Michigan: A dentist may delegate administering nitrous oxide analgesia to a registered dental hygienist under direct supervision to a patient 18 years of age or older if the dental hygienist has met all of the following: (1) Successfully completed an approved course in the administration of nitrous oxide analgesia including content in nitrous oxide analgesia medical emergency techniques, pharmacology of nitrous oxide, nitrous oxide techniques, and if such a course is available, selection of pain control modalities. The course must consist of a minimum of 4 hours didactic instruction and 4 hours of clinical experience; (2) Successfully completed a state or regional board administered written examination in local anesthesia within 18 months of completion of the approved course; (3) Successfully completed a state or regional board administered written examination on nitrous oxide analgesia, within 18 months of completion of the approved course; and (4) Maintains and provides evidence of current certification in basic or advanced cardiac life support. A dental hygienist shall not administer more than 50% nitrous oxide (Mich. Admin. Code r. 338.11410 and MCL 333.16611 (4)).
Minnesota: A dental hygienist may administer nitrous oxide inhalation analgesia in accordance with all of the following: (1) Completion of CPR training and current CPR certification; (2) Usage of only use fail-safe anesthesia equipment capable of positive pressure respiration; (3) Successful completion of a course on the administration of nitrous oxide inhalation analgesia from an institution accredited by the Commission on Dental Accreditation. The course must be a minimum of 12 hours comprised of didactic instruction, personally administering and managing at least three individual supervised cases of analgesia, and supervised clinical experience using fail-safe anesthesia equipment capable of positive pressure respiration; (4) Under the appropriate level of supervision by a dentist who is current with the requirements to administer nitrous oxide inhalation analgesia (Minn. Admin. Code 3100.3600 subp. 4.).
Summary of factual data and analytical methodologies:
This rule implements 2013 Wisconsin Act 354. Numerous other states’ requirements were reviewed and considered while drafting these rules. Analysis and supporting documents used to determine effect on small business or in preparation of economic impact analysis:
The rule was posted for public comment on the economic impact of the proposed rule, including how this proposed rule may affect businesses, local government units, and individuals, for a period of 14 days. No comments were received.
Fiscal Estimate and Economic Impact Analysis:
The Fiscal Estimate and Economic Impact Analysis document is attached.
Effect on small business:
These proposed rules do not have an economic impact on small businesses, as defined in s. 227.114 (1), Stats. The Department’s Regulatory Review Coordinator may be contacted by email at Eric.Esser@wisconsin.gov, or by calling (608) 267-2435. Agency contact person:
Katie Vieira (Paff), Administrative Rules Coordinator, Department of Safety and Professional Services, Division of Policy Development, 1400 East Washington Avenue, Room 151, P.O. Box 8935, Madison, Wisconsin 53708; telephone 608-261-4472; email at Kathleen.Vieira@wisconsin.gov. Place where comments are to be submitted and deadline for submission:
Comments may be submitted to Katie Vieira (Paff), Administrative Rules Coordinator, Department of Safety and Professional Services, Division of Policy Development, 1400 East Washington Avenue, Room 151, P.O. Box 8366, Madison, WI 53708-8935, or by email to Kathleen.Vieira@wisconsin.gov. Comments must be received on or before the public hearing to be held on September 2, 2015 to be included in the record of rule-making proceedings. ------------------------------------------------------------------------------------------------------------
TEXT OF RULE
Section 1. DE 3.03 (1) is amended to read:
DE 3.03 (1) Administer or prescribe, either narcotic or analgesics or systemic-affecting nonnarcotic drugs, or anesthetics except as provided under ch. DE 15. Section 2. DE 11.03 (1) is amended to read:
DE 11.03 (1) A dentist or a dental hygienist who holds a valid certificate under ch. DE 15 may use nitrous oxide inhalation on an outpatient basis for dental patients provided that he or she has adequate equipment with failsafe features and a 25% minimum oxygen flow. Section 3. Chapter DE 15 is created to read: CERTIFICATION OF DENTAL HYGIENISTS TO ADMINISTER NITROUS OXIDE INHALATION ANALGESIA
DE 15.02 Definitions. In this chapter:
(1) “Accredited” has the meaning given in s. 447.01 (1), Stats. (2) “ADA CERP” means american dental association continuing education recognition program.
(3) “AGD PACE” means academy of general dentistry program approval for continuing education.
DE 15.03 Qualifications for certification of licensed dental hygienists to administer nitrous oxide inhalation analgesia. An applicant for certification to administer nitrous oxide inhalation analgesia shall be granted a certificate by the board if the applicant complies with all of the following:
(1) Has a current license to practice as a dental hygienist in this state.
(2) Has completed the educational requirements of s. DE 15.05. (3) Has submitted the information required in the application under s. DE 15.04. DE 15.04 Application procedure. An applicant for a certificate to administer nitrous oxide inhalation analgesia shall file a completed application on a form provided by the board. The application shall include all of the following:
(1) The dental hygienist license number in this state and the signature of the applicant.
(2) Evidence of successful completion of a didactic and clinical certification program, resulting in the dental hygienist becoming competent to administer nitrous oxide inhalation analgesia under the delegation and supervision of a dentist, the curriculum of which meets or exceeds the basic course requirements set forth in s. DE 15.05. DE 15.05 Educational requirements. The following educational requirements are necessary for the board to approve and grant certification to a licensed dental hygienist in the administration of nitrous oxide inhalation analgesia:
(1) The certification program in the administration of nitrous oxide inhalation analgesia shall be sponsored by an accredited dental or dental hygiene school or be an approved ADA CERP or AGD PACE provider.
(2) The nitrous oxide inhalation analgesia administration certification program shall provide a minimum of 8 hours of instruction and shall consist of all of the following:
(a) Didactic instruction including all of the following:
1. Legal aspects of nitrous oxide inhalation analgesia administration in Wisconsin.
2. Physiological and psychological aspects of anxiety.
3. Stages of consciousness and the levels of sedation.
4. Respiratory and circulatory physiology and related anatomy.
5. Pharmacology of nitrous oxide.
6. Advantages and disadvantages as well as the indications and contraindications for nitrous oxide inhalation analgesia administration.
