One of the many privileges of DOCS Education membership is access to our EliteDOCS® Forum, an exclusive 24/7 online community where there are always fellow dentists and faculty members happy to respond to requests for advice and support.
What follows are some recent posts and responses from the EliteDOCS® Forum. (Original questions and answers have been edited and amended for publication.)
A DOCS Education member in Chicago asks:
The Drug Enforcement Agency Compliant Drug Log Book that was distributed to us last year at the DOCS Education sedation seminar, states that we are supposed to “close out” our inventory of controlled substances every year.
Does this mean we need to dispose of/trash all unused substances? How do I know that the controlled substances are expired? If they are not expired, can we still use them?
How do we go about changing out the controlled substances?
DOCS Education Faculty Member, Jerome Wellbrock, DMD, MAGD, responds:
Closing out the year is like taking an annual inventory. All drugs should be re-logged at the start of the new year if you are using a new book.
No drugs should be pulled from your inventory unless they are expired. There is always an expiration date on the drug bottle.
You should keep a log book for all your meds and the date they expire, including all sedation drugs, and all your emergency drugs, including oxygen.
It is a good idea to check your oxygen supply once a week and your drugs once a month. This helps you to reorder in a timely manner.
You need to follow FDA Guidelines and use DEA Form 41 to dispose of expired drugs. Identify a controlled substance public disposal location near you by clicking here
Confusion over what is required by the Illinois regulators
A DOCS Education member in Rockford, Illinois posts:
We received a general letter from the Illinois Department of Financial and Professional Regulation re: Notice to Anesthesia/Sedation Permit Holders instructing all dental providers to be familiar with the permits practice requirements.
IDFPR then partially lists some applicable laws:
Statement #4 Reads:
The anesthesia team must consist of three members (they are not specific). ...one assistant must have completed a 12-hour approved anesthesia assistants monitoring course. Please see the Act's Administrative Rules at 68 IAC 1220.510.
Questions:
- Who are the members of the "Anesthesia Team?" (I assume one is the dentist.)
- If we provide oral conscious sedation (minimal to moderate, with no night before dosing), is it legal for the dentist to administer OCS and allow a single hygienist to provide care and monitor the patient in the operatory?
- Does minimal-to-moderate OCS require a DDS at all times in operatory? For example: the anxious patient scheduled for hygiene who receives Diazepam 5mg (and similar cases)?
- Are the regulations for OCS requiring a DDS and minimum of two dental assistants be present in the operatory for any/all minimal to moderate OCS?
John P. Bitting, Esq., DOCS Education’s Regulatory Counsel, responds:
John P. Bitting, Esq.
It would appear that the IDFPR sent this letter to every Illinois dentist instead of just the sedation permit holders. Accordingly, our office received a flood of calls, and I can understand the concern.
Most of this alert pertains to moderate IV sedation, not oral minimal sedation. Illinois only tracks moderate sedation and general anesthesia. However, the regulators do want minimal sedation assistants to have training, which yours likely have already.
Illinois requires an assistant who monitors a minimal sedation patient to have the 12 hours of training. Only one monitoring assistant is required during minimal sedation.(Moderate IV sedation requires the dentist plus two team members, hence the “team of three” concept noted above.)
Minimal sedation in Illinois doesn’t require a permit. Therefore, you may use all of the DOCS protocols as long as the patient’s response meets the definition of minimal sedation. This includes using Valium the night before, so that isn’t a problem.
During minimal sedation, the dentist is allowed to leave the operatory (not the office) if the trained monitoring assistant stays with the patient.
I don’t think there’s much here for you and other DOCS Education members in Illinois to worry about.
The appropriate treatment for a patient taking post-traumatic stress disorder medication?
A DOCS Education member in Shrewsbury, Pennsylvania asks:
My patient takes Klonopin (Clonazepam) for post-traumatic stress. She does not take it every day. I realize that the medication may increase her sedation level. I told her not to take it 24 hours before her appointment.
I’m not sure if I need to alter my treatment time and the meds that I use?
DOCS Education Faculty Member, Jerome Wellbrock, DMD, MAGD, responds:
You should not have to alter your planned appointment or protocol. If your patient needs to take the Klonopin, I would have her take it as usual. You may need a lower dose of sedation meds, so dose low and go slow.
YOUR TURN:
Do you have pharmacology, protocol, practice management, equipment/drug, or regulatory questions you’d like answered? Likewise, would you like to lend your voice and experience to help fellow dentists from around the country?
Membership Director, Lindsay Olsen
EliteDOCS forum members are connected to one another – and to our faculty – 24/7. There are always friendly and knowledgeable fellow dentists online who are happy to respond to requests for advice and support.
To join our DOCS Education community of professionals serving at the forefront of dentistry, and receive all of the privileges to which membership entitles you – including access to EliteDOCS – visit us online here, or contact Lindsay Olsen, our Membership Director, at 206-812-7712.
