Transcript How Do We Comply with all the Rules and Regulations?

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