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.
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:
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.
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:
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.
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.