What to expect at a sedation and anesthesia facility inspection
Originally published in Dispatch 2017 Vo1. 31, No. 2
The College has in place a number of requirements to ensure patient safety when sedation and/or general anesthesia is used in a dental office.
The Standard of Practice on the Use of Sedation and Anesthesia in Dental Practice sets out the general professional responsibilities expected of the dentist and staff. It then addresses specific standards for each modality (level) of sedation and other topics, such as patient selection, medical history, office protocols, emergency drugs, equipment, and recovery protocols.
There is also a by-law that sets out the educational requirements needed for those who administer sedation and/or general anesthesia and the need to apply to have the provider’s credentials and training recognized by the College (member authorization). The by-law stipulates the requirement for each office doing sedation procedures to have an initial onsite inspection and then ongoing (every three years) onsite inspections. Offices that pass inspection will be issued a facility permit.
ON-SITE FACILITY INSPECTIONS
Initially, and then every three years, the College must inspect all dental offices wishing to hold a facility permit allowing them to offer sedation services. This inspection is required to ensure that the facility is in compliance with the College’s Standard of Practice.
A College inspector will call you to set-up a mutually convenient time for this inspection. The dentist owner of the practice should be on site when the inspector is there in order to answer any questions. It is also advised that the practice owner self-audits their practice prior to the inspection to ensure all required materials are organized, and readily available.
The inspector will review:
- The HCP-CPR or its equivalent of any sedation for the sedation/GA assistant and recovery supervisor.
- The pre-operative and post-operative instructions for each sedation/GA provider.
- Maintenance records for all automated equipment used on the patient.
- Required equipment.
- Required emergency drugs including expiry dates and sedation/GA records for each sedation/GA provider.
A checklist of required equipment and emergency drugs (developed from the standard of practice) for each level of sedation along with sample sedation records can be downloaded from the RCDSO website.
At the time of inspection, facility inspectors will obtain copies of reviewed patient sedation records. Dentists now receive a copy of the inspection report and have the ability to respond if they wish within 30 days of the inspection.
INSPECTION REPORT OUTCOMES
Following an inspection, several outcomes are possible:
- If no deficiencies are noted, the practice may continue to provide sedation/GA.
- If warranted, the College may request additional information or ask for clarification of some issues.
- Where deficiencies are noted with sedation equipment and/or emergency drugs and/or unsatisfactory sedation records, as per the by-law, the deficiencies are required to be posted on the public register until corrected.
- Lastly, an authorization or permit may be rescinded or revoked if the Registrar believes there is a public safety issue. In some instances, this may lead to an investigation.