D.C. Mun. Regs. tit. 17, r. 17-10710

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 17-10710 - MONITORING AND DOCUMENTATION

10710.1

A dentist administering moderate sedation, deep sedation, or general anesthesia to a patient:

(a) Shall remain in the operatory room to monitor the patient continuously until the patient meets the criteria for recovery;

(b) Shall not induce a second patient until the first patient:

(1) Is conscious;

(2) Is spontaneously breathing;

(3) Has stable vital signs;

(4) Is ambulatory with assistance; and

(5) Is under the care of a qualified auxiliary; and

(c) Shall not leave the facility until the patient meets the criteria for discharge and is discharged from the facility.

10710.2

When moderate sedation is administered, monitoring shall include:

(a) Consciousness: the patient's level of sedation and responsiveness to verbal commands shall be continually assessed;

(b) Oxygenation: the oxygen saturation shall be continuously evaluated by pulse oximetry;

(c) Ventilation:

(1) The dentist shall continuously observe chest excursions and monitor ventilation and breathing by monitoring end-tidal carbon dioxide, unless precluded by the nature of the patient, procedure, or equipment; and

(2) The dentist shall ensure that the patient's ventilation is monitored by continual observation of qualitative signs, including auscultation of breath sounds with a precordial or pretracheal stethoscope;

(d) Circulation:

(1) The dentist shall continually evaluate the patient's blood pressure and heart rate unless invalidated by the nature of the patient, procedure, or equipment and this is noted in the time-oriented anesthesia record; and

(2) Circulation shall be monitored by continuous ECG monitoring of patients with significant cardiovascular disease.

10710.3

When deep sedation or general anesthesia is administered, monitoring shall include:

(a) Oxygenation: oxygen saturation shall be continuously evaluated by pulse oximetry;

(b) Ventilation:

(1) For an intubated patient, end-tidal carbon dioxide shall be continually monitored and evaluated unless precluded or invalidated by the nature of the patient, procedure, or equipment; and

(2) Ventilation shall also be monitored and evaluated by continual observation of qualitative signs, including auscultation of breath sounds with aprecordial or pretracheal stethoscope, unless precluded by use of appropriate equipment;

(c) Respiration rate shall be continually monitored and evaluated;

(d) Circulation: the dentist shall continuously evaluate heart rate and rhythm via ECG throughout the procedure, as well as pulse rate via pulse oximetry;

(e) The dentist shall also continually evaluate blood pressure;

(f) Temperature: a device capable of measuring body temperature shall be readily available during the administration of deep sedation or general anesthesia; and

(g) The equipment to continuously monitor body temperature shall be available and shall be performed whenever triggering agents associated with malignant hyperthermia are administered.

10710.4

Appropriate time-oriented anesthetic record shall be maintained, including the names of all drugs, dosages, and their administration times, including local anesthetics, dosages, and monitored physiological parameters. Additionally, pulse oximetry, end-tidal carbon dioxide measurements (if taken), heart rate, respiratory rate, blood pressure, and level of consciousness (if appropriate) shall be recorded continually.

10710.5

A treating dentist who allows a physician, another dentist, or certified registered nurse anesthetist to administer moderate sedation, deep sedation, or general anesthesia under this chapter shall ensure that the physician, dentist, or certified registered nurse anesthetist is properly licensed and authorized to administer anesthesia or sedation in the District and does not leave the site until the patient meets the criteria for discharge and is discharged from the facility.

10710.6

A treating dentist who allows a physician, another dentist, or certified registered nurse anesthetist to administer moderate sedation, deep sedation, or general anesthesia shall ensure that the physician, dentist, or certified registered nurse anesthetist does not induce a second patient until the first patient:

(a) Is conscious;

(b) Is spontaneously breathing;

(c) Has stable vital signs;

(d) Is ambulatory with assistance; and

(e) Is under the care of a qualified auxiliary.

D.C. Mun. Regs. tit. 17, r. 17-10710

Final Rulemaking published at 67 DCR 8806 (7/17/2020)