WSAPD

This guide will help you update your policies and procedures to comply with the Washington Dental Quality Assurance Commission sedation rules approved in December 2023. This update impacts all pediatric dentists practicing in Washington State. 

How to Use this Resource

Our goal is to present this information in an easily digestible format and to provide context and resources for implementation but we also recommend that all dentists read the updated rules. You will need to determine which new regulations are applicable to your workflow and office. The DQAC Anesthesia Committee has also developed an FAQ page to answer some of the most common questions. You will also find helpful complementary information on WSDA’s Updated Dental Anesthesia Rules webpage. 

We have listed information that we believe is applicable to all pediatric dentists followed by sections according to your level of permitting. 

Rule Changes

New and updated rules that apply to all pediatric offices for all sedation permitting levels. 

BLS and PALS must include a hands-on in person component. For online courses an in-person skills check is required. 

Self-assessments of clinic preparedness for emergencies, emergency equipment, and emergency drugs is required on an annual basis with written attestations to be kept for 5 years

Written emergency protocols must be maintained, reviewed annually, and updated when appropriate. All staff must be trained in these protocols.

Equipment required for all offices administering any type of anesthetic: 

  • Stethoscope or equivalent monitoring device
  • Blood pressure cuffs to accommodate the size patients you treat
  • Portable oxygen delivery with bag-valve-mask 

 

Additional equipment required for parenteral, deep, and general anesthesia permit holders.  

  • Bronchodilator including, but not limited to albuterol 
  • Sugar or glucose 
  • Aspirin 
  • Antihistaminic including, but not limited to diphenhydramine  
  • Coronary artery vasodilator including, but not limited to nitroglycerin  
  • Anti-anaphylactic agent including, but not limited to epinephrine

 

Additional meds required for parenteral sedation permit holders. 

24 hour on-call availability required including coverage when unavailable. 

AED required and must be accessible within 60 seconds.

For patients 14 and older and pediatric patients ASA II, ASA III or ASA IV, obtain vitals prior to administration of any anesthetic, including topical. Vitals required include blood pressure and heart rate.  

The only type of anesthetic dental assistants may apply is topical. Though there is conflicting language between the new sedation rules and the scope of practice rules for dental assistants, we have verbal confirmation from the DQAC Anesthesia Committee that the scope of practice rules take precedence. 

New and updated rules that apply based on your sedation workflow and permitting level. 
While anesthesia and level of sedation is a spectrum and we are expected to rescue patients who unintentionally enter a higher level of sedation, our required permitting level is determine by the targeted level of sedation and mode of administration. 
We have excluded the updated information regarding application for these permits as we expect that our members already possess sedation permitting at the level they desire.

Record maximum concentration of N2O and start/stop times or total duration of administration. Documentation must also indicate that both nitrous oxide and oxygen were administered.

A second individual must be available to respond to requests from the anesthesia provider.

Minimal sedation restricted to  a single dose of a single oral agent with or without nitrous. Dose limited to manufacturer’s recommended home use maximum.*

Consult with PCP for ASA III and ASA IV patients. If unresponsive, document the attempt or lack of medical home.  

Document discharge information including condition upon discharge. 

This section reflects changes to Moderate Enteral Sedation and requirements for Pediatric Endorsement because as pediatric dentists you would be required to add the Pediatric Sedation Endorsement to sedate patients 12 years of age or younger. 

Maintain BLS and PALS

Consult with PCP for ASA III and ASA IV patients. If unresponsive, document the attempt or lack of medical home.   

Assess BMI. No language is included requiring documentation of BMI but documentation of assessment 

Document discharge information including condition upon discharge and responsible party to whom patient is released. 

Complete 14 hours relevant continuing education every 3 years – previously 7 hours every 5 years. 

This section reflects changes to Moderate Parenteral Sedation and requirements for Pediatric Endorsement because as pediatric dentists you would be required to add the Pediatric Sedation Endorsement to sedate patients 12 years of age or younger. 

Maintain BLS and PALS.

Run 12 different emergency drills 2x/year for a total of 24 drill events. Document team members present and maintain documentation for 3 years for random audits.

Onsite inspection every 5 years- additional information in next section. 

Operatory must accommodate 2 people moving freely, permit positioning for emergency airway management, maintain backup lighting to visualize patient perfusion and backup suction. 

LMAs must be available for emergency use.

Review NPO status.

Consult with PCP for ASA III and ASA IV patients. If unresponsive, document the attempt or lack of medical home.

Assess BMI.

Complete focused physical examination including vital signs, assess airway, auscultate heart and lungs.  

When operative provider is also the anesthesia provider, they must be continuously assisted by a trained anesthesia monitor who may also function as the dental assistant.  

Monitor ECG continuously for patients with clinically significant CV disease but is not required for uncooperative pediatric patients. Documentation regarding inability to utilize ECG required.

Monitor EtCO2 unless impossible due to uncooperative patient. Documentation regarding inability to utilize ECG required.

Blood pressure, heart rate, pulse, blood oxygen concentration, and respiration rate assessed and recorded every 5 minutes. 

Document discharge information including condition upon discharge and responsible party to whom patient is released. 

Anesthetic agents classified by the FDA as general anesthetics including propofol, ketamine, sevofluorane, halothane, and isoflurane are restricted

Contract required to provide parental sedation in another dentist’s office. 

Complete 14 hours relevant continuing education every 3 years (previously every 5 years). 

For offices utilizing general anesthesia services provided by a dentist licensed by DQAC with a General Anesthesia Sedation Permit

Run 12 different emergency drills 2x/year for a total of 24 drill events. Document team members present and maintain documentation for 3 years for random audits.

Onsite inspection every 5 years- additional information in next section. 

When operative provider is also the anesthesia provider, they must be continuously assisted by a trained anesthesia monitor who may NOT function as the dental assistant.  

Consult with PCP for ASA III and ASA IV patients. If unresponsive, document the attempt or lack of medical home.

Complete 18 hours relevant continuing education every 3 years

For pediatric dentists with dental anesthetist or physician anesthesiologists a written contract is required. 

Written contract must specify:

Anesthesiologist is responsible for anesthetic management of the patient preoperatively, intraoperatively, and postoperatively and responsible for verifying discharge criteria are met. 

Who is responsible for providing equipment, monitoring, and training to meet sedation rules as they apply to general anesthesia. 

Additional Details for Rules that May Apply to Your Office 

Resources

AED Automatic External Defibrillator 

ASA American Society of Anesthesiologists

BLS Basic Life Support

BMI Body Mass Index

ECG Echocardiogram 

EtCO2 End-tidal carbon dioxide 

FDA Federal Drug Administration

N2O Nitrous Oxide 

NPO Nothing Per Oral  

PALS Pediatric Advanced Life Support

PCP Primary Care Provider

Member Exclusive Resources

Written Emergency Protocol, Anesthesia Provider Contract, Pediatric Specific Drills

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Terms of Use

These resources are intended to assist you in understanding the rules as dictated by the Dental Quality Assurance Commission. The DQAC was consulted but does not endorse or provide official support of our materials. It is your responsibility to evaluate the usefulness of the information provided herein. Legal advice, if desired, should be sought from competent counsel versed in Washington State rules and regulations. Washington State Academy of Pediatric Dentistry disclaims any and all warranties, expressed or implied, as to the quality, accuracy, or completeness of the information provided herein. If additional questions arise we recommend contacting the DQAC program administrator.