article likely is too long for CADS … might need to take some info out of their version, possibly
highlights below … submit longer version to SAADS and DCS
Rule 110.13 requires the use of a Preoperative Checklist by a dentist administering nitrous oxide or Level 1, 2, 3, or 4 sedation/anesthesia. A common misconception is that a dentist administering only nitrous oxide or nitrous oxide in combination with local anesthesia is not required to use the form. Dentists sometimes mistakenly believe that nitrous does not “count” as sedation or anesthesia, so the form is not required. Another common misconception is that the form is not required if the patient is minor. However, Rule 110.13 makes it clear that a Preoperative Checklist “must be completed” prior administering nitrous oxide or Level 1, 2, 3, or 4 sedation/anesthesia.” (emphasis added).
The rule specifies that the checklist “must be completed by the sedation/anesthesia provider, or by the dentist” delegating the administration of sedation/ anesthesia to another provider. In other words, dentists should avoid delegating completion of the Checklist to staff. If a staff member does complete the form, the dentist should review it carefully before signing it. The dentist ultimately is responsible for ensuring the information reported on the form is complete and accurate.
Several items required to be documented in a Preoperative Checklist frequently are overlooked, namely ASA classification, NPO status, and airway assessment. These fields on the checklist often are left blank or crossed through. Dentists mistakenly believe this information is not required unless Level 1, 2, 3 or 4 sedation/anesthesia is being administered. Rule 110.13 makes it clear this is not the case. In addition, with regard to documenting an airway assessment, the rule specifies “including Mallampati score and/or Brodsky score as necessary for adequate patient evaluation.” Best practice is to document one of these two scores.
Another area of confusion regards the recording of ventilation and respiratory rate. The rule requires that this information be “obtained through patient observation, auscultation, or capnography.” Best practice is for the Preoperative Checklist to document which method was used. The checklist might read as follows - “Ventilation and respiratory rate obtained through which: patient observation / auscultation / capnography.” The provider can circle the method used.
It may also be helpful to consider feedback from Board sedation inspectors regarding the Checklist. Many dentists, while undergoing a sedation inspection, have been compelled by the inspectors to clearly identify on their checklist 1) whether (or not) the patient is a pediatric patient; 2) whether (or not) the patient is a high risk patient; and 3) some indication if there are any omissions of required information.
Carefully read Rule 110.13 and compare it with your Preoperative Checklist form to ensure full compliance with the rule’s requirements.
Laura Diamond is an administrative and healthcare attorney based in Austin, Texas with a statewide practice representing dentists before the Texas State Board of Dental Examiners. Ms. Diamond can be reached at ldiamond@dsedlaw.com or (512) 472-4845. © Laura Diamond 2024. This article is not legal advice.
Duane Tinker is the CEO of Dental Compliance Specialists, a healthcare compliance consulting
firm in Fort Worth, Texas. Mr. Tinker can be reached at duane@dentalcompliance.com or (817)
755-0035.