1. (a) A dentist administering nitrous oxide or Level 1, 2, 3, or 4 sedation/anesthesia must create, maintain, and include in the patient's dental records required by §108.8 of this title (relating to Records of the Dentist) a document titled "preoperative sedation/anesthesia checklist." The checklist must be completed prior to commencing a procedure for which the dentist will administer nitrous oxide or Level 1, 2, 3, or 4 sedation/anesthesia. The checklist may be paper or electronic.
2. (b) A dentist delegating the administration of sedation/anesthesia to another provider in accordance with Texas Occupations Code §258.001(4), must maintain in the patient's dental records required by §108.8 of this title (relating to Records of the Dentist), a document titled "preoperative sedation/anesthesia checklist." The checklist must be completed by the sedation/anesthesia provider, or by the dentist delegating the procedure with information provided by the sedation/anesthesia provider as necessary, prior to commencing a procedure for which the dentist has delegated another provider to administer the sedation/anesthesia. The checklist may be paper or electronic.

3. (c) At a minimum, the preoperative checklist must include documentation of the following as applicable for each level of sedation/anesthesia administered, consistent with the requirements of §§110.3 - 110.6 of this chapter (relating to Sedation and Anesthesia):

   1. (1) Medical history, including documentation of the following:

      1. (A) review of patient medical history;
      2. (B) review of patient allergies;
      3. (C) review of patient surgical and/or anesthesia history;
      4. (D) review of family surgical and/or anesthesia history; and
      5. (E) review of patient medications and any modifications;
   2. (2) Confirmation that written and verbal preoperative and post-operative instructions were delivered to the patient, parent, legal guardian, or care-giver;
   3. (3) Medical consults, as needed;

   4. (4) Physical examination, including documentation of the following:

      1. (A) American Society of Anesthesiologists Physical Status Classification (ASA) classification;
      2. (B) NPO status; and
      3. (C) Preoperative vitals, including height, weight, blood pressure, pulse rate, and respiration rate;

   5. (5) Anesthesia-specific physical examination including documentation of the following as necessary for the level of sedation/anesthesia administered:

      1. (A) Airway assessment, including Mallampati score and/or Brodsky score as necessary for adequate patient evaluation; and
      2. (B) Ventilation and respiratory rate obtained through patient observation, auscultation, or capnography;
   6. (6) Confirmation of pre-procedure equipment readiness check;
   7. (7) Confirmation of pre-procedure treatment review (correct patient and procedure); and
   8. (8) Special preoperative considerations as indicated for sedation/anesthesia administered to pediatric or high risk patients.
4. (d) The preoperative checklist must include documentation of the reason for omission of any items required by subsection (c) of this section.
5. (e) The information required in subsection (c) of this section may be gathered at any time, but the dentist administering or delegating the administration of sedation/anesthesia must verify that the information is current and correct prior to the administration of sedation/anesthesia.

Source Note:The provisions of this §110.13 adopted to be effective May 10, 2018, 43 TexReg 2777; amended to be effective March 20, 2019, 44 TexReg 1440.