Rule 24.138.3223 - MINIMUM MONITORING STANDARDS(1) Minimum standards for monitoring deep sedation/general anesthesia patients shall include the following: (a) preoperative: (i) vital signs - to include blood pressure, heart rate, pulse, and oximetry results. Temperature may be necessary; and(ii) electrocardiac monitoring.(b) intraoperative: (i) vital signs - to include blood pressure, heart rate, pulse, and oximetry results to be taken and recorded at least every five minutes;(ii) precordial or pretracheal stethoscope and capnography used to monitor respiratory rate;(iii) continuous electrocardiac monitoring;(iv) continuously running intravenous line;(v) continuous monitoring of skin and mucosal color;(vi) end tidal CO2 monitoring must be utilized for intubated patients under general anesthesia; and(vii) additional monitoring devices as indicated.(c) postoperative: (i) vital signs - to include blood pressure, pulse, and oximetry results recorded at the completion of the procedure and prior to discharge with associated times; and(ii) the patient must not leave the recovery area until the cardiovascular, respiratory stability, and absence of nausea and vomiting are assured, and the patient is awake and oriented.(d) Food and Drug Administration approved medical devices or manual sphygmomanometer stethoscope for monitoring blood pressure shall be used during the sedation procedure.(2) The minimum standards for monitoring moderate sedation patients shall include the following: (a) preoperative: (i) vital signs to include blood pressure, pulse, respiratory rate, and oximetry results; and(ii) blood pressure monitoring for pediatric patients as indicated, unless unable to obtain.(b) intraoperative: (i) continuous electrocardiac on American Society of Anesthesiologists (ASA) Class 2 and greater patients;(ii) all vital signs - to include blood pressure, heart rate, pulse, and oximetry results to be monitored and recorded at least every five minutes. Only appropriate blood pressure and oximetry results monitoring for pediatric patients need be recorded, unless unable to obtain;(iii) a precordial or pretracheal stethoscope and capnography used to continually monitor respiration; and(iv) continuous monitoring skin and mucosal color.(c) postoperative: (i) vital signs, blood pressure, heart rate, pulse, and oximetry results should be taken at completion of the procedure and prior to discharge;(ii) only appropriate blood pressure and oximetry results monitoring for pediatric patients need be recorded. When these parameters are unable to be obtained, other documentation should be evident, verifying adequate respiratory and cardiovascular function; and(iii) prior to discharge, cardiovascular and respiratory systems must be adequate, with the absence of nausea and vomiting.(d) Food and Drug Administration approved medical devices or manual sphygmomanometer stethoscope for monitoring blood pressure shall be used during the sedation procedure.(3) Minimum standards for monitoring minimal sedation patients shall include the following: (a) preoperative: (i) vital signs, blood pressure, and heart rate; or(ii) for pediatric patients, all vital signs, unless unable to obtain.(b) when the dentist who administers the nitrous oxide/oxygen and/or is not in the operatory, there must be a dental auxiliary who remains with the patient and provides direct observation. The dental auxiliary must have specific instruction in the observation of nitrous oxide/oxygen sedated patients and shall monitor the patient until discharged.(4) During dental procedures that require deep sedation/general anesthesia as described in (1) or moderate sedation as described in (2), the procedure must be attended by qualified individuals as listed below: (a) When administering deep sedation/general anesthesia, in addition to the permit holder and an auxiliary, there must be at least one person present to monitor vital signs during the procedure. That person must be: (i) a physician anesthesiologist licensed to practice medicine in Montana;(ii) a certified registered nurse anesthetist recognized in that specialty by the Montana Board of Nursing;(iii) a dentist who has successfully completed an accredited advanced dental education program in dental anesthesiology;(iv) an oral and maxillofacial surgeon who has successfully completed an accredited oral and maxillofacial training program; or(v) a trained healthcare professional.(b) When administering moderate sedation, in addition to the permit holder at least one other person on staff and present must be a trained healthcare professional.Mont. Admin. r. 24.138.3223
NEW, 1985 MAR p. 1994, Eff. 12/27/85; AMD, 1994 MAR p. 1130, Eff. 4/29/94; TRANS, from Commerce, & AMD, 2003 MAR p. 2435, Eff. 10/31/03; AMD and TRANS, from 24.138.3204, 2011 MAR p. 2629, Eff. 12/9/11; AMD, 2017 MAR p. 2281, Eff. 12/9/2017; AMD, 2019 MAR p. 2366, Eff. 12/28/2019; AMD, 2024 MAR p. 2205, Eff. 9/21/2024AUTH: 37-1-131, 37-4-205, 37-4-408, MCA; IMP: 37-1-131, 37-4-101, 37-4-205, 37-4-408, 37-4-511, MCA