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Plboards.state.wy.us

Wyoming State Board of Dental Examiners
Guidelines for Office Evaluations for Anesthesia
Level 3 Enteral (Oral) Conscious Sedation
PART I-Case Review

Three cases should be discussed and the records reviewed. It is suggested that two short cases, including a child, and a longer one be discussed. The evaluators may request more records for
review. No evaluation can be considered complete unless this part is included.
PART II-Check Advanced Cardiac Life Support Certification for Operator and BLS
Certification for Assistants.

PART III-Simulated Emergencies

The evaluators and the anesthesia/sedation team should not just talk about the emergency situations and how they should be managed. The individual performing the anesthesia/sedation and his/her team must discuss their method of treatment for the following situations: Management of foreign bodies in the airway The simulated emergency procedures are to be demonstrated in the operating area with full participation of the office staff. All emergency equipment should be present, including syringes,
medications, etc.
PART IV-Office equipment, Records and Emergency Medications

All office equipment and records related to patient care should be available for inspection by the visiting doctors. Specific attention should be directed to the following areas: The oxygen and supplemental gas-delivery system-backup system Patient transportation equipment (if used) Completeness of emergency anesthesia equipment and medications
PART V-Discussion Period

This final part of the evaluation should be conducted in private away from staff and patients. The evaluators at this time may note deficiencies and make positive suggestions for improving the office facility and patient management. At the completion of the evaluation visit, one member of the evaluating team should complete, detach and mail pages labeled ANESTHESIA EVALUATION CHECKLIST.
EMERGENCY EQUIPMENT AND DRUGS

I.
Surgical and/or operating Anesthetic Team
A.
Local anesthesia and conscious sedation--doctor and one assistant All assistants must be BLS certified and capable of performing CPR Required Equipment
A.
Source of oxygen and equipment to deliver positive-pressure ventilation McGill forceps or other suitable instruments ECG or electocardioscope, with leads and electropaste Equipment to establish intravenous infusion SUGGESTED DRUGS
It is required that each office providing these Level 3 (Conscious Sedation) services be prepared to treat emergencies outlined in Part III. Commonly accepted or ACLS approved pharmacological agents must be present in the office to treat these emergencies. Water for injections and/or mixing or dilution of drugs Hydrocortisone sodium sucinate (Solu-Cortef) 50 mg/ml either/or ANESTHESIA EVALUATION CHECKLIST
APPLICANT:_________________________________________________________________
FACILITY:___________________________________________________________________

Street Address

PART I – ORAL SEDATION TECHNIQUE AND DRUGS


PART II – REVIEW CPR


PART III - SIMULATED EMERGENCIES

1.
Management of foreign bodies in the airway COMMENTS: _________________________________________________________________
______________________________________________________________________________

______________________________________________________________________________
______________________________________________________________________________

PART IV - OFFICE EQUIPMENT, RECORDS AND EMERGENCY MEDICATIONS

Oxygen and gas delivery system and backup _____________ COMMENTS: _________________________________________________________________
______________________________________________________________________________

______________________________________________________________________________
______________________________________________________________________________

PART V - DISCUSSION PERIOD


COMMENTS: _________________________________________________________________
______________________________________________________________________________

______________________________________________________________________________
______________________________________________________________________________

OVERALL EVALUATION
Evaluation Consultant:

Source: http://plboards.state.wy.us/dental/PDF%5CAppInstAndForms%5CGuidelines%20for%20Office%20Evaluations%20for%20Anesthesia%20Level%203%20Enteral%20(Oral)%20Conscious%20Sedation.pdf

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