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DE 11.07(3) (3) Nothing in this section may be construed to prevent a dentist from employing or working in conjunction with a certified registered nurse anesthetist, or with a licensed physician or dentist who is a member of the anesthesiology staff of an accredited hospital, provided that the anesthesia personnel must remain on the premises of the dental facility until the patient under general anesthesia or deep sedation regains consciousness.
DE 11.07 History History: CR 04-095: cr. Register August 2006 No. 608, eff. 1-1-07.
DE 11.08 DE 11.08 Office facilities and equipment.
DE 11.08(1) (1) A dental office shall have all of the following if a dentist is administering conscious sedation-enteral, conscious sedation-parenteral, deep sedation, and general anesthesia:
DE 11.08(1)(a) (a) An operating room containing all of the following:
DE 11.08(1)(a)1. 1. Oxygen and supplemental gas-delivery system capable of delivering positive pressure oxygen ventilation.
DE 11.08(1)(a)2. 2. Suction and backup system.
DE 11.08(1)(a)3. 3. Auxiliary lighting system.
DE 11.08(1)(a)4. 4. Gas storage facilities.
DE 11.08(1)(a)5. 5. An operating chair capable of withstanding cardiopulmonary resuscitation or a back board.
DE 11.08(1)(a)6. 6. Emergency equipment including a defibrillator, cardiopulmonary pocket mask, and appropriate emergency medications.
DE 11.08(1)(a)7. 7. Monitoring equipment including a pulse oximeter, blood pressure cuff, and precordial or pretracheal stethoscope.
DE 11.08(1)(a)8. 8. An EKG if administering deep sedation or general anesthesia.
DE 11.08(1)(b) (b) A recovery room containing all of the following:
DE 11.08(1)(b)1. 1. Oxygen and supplemental gas-delivery system capable of delivering positive pressure oxygen ventilation.
DE 11.08(1)(b)2. 2. Suction and backup system.
DE 11.08(1)(b)3. 3. Auxiliary lighting system.
DE 11.08(1)(b)4. 4. Wheelchair.
DE 11.08(1)(b)5. 5. An operating chair capable of withstanding cardiopulmonary resuscitation or a back board.
DE 11.08(1)(b)6. 6. Emergency equipment including a defibrillator, cardiopulmonary pocket mask, and appropriate emergency medications.
DE 11.08(2) (2) Nothing in this section shall be construed to prevent an operating room from also being used as a recovery room, nor shall it be construed to prevent the sharing of equipment between an operating room and a recovery room, provided all the required equipment is in the room being used.
DE 11.08 History History: CR 04-095: cr. Register August 2006 No. 608, eff. 1-1-07.
DE 11.09 DE 11.09 Standards of care.
DE 11.09(1)(1) Before the administration of any type of sedation a complete written medical history shall be obtained from each patient. The medical history shall identify any medications a patient is taking and any allergies to medication a patient has.
DE 11.09(2) (2) The recording of a time-oriented anesthesia record including appropriate vital signs, blood pressure, pulse, and oxygen saturation q 5 minutes, is required for conscious sedation-enteral, conscious sedation-parenteral, deep sedation, and general anesthesia.
DE 11.09(3) (3) During the anesthesia period for conscious sedation-enteral, conscious sedation-parenteral, deep sedation, or general anesthesia, the oxygenation, ventilation, and circulation of the patient shall be continually evaluated, and any medications that are administered shall be documented in writing, including the dosages, time intervals, and the route of administration.
DE 11.09(4) (4) A patient shall be continually observed during the anesthesia period for conscious sedation-enteral, conscious sedation-parenteral, deep sedation, and general anesthesia either by the treating dentist or by qualified staff. No permit holder shall have more than one person in conscious sedation-enteral, conscious sedation-parenteral, deep sedation, or general anesthesia at one time, notwithstanding patients in recovery.
DE 11.09(5) (5) Operative supervision is required for deep sedation and general anesthesia.
DE 11.09(6) (6) Qualified staff shall continuously monitor post-treatment patients before final evaluation and discharge by the dentist. Written post-operative instructions shall be given to each patient or to a responsible adult who accompanies the patient for those individuals having undergone conscious sedation-enteral, conscious sedation-parenteral, deep sedation, or general anesthesia. Documentation of the post-operative instructions shall be noted in the patient's chart.
DE 11.09(8) (8) Any dentist whose patient lapses into conscious sedation-enteral from anxiolysis shall meet the requirements found in s. DE 11.05 and shall follow any applicable requirements in s. DE 11.09.
DE 11.09(9) (9) Unless a dentist holds a class 3 permit, he or she shall not administer any drug that has a narrow margin for maintaining consciousness including, but not limited to, ultra-short acting barbiturates, propofol, ketamine, or any other similarly acting drugs.
DE 11.09(10) (10) Dentists shall maintain verifiable records of the successful completion of any and all training of staff.
DE 11.09 History History: CR 04-095: cr. Register August 2006 No. 608, eff. 1-1-07.
DE 11.09 Note Note: Section DE 11.09 (7) dealing with titration, has been removed from the rule in compliance with statutory restraints based on the objections by the Senate Committee on Health and the Joint Committee for Review of Administrative Rules. The Wisconsin Dentistry Examining Board intends to promulgate s. DE 11.09 (7) upon resolution of those objections.
DE 11.10 DE 11.10 Reporting of adverse occurrences related to anesthesia administration. Dentists shall submit a report within 30 days to the board of any mortality or other incident which results in temporary or permanent physical or mental injury requiring hospitalization of a patient during, or as a result of, anesthesia administration under this chapter. The report shall be on a form approved by the board and shall include, at the minimum, responses to all of the following:
DE 11.10(1) (1) A description of the dental procedures.
DE 11.10(2) (2) The names of all participants in the dental procedure and any witnesses to the adverse occurrence.
DE 11.10(3) (3) A description of the preoperative physical condition of the patient.
DE 11.10(4) (4) A list of drugs and dosage administered before and during the dental procedures.
DE 11.10(5) (5) A detailed description of the techniques utilized in the administration of all drugs used during the dental procedure.
DE 11.10(6) (6) A description of the adverse occurrence, including the symptoms of any complications, any treatment given to the patient, and any patient response to the treatment.
DE 11.10(7) (7) A description of the patient's condition upon termination of any dental procedures undertaken.
DE 11.10 Note Note: Forms are available at the office of the Dentistry Examining Board located at 1400 East Washington Avenue, P.O. Box 8935, Madison, WI 53708.
DE 11.10 History History: CR 04-095: cr. Register August 2006 No. 608, eff. 1-1-07.
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