Section R4-11-1304. Permit to Employ or Work with a Physician Anesthesiologist or Certified Registered Nurse Anesthetist (CRNA)

A.      This Section does not apply to a Section 1301 permit holder or a Section 1302 permit holder practicing under the provisions of R4-11-1302(I) or a Section 1303 permit holder practicing under the provisions of R4-11-1303(H). A dentist may utilize a physician anesthesiologist or certified registered nurse anes- thetist (CRNA) for anesthesia or sedation services while the dentist provides treatment in the dentist’s office or  dental clinic after obtaining a Section 1304 permit issued by the Board.

1.        The physician anesthesiologist or CRNA meets the requirements as specified in R4-11-1301(I).

2.        The dentist permit holder shall provide all dental treat- ment and ensure that the physician anesthesiologist or CRNA remains on the dental office or dental clinic prem- ises until any patient receiving anesthesia or sedation ser- vices is discharged.

3.        A dentist may renew a Section 1304 permit every five years by complying with R4-11-1307.

B.       To obtain or renew a Section 1304 permit, a dentist shall:

1.        Submit a completed application on a form provided by the Board office that, in addition to the requirements of subsections (B)(2) and (3) and R4-11-1307 includes:

a.         General information about the applicant such as:

i.         Name;

ii.        Home and office addresses and telephone num- bers;

iii.      Limitations of practice;

iv.       Hospital affiliations;

v.        Denial, curtailment, revocation, or suspension of hospital privileges;

vi.       Denial of membership in, denial of renewal of membership in, or disciplinary action by a den- tal organization; and

vii.     Denial of licensure by, denial of renewal of licensure by, or disciplinary action by a dental regulatory body; and

b.        The dentist’s dated and signed affidavit stating that the information provided is true, and that the dentist

C.     

	has read and complied with the Board’s statutes and		3.     The evaluation team shall recommend one of the follow-
	rules;		ing:
2.	On forms provided by the Board, provide a dated and		a.      Pass. Successful completion of the onsite evalua-
	signed affidavit attesting that any dental office or dental		tion; or
	clinic where the dentist provides treatment during admin-		b.     Conditional approval for failing to have appropriate
	istration of general anesthesia or sedation by a physician		equipment, proper documentation of controlled sub-
	anesthesiologist or CRNA:		stances,  or  proper   recordkeeping.  The  applicant
	a.      Contains the following properly operating equip-		must   submit  proof  of  correcting  the  deficiencies
	ment and supplies during the provision of general		before a permit is issued.
	anesthesia and sedation:		4.     The evaluation of an additional dental office or dental
	i.      Emergency drugs;		clinic in which a Section 1304 permit holder provides
	ii.     Electrocardiograph monitor;		treatment during the administration general anesthesia or
	iii.   Pulse oximeter;		sedation by a physician anesthesiologist or CRNA may
	iv.   Cardiac   defibrillator  or  automated  external		be waived by the Board staff upon receipt in the Board
	defibrillator (AED);		office of an affidavit verifying compliance with subsec-
	v.     Positive  pressure  oxygen   and  supplemental		tion (B)(2).
	continuous flow oxygen;	D.	A Section 1304 permit holder shall keep an anesthesia or seda-
	vi.   Suction  equipment,   including  endotrachael,		tion record for each general anesthesia and sedation procedure
	tonsillar or pharyngeal and emergency backup		that includes the following entries:
	medical suction device;		1.     Pre-operative and post-operative electrocardiograph doc-
	vii.  Laryngoscope, multiple blades, backup batter-		umentation;
	ies and backup bulbs;		2.     Pre-operative, intra-operative, and post-operative, pulse
	viii. Endotracheal tubes and appropriate connectors;		oximeter documentation;
	ix.   Magill forceps;		3.     Pre-operative, intra-operative, and post-operative blood
	x.     Oropharyngeal and nasopharyngeal airways;		pressure and vital sign documentation; and
	xi.   Auxiliary lighting;		4.     A list of all medications given, with dosage and time
	xii.  Stethoscope; and		intervals and route and site of administration;
	xiii. Blood pressure monitoring device; and		5.     Type of catheter or portal with gauge;
	b.     Maintains a staff of supervised personnel capable of		6.     Indicate nothing by mouth or time of last intake of food
	handling procedures, complications, and emergency		or water;
	incidents. All personnel involved in administering		7.     Consent form; and
	and monitoring general anesthesia or sedation shall		8.     Time of discharge and status, including name of escort.
	hold a current course completion confirmation in	E.	For intravenous access, a Section 1304 permit holder shall
	cardiopulmonary resuscitation (CPR) Health Care		ensure that the physician anesthesiologist or CRNA uses a new
	Provider level;		infusion set, including a new infusion line and new bag of
3.	Hold a valid license to practice dentistry in this state; and		fluid for each patient.
4.	Provide confirmation of completing coursework within	F.	A Section 1304 permit holder shall ensure that the physician
	the last two years prior to submitting the permit applica-		anesthesiologist or CRNA utilizes supplemental continuous
	tion in one or more of the following:		flow oxygen for patients receiving general anesthesia or seda-
	a.      Advanced  cardiac  life   support  (ACLS)   from  the		tion for the duration of the procedure.
	American Heart Association or another agency that	G.	The Section 1304 permit holder shall continuously supervise
	follows the same procedures, standards, and tech-		the patient from the administration of anesthesia or sedation
	niques for training as the American Heart Associa-		until termination of the anesthesia or sedation procedure and
	tion;		oxygenation, ventilation and circulation are stable. The Sec-
	b.     Pediatric advanced life support (PALS) in a practice		tion 1304 permit holder shall not commence with a subsequent
	treating pediatric patients; or		procedure or treatment until the patient is in monitored recov-
	c.      A   recognized   continuing   education   course   in		ery or meets the guidelines for discharge.
	advanced airway management.		Historical Note

  

 

After submitting the application and written evidence of com- pliance with requirements in subsection (B) to the Board, the applicant shall schedule an onsite evaluation by the Board. After the applicant completes the application requirements and successfully completes the onsite evaluation, the Board shall issue the applicant a Section 1304 permit.

1.        The onsite evaluation team shall consist of one dentist who is a Board member, or Board designee.

2.        The onsite team shall evaluate the following:

a.         The availability of equipment and personnel as spec- ified in subsection (B)(2);

b.        Proper documentation of controlled substances, that includes a perpetual inventory log showing the receipt, administration, dispensing, and destruction of controlled substances; and

c.         Proper recordkeeping as specified in subsection (E) by reviewing previous anesthesia or sedation records.

New Section R4-11-1304 renumbered from R4-11-805 and amended by final rulemaking at 5 A.A.R. 580, effec- tive February 4, 1999 (Supp. 99-1). Former Section R4- 11-1304 renumbered to R4-11-1305; new Section R4-11- 1304 renumbered from R4-11-1303 and amended by final rulemaking at 9 A.A.R. 1054, effective May 6, 2003 (Supp. 03-1). Section repealed; new Section made by final rulemaking at 19 A.A.R. 341, effective April 6,

2013 (Supp. 13-1).