STATE OF IOWA IOWA DENTAL BOARD KIM REYNOLDS, GOVERNOR JILL STUECKER ADAM GREGG, LT. GOVERNOR EXECUTIVE DIRECTOR ANESTHESIA CREDENTIALS COMMITTEE AGENDA NOVEMBER 1, 2018 12:00 P.M. *Updated 10/26/2018* Location: Iowa Dental Board, 400 SW 8th St., Suite D, Des Moines, Iowa. The public can also participate by telephone using the call-in information below: 1. Dial the following number to join the conference call: 1-866-685-1580 2. When promoted, enter the following conference code: 0009990326# Members: Michael Davidson, D.D.S., Chair; Steven Clark, D.D.S.; John Frank, D.D.S.; Douglas Horton, D.D.S.; Gary Roth, D.D.S.; Kurt Westlund, D.D.S.; Jonathan DeJong, D.D.S.; Kaaren Vargas, D.D.S. (alternate) I. CALL MEETING TO ORDER – ROLL CALL II. COMMITTEE MINUTES a. July 19, 2018 – Teleconference III. APPLICATION FOR GENERAL ANESTHESIA PERMIT <No applications received to date.> IV. APPLICATION FOR MODERATE SEDATION PERMIT a. Megumi Williamson, D.D.S. b. Zachary Stecklein, D.D.S. V. OTHER BUSINESS a. For Review and Recommendation – Updated Draft of Proposed Rulemaking – IAC 650—Ch. 29, “Sedation and Nitrous Oxide Inhalation Analgesia” b. 2019 Meeting Dates VI. OPPORTUNITY FOR PUBLIC COMMENT 400 SW 8th STREET, SUITE D, DES MOINES, IA 50309-4687 PHONE:515-281-5157 FAX:515-281-7969 http://www.dentalboard.iowa.gov VII. ADJOURN If you require the assistance of auxiliary aids or services to participate in or attend the meeting because of a disability, please call the Board office at 515/281-5157. Please Note: At the discretion of the committee chair, agenda items may be taken out of order to accommodate scheduling requests of committee members, presenters or attendees or to facilitate meeting efficiency. STATE OF IOWA IOWA DENTAL BOARD KIM REYNOLDS, GOVERNOR JILL STUECKER ADAM GREGG, LT. GOVERNOR EXECUTIVE DIRECTOR ANESTHESIA CREDENTIALS COMMITTEE MINUTES July 19, 2018 Conference Room 400 S.W. 8th St., Suite D Des Moines, Iowa Committee Members July 19, 2018 Michael Davidson, D.D.S. Present Steven Clark, D.D.S. Present Jonathan DeJong, D.D.S. Present John Frank, D.D.S. Present Douglas Horton, D.D.S. Present Gary Roth, D.D.S. Present Kurt Westlund, D.D.S. Present Kaaren Vargas, D.D.S. (alternate) Absent Staff Members Jill Stuecker, Christel Braness, Steve Garrison I. CALL MEETING TO ORDER – JULY 19, 2018 Ms. Braness called the meeting of the Anesthesia Credentials Committee to order at 12:03 p.m. on Thursday, July 19, 2018. The meeting was held by electronic means in compliance with Iowa Code section 21.8. The purpose of the meeting was to review meeting minutes, applications for sedation permit, and other committee-related business. Roll Call: Member Clark DeJong Frank Davidson Horton Roth Westlund Vargas Present x x x x x x Absent x x A quorum was establishedDRAFT with six (6) members present. II. COMMITTEE MINUTES . May 17, 2018 – Teleconference 400 SW 8th STREET, SUITE D, DES MOINES, IA 50309-4687 PHONE:515-281-5157 FAX:515-281-7969 http://www.dentalboard.iowa.gov MOVED by DAVIDSON, SECONDED by FRANK, to APPROVE the minutes as submitted. Motion APPROVED unanimously. III. APPLICATION(S) FOR GENERAL ANESTHESIA PERMIT . Gentry Hansen, D.D.S. Ms. Braness provided an overview of the application. MOVED by DAVIDSON, SECONDED by DEJONG, to APPROVE the application as submitted. Motion APPROVED unanimously. Brandon M. Syme, D.D.S. Ms. Braness provided an overview of the application. MOVED by DEJONG, SECONDED by CLARK, to APPROVE the application as submitted. Motion APPROVED unanimously. IV. APPLICATION(S) FOR MODERATE SEDATION PERMIT . Marian Antonious, D.D.S. Ms. Braness provided an overview of the application. MOVED by CLARK, SECONDED by HORTON, to APPROVE the application as submitted. Motion APPROVED unanimously. V. OTHER BUSINESS . For Review and Discussion – Updated Draft of Proposed Rulemaking – IAC 650—Ch. 29, “Sedation and Nitrous Oxide Inhalation Analgesia” i. ADA Sedation Guidelines ii. Letter Requesting Information Regarding Sedation Guidelines in Other States and With National Organizations Ms. Braness provided an update on the status of the proposed rulemaking. Dr. Frank addressed the letter, which he has proposed. The intent would be to gather information related to deep sedationDRAFT and general anesthesia on the national level. Dr. Frank believed that this would be useful in moving forward on the rulemaking. Dr. Frank recommended that minimum standards for sedation training be required. Anesthesia Credentials Committee – Subject to ACC Approval July 19, 2018 (Draft: 8/14/2018) 2 Dr. Horton reported that this issue was discussed at a meeting of the ASDA (American Society of Dental Anesthesiology) in Boston, MA. Many of the comments from that meeting were similar to those expressed by Dr. Frank. Dr. Westlund joined the meeting at 12:14 p.m. Dr. Roth asked about the number of waivers that specifically requested exemptions pertaining to deep sedation and general anesthesia. Ms. Braness reported that 3-4 waivers had been received to date. Dr. Davidson stated that at the previous Board meeting, the Board members appeared to be in favor of having a separate anesthesia provider when possible; though, not to the extent of prohibiting a single provider. The committee continued to discuss the concerns related to the proposed changes. Dr. Horton was in favor of requiring some training in airway management. Dr. Frank stated that there were a number of concerns related to providing deep sedation in a dental office. As an example, Dr. Frank stated that patients occasionally get violent during recovery. An untrained dentist may not be prepared for that sort of outcome. Dr. Westlund agreed that there needed to be measures in place that would protect the public. Ms. Stuecker reported that there would be a panel discussion related to these rules at the August 2018 Board meeting. Ms. Stuecker also referenced the letter that Dr. Frank had proposed. Ms. Stuecker asked if there was a consensus by the committee to send the letter. Dr. Westlund was in favor of sending the letter; though, he recommended clarifying some of the language. For example: . What restrictions or requirements do states have in place concerning the delegation of sedation to another provider? . Must the delegation of sedation be lateral (e.g. moderate sedation permit holder could delegate moderate sedation)? . Could the delegation of sedation also be vertical (e.g. moderate sedation permit holder could delegate deep sedation)? Dr. Roth indicated that he was in favor of using less restrictive language, and allowing permit holders to delegate one level higher. Dr. Frank asked if a moderate sedation course would be sufficient for the purposes of delegating the administration of deep sedation. MOVED by DAVIDSON, SECONDED by CLARK, to send the letter. Motion APPROVED unanimously. DRAFT Dr. Davidson addressed the proposed requirement for ACLS or PALS certification for dental auxiliary who monitor sedation services. Dr. Davidson was in favor of requiring this for deep sedation or general anesthesia; however, he believed that it may be unnecessary for moderate sedation. Anesthesia Credentials Committee – Subject to ACC Approval July 19, 2018 (Draft: 8/14/2018) 3 Ms. Braness noted that any training, which would be required by rule would need to be training that could be obtained. It was not clear to Ms. Braness whether alternatives were available within existing programs. Dr. Horton, Dr. Westlund and Dr. Frank noted that groups such as the ASDA and AAOMS have programs specifically designed for auxiliary who assist in sedation. Ms. Braness stated that she would research these options further as an alternative to ACLS/PALS certification. Dr. Thies agreed that ACLS/PALS certification may not be accessible to dental auxiliary, and was in favor of other training that would be better focused on the services auxiliary would be able to perform in emergencies. OPPORTUNITY FOR PUBLIC COMMENT There weren’t any comments received. VI. ADJOURN MOVED by WESTLUND, SECONDED by DEJONG, to ADJOURN. Motion APPROVED unanimously. The Anesthesia Credentials Committee adjourned its meeting at 12:45 p.m. NEXT MEETING OF THE COMMITTEE The next meeting of the Anesthesia Credentials Committee is scheduled for August 30, 2018. The meeting will be held at the Board office and by teleconference. These minutes are respectfully submitted by Christel Braness, Program Planner 2, Iowa Dental Board. DRAFT Anesthesia Credentials Committee – Subject to ACC Approval July 19, 2018 (Draft: 8/14/2018) 4 APPLICATION FOR MODERATE SEDATION PERTVTIT IOWA DENTAL BOARI) 400 S.W. 8th Srreet, Suite D. Des Moines. lowa 50309-4687 Ph. (51 5) 281-5157 http://www.dentalboard.iowa.gov 'l'his lbrm must be completed and retumed to the lowa Dental Board. lnclude the non-rdundable applicaaion fee $500. Do not submit pa) ment in cash. Complete each question on the application. lfnot aoolicable. mark "N/A." Full Lcarl NrmG: (Lrsl. Flrrt, Mlddl.) W i tlia mso^ Mear r wti H *a. Olh.r N.mcs tlscd: (c.9, Mridcn Nrmr) Mequ-mi A ira llomc Addrcss: oM+ EasrbeoA A. City: County: Strt.: Zlgi t-ooa, C'rW .l r,ha 1oA AA 52245 lowr l,iccnrc ll: lssu. Dra.: Erparlaion Drt.: Typ. of Prrcllcc: FAC. LhIAq oA/x/zotg Dg/ / 2D2o Frtrtil+tt ord?*itP LOCATIONS IN IOWA WHERE MODERATE SEDATION"1 SERVICES WILL BE PROVIDED l.iP Oflicc Oflicc Addrcsr Cltv Phonc Codc llourJDrvs Tr,4t nv?,€*ry of hs . cdtelzotvA Q:4111- g:q 9ol Narrmn 2),7fuu', Aou City 52142 on- req-+o4r+ t^an-tlulrh( BASIS FOR APPLICATION Chcck if D.tc(s) Typc of Tmlning Completcd coDDlctcd comolctcd: A minimum of 60 hours instruction tlat meets ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Denul Studenrs.