In this section:
Newsletter: November 2019
In this newsletter
- Greetings from the Chief Executive
- Medical emergencies - updated practice standard
- New obligations under the sedation practice standard
- Do you have infection control under control? It's more than a tick-box exercise
- Outcome from consultation on the age limit for restorative activities in the oral health therapy scope of practice
- Implementing the new recertification programme
- Current consultations
- Remote DIY dentistry – understand your professional obligations
- IT system update
- Children's Act worker safety checks
- Patient Safety Week 3–9 November 2019
On 1 October 2019, the last of a staggered series of new requirements for the sedation practice standard came into effect.
On 1 October 2019, the last of a staggered series of new requirements for the sedation practice standard came into effect. The new requirements are set out in this article.
Use of capnography for intended level of moderate sedation
Standard 10 requires the use of capnography to monitor the patient when providing an intended level of moderate sedation, except when using only nitrous oxide/oxygen for sedation.
We have received several queries recently about this provision. The sedation practice standard sets out definitions for the minimal and moderate levels of sedation as well as key expectations. These are:
- Minimal sedation is a drug-induced state during which the patient responds normally to verbal commands. Cognitive function and physical co-ordination may be impaired but airway reflexes, cardiovascular and ventilatory functions are unaffected.
- Moderate sedation is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation, throughout the period of sedation. The patient has the ability to maintain their airway patency on request, spontaneous ventilation is adequate and cardiovascular function is usually maintained.
The sedation practice standard acknowledges that the transition from complete consciousness through the various levels of sedation to general anaesthesia is a continuum and not a set of discrete, well defined stages.
The use of the word “intended” in standards where the level of sedation is used reflects this principle. This allows room for an unpredictable response to a sedative drug by an individual patient while requiring the practitioner to define the level of sedation intended at the outset.
We remind practitioners that oral sedation should only be used for an intended level of minimal sedation—as this sedative technique can result in a less predictable response than when a sedative drug is administered intravenously or via inhalation. The use of the word ‘intended’ in the standards does not mean that practitioners providing oral sedation can repeatedly sedate patients to a level of moderate sedation, having “intended” to sedate them to a minimal level.
Education and training
The new training provisions in standards 15, 16 and 17 also come into effect on 1 October 2019.
Standard 15 requires formal education and training for:
Dentists and dental specialists wishing to provide sedation who have:
- never provided sedation, or
- have provided sedation in the past but who have not maintained competence.
The formal education and training programme must ensure practitioners meet the competencies defined in Appendix B of the sedation practice standard. As with other areas of practice, practitioners must maintain their competence.
Please note:
- practitioners who have achieved competency in providing sedation before 1 October through a combination of training, experience and continuing education, and have maintained competence, do not need to complete a formal education and training programme to continue providing sedation
- the University of Otago Bachelor of Dental Surgery qualification is considered sufficient education and training to provide and monitor nitrous oxide/oxygen and oral sedation for patients over 6 years of age, subject to the practitioner maintaining competence in these areas.
Standard 16 requires formal education and training for individuals who do not have formal sedation training and are monitoring the patient throughout the sedation and/or recovery periods, regardless of the type of sedative technique used (oral sedation, IV, nitrous oxide/oxygen). The formal education and training programme must ensure individuals meet the competencies defined in Appendix C of the practice standard. These individuals must also maintain their competence.
Standard 17 requires scenario training relevant to the management of sedation-related complications to be included in the NZRC CORE Advanced training. The medical emergencies practice standard requires dentists and dental specialists performing any form of sedation, with the exception of relative analgesia, to complete the NZRC CORE Advanced resuscitation training.