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How Do We Comply with all the Rules and Regulations?

Ensure adherence to stringent rules and regulations in medical practices. Store controlled substances securely, conduct biennial inventories, and meticulously document receipt, dispensing, and disposal. Evaluate patients thoroughly preoperatively, providing detailed instructions and obtaining informed consent. Follow time-oriented anesthesia documentation protocols and monitor patients closely during recovery and discharge. Comply with Texas State Board of Dental Examiners Regulations, emphasizing continuous supervision and monitoring vital signs. Understand limitations of pulse oximetry and the importance of accurate monitoring for patient safety.

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How Do We Comply with all the Rules and Regulations?

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  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

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

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

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

  10. Monitors

  11. 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

  12. 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

  13. 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

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