Emergency Preparedness Policies
and Procedures (Rule 110.14): This
rule mandates all permit holders to
develop written emergency preparedness
policies and procedures which establish
a plan for the management of medical
and sedation emergencies. These devel-
oped policies must include training
requirements specific to the permit
holder’s equipment and drugs and must
include individual office staff responsibil-
ities in response to a medical emergency.
Staff training logs, documenting simula-
tion training in response to emergencies,
and an emergency drug log are required
per this rule. The permit holder must at
least annually review all the above poli-
cies, procedures and logs to document
whether an update is necessary.
Prevention of and Response to Seda-
tion/Anesthesia Emergencies (Rule
110.15): This rule pertains to an equip-
ment readiness log which needs to be
reviewed and updated at least annually.
Permit holders must have immediately
available (easily accessible) an adequate
unexpired supply of reversal and resusci-
tative agents, a positive pressure ventila-
tion device capable of delivering high
flow oxygen with appropriately sized
facemasks, advanced airways, appropri-
ate monitors, and equipment such as
stethoscope, pulse oximeter, sphygmo-
manometer or automatic blood pressure
monitor, portable backup suction and
lighting system in an event of general
power failure. These requirements apply
based on the level of sedation permits
held. Additional items may be required
for higher level permit holders. Please
visit www.tsbde.texas.gov for more
information.
Sedation/Anesthesia of High-Risk
Patients (Rule 110.16): A permit holder
may not administer sedation/anesthesia
under a level 2, level 3, or level 4 permit to
a high-risk patient, defined as ASA III or
IV based on the American Society of Anes-
thesiologists Physical Status unless the
permit holder has completed either a uni-
versity or hospital-based residency of at
least 12 months in length (grandfathered)
or a board-approved educational program
that includes a minimum of 16 hours of
didactic training in sedation of high-risk
patients along with satisfactory manage-
ment of sedation in at least 10 cases involv-
ing high-risk patients. All cases may be
completed through a high-fidelity seda-
tion/emergency simulation program. The
requirements for this rule do not go into
effect until September 1, 2019.
Sedation/Anesthesia of Pediatric
Patients (Rule 110.17): A permit holder
may not administer sedation under a
level 2, level 3, or level 4 permit to a pedi-
atric patient defined as younger than 13
years of age unless the permit holder has
completed either a university or hospital-
based residency of at least 12 months in
length (grandfathered) or a board-
approved educational program that
includes a minimum of 16 hours of didac-
tic training in sedation of pediatric
patients along with satisfactory manage-
ment of sedation in at least 15 cases
involving pediatric patients where no
more than 7 cases are observed on live
patients, and at least 8 cases are per-
formed as part of a hands-on, high-
fidelity emergency/sedation simulation
program. The requirements for this rule
do not go into effect until September 1,
2019.
Inspection of Sedation/Anesthesia
Providers (Rule 110.18): The TSBDE
may conduct inspections of a licensee,
equipment and any document required
by TSBDE rules. The inspections process
will be limited to the applicable seda-
tion/anesthesia rules in effect for each
permit level at the time of the inspection.
There will be at least 10 business days’
notice before conducting an on-site
inspection. All level 2, 3 and 4 permit
holders will be subject to at least one
inspection prior to September 1, 2022
unless they received their initial sedation
permit after March 1, 2018 in which case
they will be inspected within a year.
The initial inspection will be a compli-
ance inspection, in which a Board staff
member will evaluate the permit holder’s
compliance through completing a check-
list and auditing one sedation/anesthesia
record of the inspector’s choosing, which
was completed prior to the date the
licensee was notified of the inspection.
If the inspection results in the identifica-
tion of a violation, the permit holder
must immediately cease providing seda-
tion/anesthesia services until satisfactory
proof is provided to Board staff that the
violation has been corrected. A failure by
Board staff to respond within two busi-
ness days to permit holder’s satisfactory
proof of remediation shall represent an
affirmative defense to disciplinary action.
Additionally, the permit holder shall pay
an amount of not more than $500 to
cover the expenses of additional review
and inspection by Board staff as a result
of any violations identified during the ini-
tial inspection.
The Board will also develop and admin-
ister an online jurisprudence examina-
tion to determine a permit holder’s
knowledge of the Dental Practice Act,
Board rules, and other applicable laws
relating to the administration of seda-
tion/anesthesia. All permit holders must
pass the online jurisprudence examina-
tion once every five years.
For more information and details on all
recently adopted board rules please visit
www.tsbde.texas.gov.
Dr. Shawn Seifikar
is a dentist anesthe-
siologist and a mem-
ber of the Texas
Dental Review Com-
mittee appointed by
Governor Abbott. He
is an adjunct faculty
at Texas A&M Col-
lege of Dentistry’s
Graduate Periodon-
tics Department and President of Southwest
Sedation Education.
W: www.swsedationeducation.com
E: [email protected]
P: (888) 761-2442
www.houstondentistrymagazine.com
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