How Do We Comply with all the Rules and Regulations?

1. How Do We Comply with all the Rules and Regulations?

2. 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

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

4. 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

5. 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

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

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

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

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

12. Monitors

13. 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

14. 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

15. 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