signs, and pertinent laboratory data and information obtained by medical consultations, and that the applicant can modify treatment plans accordingly;

2. Understand and evaluate the effects of conscious sedation agents on the medical, physical and psychological status of patients;

3. Perform venipunctures and maintain intravenous access during PCS procedures;

4. Recognize and manage complications from drug administrations;

5. Understand the clinical pharmacology of the drugs used for PCS and the interactions of these drugs;

6. Maintain patient airways and support ventilation;

7. Monitor patients during the administration of PCS using clinical evaluations and mechanical means, including the use of an EKG monitor and a pulse oximeter, capnography, and the interpretation of such readings;

8. Manage patients during the post-operative period and assess patients' suitability for discharge; and

9. Maintain accurate anesthetic records including drug dosages, vital signs and patient responses.

(e) All offices in which parenteral conscious sedation is conducted shall be inspected and approved once every five years by the State Board of Dentistry, or its designee, and shall, at a minimum, have the equipment and supplies set forth at (i) below and at N.J.A.C. 13:30-8.26, which shall be readily accessible and maintained in good operating condition and shall meet the following standards:

1. The operating room shall have space large enough to provide adequate accommodation of the patient on a table or in an operating chair, and allow an operating team consisting of at least three individuals to move about the patient without restriction or limitation;

2. A recovery area that has available oxygen and monitoring equipment, adequate lighting, suction, and electrical outlets. The recovery area can be the operating theatre; and

3. A lighting system adequate to permit visual evaluation of the patient's skin and mucosal color.

(f) A licensee who administers parenteral conscious sedation shall:

1. Be able to recognize and manage complications and medical emergencies from drug administrations;

2. Understand the clinical pharmacology of the drugs used for parenteral conscious sedation and the interactions of these drugs;

3. Maintain patient airways and support ventilation;

4. Monitor patients during the administration of parenteral conscious sedation using clinical evaluations and mechanical means, including the use of an EKG monitor, pulse oximeter, and capnogram, and the interpretation of such readings;

5. Manage patients during the post-operative period and assess patients' suitability for discharge; and

6. Maintain accurate and contemporaneous anesthetic records including drugs, dosages, vital signs, and patient responses.

(g) An applicant for a PCS permit shall obtain emergency training by completing the American Heart Association course in Basic Life Support for Healthcare Professionals, or its equivalent, and a course in Advanced Cardiac Life Support, or its equivalent, and shall maintain current certification in such courses. The applicant shall furnish proof of this training and certification to the Board upon application for a PCS permit and proof of recertification upon biennial renewal of the permit.

(h) An applicant for a PCS permit shall certify to the Board upon application for a permit and upon biennial renewal of the permit that the dentist employs no fewer than two persons who will be present in the office, at least one of whom shall assist in monitoring the patient whenever PCS is employed. The applicant shall further certify that these persons are trained in, and capable of, monitoring vital signs and of assisting in emergency procedures and that they maintain current certification in the American Heart Association course in Basic Life Support for Healthcare Professionals, or its equivalent, or in Advanced Cardiac Life Support, or its equivalent.

(i) An applicant for a PCS permit shall certify as part of the application for a permit and upon biennial renewal of the permit that he or she possesses basic equipment and supplies to deal with emergency situations. The permit holder's facility shall contain the following readily accessible and properly operating equipment:

1. Emergency drug kit, consisting of, at a minimum, the following:

i. Analgesics;

ii. Local anesthetics;

iii. Vasopressors;

iv. Vasodilators (coronary);

v. Anti-bradicardic agents;

vi. Bronchodilators;

vii. Muscle relaxant for treatment of laryngospasm;

viii. Antihistamine;

ix. Narcotic antagonist;

x. Anticonvulsant;

xi. Steroids;

xii. Tranquilizers;

xiii. Anti-hypertensive;

xiv. Benzodiazepines;

xv. Benzodiazepine antagonist;

xvi. Anti-arrhythmic (for example, lidocaine or amiodarone);

xvii. Aspirin;

xviii. Nitroglycerine (tablets, paste, or spray);

xix. Antiemetic; and

xx. Dantrolene for those practice locations where succinylcholine is used routinely, but not for emergency use, or where halogenated hydrocarbon general anesthetic inhalation agents are used;

2. Battery-powered clocks or watches;

3. Stethoscope;

4. Mouth props (assorted adult and pediatric sizes);

5. Suction equipment capable of aspirating gastric contents from the mouth and pharynx;

6. Emergency suction device;

7. Nasopharyngeal tubes;

8. Oropharyngeal tubes;

9. A blood pressure monitoring device;

10. An EKG monitor;

11. A pulse oximeter or its equivalent;

12. Respiration monitoring equipment (for example, visible reservoir bag);

13. Intravenous solutions ("ACLS compatible" IV administration sets and tubing);

14. Syringes, needles, IV catheters, and tape scissors;

15. Laryngoscopes, assorted size blades, and spare batteries;

16. Endotracheal tubes (adult and pediatric sizes);

17. Magil forceps;

18. Yankauer type suction tips and catheter suction; and

19. A capnometer.

(j) A licensee who holds a current general anesthesia permit issued by the Board of Dentistry shall be authorized to use PCS and shall not be required to apply for a PCS permit pursuant to this section.

(k) A dentist who utilizes the services of a PCS permit holder or an M.D. or D.O. who is a member of the anesthesiology staff of an accredited hospital or who is authorized to perform anesthesia services by the Board of Medical Examiners pursuant to N.J.A.C. 13:35-4Ashall not be deemed to be administering PCS, provided that the PCS permit holder or M.D. or D.O. remains present during the administration of PCS through patient discharge, and bears full responsibility during the entire procedure until the patient has recovered fully and has been discharged.

(l) A PCS permit holder invited by a dentist to provide PCS services at a specific location shall bear full responsibility for compliance with all provisions of this section including the minimum requirements for assisting staff and equipment set forth at (e), (h), and (i) above. When a PCS permit holder utilizes mobile equipment and supplies to administer PCS pursuant to this section, the mobile equipment, drugs, and supplies of the permit holder shall be inspected by the Board or its designee not less than once every three years. "Mobile equipment, drugs, and supplies," for purposes of this subsection, means any equipment, drugs, and/or supplies that are transported and used by a permit holder to administer PCS in one or more locations. When more than one permit holder utilizes the mobile equipment and supplies, it shall be the responsibility of the permit holder using the equipment and supplies to ensure that the mobile equipment, drugs, and supplies satisfy the requirements of this section as set forth at (i) above prior to the administration of PCS.

(m) Prior to the administration of a PCS agent, the permit holder shall conduct a physical evaluation of the patient, review the patient's up-to-date medical history, which shall include any changes and any medications, including natural and homeopathic medications, allergies, and sensitivities. The patient history shall be maintained in the files of each dentist for a period of not less than seven years. Specific contemporaneous records on the use of PCS shall be kept as part of every patient chart and shall include the agents utilized, the dosage, and the duration of sedation. The patient record, including medical history, shall be maintained in accordance with N.J.A.C. 13:30-8.7.

(n) A licensee who holds a PCS permit shall certify to the Board upon biennial renewal that the holder has completed a least 20 hours during the previous two-year period in continuing education courses devoted to PCS consistent with the requirements set forth in N.J.A.C. 13:30-5.1.

(o) Any designee of the Board shall be authorized during ordinary business hours to enter and inspect any dental office or mobile equipment and supplies for the purpose of enforcing the provisions of this rule.

N.J. Admin. Code § 13:30-8.2

New Rule, R.1976 d.353, eff. 11/10/1976.
See: 8 N.J.R. 199(a), 8 N.J.R. 561(a).
Repealed by R.1987 d.419, effective 10/19/1987.
See: 19 N.J.R. 849(a), 19 N.J.R. 1909(b).
Section was "Additional dental hygiene functions".
New Rule, R.1990 d.174, effective 3/19/1990.
See: 21 N.J.R. 3060(a), 22 N.J.R. 976(a).
Amended by R.1995 d.191, effective 4/3/1995.
See: 27 N.J.R. 293(a), 27 N.J.R. 1424(b).
Amended by R.2003 d.262, effective 7/7/2003.
See: 34 N.J.R. 2367(a), 35 N.J.R. 2933(a).
Rewrote the section.
Amended by R.2006 d.107, effective 3/20/2006.
See: 37 N.J.R. 581(a), 38 N.J.R. 1459(b).
In (i), added "who is a member of the anesthesiology staff of an accredited hospital or"; changed N.J.A.C. reference from N.J.A.C. 13:35-4A.1 to N.J.A.C. 13:35-4A; and substituted "M.D. or D.O." for "anesthesiologist".
Amended by R.2021 d.035, effective 4/19/2021.
See: 51 N.J.R. 1648(a), 53 N.J.R. 619(c).
Rewrote the section.
Amended by R.2022 d.003, effective 1/3/2022.
See: 51 N.J.R. 1648(a), 53 N.J.R. 614(a), 54 N.J.R. 83(a).
Added new (e).