How Do We Comply with all the Rules and Regulations?

Documentation… All controlled substances must be stored in a securely locked, substantially constructed cabinet; entrance into storage only by authorized employee (YOU) Must perform a drug inventory every 24 months (biennial) Must record receipt, dispensing and disposal of all controlled substances

Documentation… Patient must be suitably evaluated PMH Baseline vital signs ASA Airway evaluation OSA Smoking Respiratory infections

Documentation… Preoperative Instructions Must be written Verify NPO status No solids for 6 hours Clear liquids up to 2 hours Medications as per usual Adult escort

Documentation… Informed Consent (written????) “patient or guardian must be advised of the procedure associated with the delivery of the sedation” Must take and record initial vital signs (BP/pulse/pulse oximetry) and thereafter as appropriate Time Oriented Anesthesia Record

Documentation… Time Oriented Anesthesia Record Person administering drugs Name of drug(s) Dosages Vital signs recorded in time oriented manner to drug administration

Documentation… Recovery and Discharge Positive pressure O2 immediately available Direct, continuous supervision until oxygenation/circulation stable Patient appropriately responsive

Documentation… Recovery and Discharge Oxygenation Circulation Activity Skin color Level of consciousness

Documentation… Recovery and Discharge Airway patency Reflexes intact Adequate hydration Patient can talk, sit unaided, and ambulate Presedation level of consciousness Responsible adult available

Monitors

Texas State Board of Dental Examiners Regulations… Patient must be monitored during time periods prior to operative procedure Dentist must maintain direct supervision during the operative procedure

Texas State Board of Dental Examiners Regulations… Oxygen Color Continuous pulse oximetry Observation of chest excursion or auscultation of breath sounds Circulation Initial BP and pulse and thereafter as appropriate

Limitation of Pulse Oximetry… Accurate at SaO2 > 75% Nail polish/cold fingers REMEMBER Pulse oximetry is an indirect measure of ventilation By the time the O2 saturation drops, patient has been hypoventilating  apnea for some period of time Significantly impacted with the use of supplemental oxygen