Standards for Conscious Sedation in the Provision of Dental Care (V1.1)

The dental faculties of the royal colleges of surgeons and the Royal College of Anaesthetists2020

Report of the Intercollegiate Advisory Committee for Sedation in Dentistry

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Executive summary ..............................................03Committee members ..........................................04Foreword ................................................................08Introduction ..........................................................09Options for care ....................................................10Preparation for sedation .....................................12

Consent for treatment ..................................12 Patient information .......................................13 Fasting ..............................................................14

Clinical environment for sedation ....................15Nature of the clinical team for sedation ..........16Techniques of sedation .......................................17

Essential principles of safe sedation practice ...........................................17Specific techniques .......................................18

Peri-operative care ...............................................20Monitoring .......................................................20Complications ................................................20Recovery, discharge and aftercare .............21

Clinical governance and audit ...........................22Education and training .......................................23

SectionsSection 1: Care pathways ...................................25Section 2: Clinical sedation techniques ...........27Section 3: Peri-operative care ............................32Section 4: Patient information ...........................34Section 5: Education and training ....................36

AppendicesAppendix 1 .............................................................38

Training in conscious sedation: generic learning outcomes .........................................38Syllabus 1: Dentists: Basic conscious sedation techniques for children, young people and adults ..........................................40Syllabus 2: Dentists: Advanced conscious sedation for young people and adults ......50

Syllabus 3: Dentists: Advanced conscious sedation for children .....................................58Syllabus 4: Dental therapists and dental hygienists: Inhalation sedation ...................68Syllabus 5: Dental nurses: Assisting during conscious sedation ...........................77

Appendix 2 .............................................................87Course accreditation .....................................87Transitional arrangements ...........................88

Appendix 3 .............................................................89Examples of patient information .................89

Appendix 4 ...........................................................114Frequently asked questions ........................114

References ...........................................................119

FiguresFigure 1: The options for managing dental anxiety ..............................................................11Figure 2: A care pathway for children and young people aged 0–16 years ...................26

TablesTable 1: Requirements for clinical sedation techniques ......................................28Table 2: Intra-operative care and monitoring ......................................................33

Contents

CONTENTS

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EXECUTIVE SUMMARY

1. This report creates a national standard for the use of conscious sedation in the delivery of dental care. The standards apply to all who practise conscious sedation techniques, whether they are dentists, doctors, nurses or dental care professionals.

2. Conscious sedation is an important modality that forms one strand of the delivery of dental care to patients who have significant anxiety. This document describes the clinical techniques that are available for conscious sedation in dentistry and the appropriate environments for their delivery.

3. The report defines the age of a child as being an individual of under 12 years in respect of the delivery of conscious sedation. It is recognised that a numerical definition has limitations when considering both physical and mental maturity. The clinical team and facilities required for the dental treatment of younger patients under conscious sedation are defined in this report. It is recognised that significant development and investment will be required to meet these requirements.

4. Dental care is provided for the benefit of our patients. This report makes recommendations about ensuring that they receive the

best care, which requires that the healthcare team makes available both verbal and written information of high quality in a form that is easily assimilated by patients, their parents or carers.

5. Patients have the right to expect a high quality service to meet their dental needs. This can only be achieved through robust, validated education and training of the entire dental team. Educational or training courses that teach clinical techniques preparing individuals for independent practice must include supervised clinical practice. The requirement for high quality education underpins the report.

6. The requirements for high quality education, which include supervised clinical practice, may limit the number of providers that are able to provide training courses.

7. Sedation services must demonstrate a high level of safety and a continuing improvement in quality. The use of appropriate audit tools to review clinical outcomes is an essential component of good clinical practice. Careful and reflective use of such data will enhance patient safety and improve the quality of care.

8. It is recommended that a system for reporting adverse

events in the delivery of conscious sedation in dentistry be developed for those working in independent practice. This should parallel systems currently used in National Health Service (NHS) institutions.

9. The report recognises the need for healthcare professionals not only to gain knowledge and skills but also to maintain and further develop them. Individuals who wish to practise conscious sedation must undergo regular continuing education in the techniques that they use. Those using a technique of conscious sedation infrequently should consider whether it is in the best interests of patients for them to continue to use it. (FAQ 10).

10. All centres providing conscious sedation for the delivery of dental care should be inspected to determine that the necessary standards are in place. This is currently the responsibility of the relevant agencies in each country in the UK.

11. It is recognised that some of the recommendations of this report will have far-reaching consequences. Implementation may have significant implications for providers and for those who commission dental clinical services but safety of patients is our priority.

Executive summary

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Committee members V1.0

COMMITTEE MEMBERS

Professor Richard Ibbetson Chairman of the Committee, Faculty of Dental Surgery, Royal College of Surgeons of Edinburgh

Dr Mike Blayney Royal College of Anaesthetists (alternate member)

Mrs Vanita Brookes Chair, Specialist Advisory Committee for Special Care Dentistry (2014 onwards)

Professor Jonathan Cowpe Chair, Joint Committee for Postgraduate Training in Dentistry (2011–2013)

Dr David Craig Dental Sedation Teachers Group

Dr David Felix Chair, Joint Committee for Postgraduate Training in Dentistry (2013 onwards)

Professor Jenny Gallagher Consultants in Dental Public Health Group

Professor Nick Girdler Faculty of Dental Surgery, Royal College of Surgeons of England

Mrs Karen Gordon Chair, Specialist Advisory Committee for Special Care Dentistry (2011–2014)

Ms Tina Gorman National Examining Board for Dental Nurses; representing the Lead Dean for Dental Care Professionals, Council of Postgraduate Dental Deans and Directors

Mr Bryan Harvey Dental Defence Union

Mr Richard Hayward Faculty of General Dental Practice (UK)

Mr Christopher Holden Society for the Advancement of Anaesthesia in Dentistry (alternate member)

Mrs Isabelle Holroyd British Society of Paediatric Dentistry

Dr Sarah Manton Faculty of Dental Surgery, Royal College of Surgeons of Edinburgh

Dr Avril Neilson Faculty of Dental Surgery, Royal College of Physicians and Surgeons of Glasgow

Mrs Kate Rivett Patient Representative, Joint Dental Faculties

Dr Nigel Robb Society for the Advancement of Anaesthesia in Dentistry

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Dr Anna-Maria Rollin Royal College of Anaesthetists

Mr Nicholas Taylor Postgraduate Dental Dean, Health Education England

Dr Kathy Wilson Faculty of Dental Surgery, Royal College of Surgeons of England (alternate member)

General Dental Council

Ms Maria Burke Administrator and Committee Manager, Royal College of Surgeons of England (2011–2013)

Mr Neil Sutcliffe Administrator and Committee Manager, Royal College of Surgeons of England (2013 onwards)

Co-opted memberDr Yvonne Hurst Head of Education, Royal College of Surgeons of Edinburgh

Observers

Professor June Nunn Faculty of Dentistry, Royal College of Surgeons in Ireland

Dr Sue Gregory Department of Health, England

Dr Tom Schnittger College of Anaesthetists of Ireland (co-opted)

Corresponding membersChief Dental Officers of the devolved nations (Scotland, Wales and Northern Ireland)

General Medical Council

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Committee members V1.1

COMMITTEE MEMBERS

Professor Callum Youngson Chair of the Committee Dr Mike Blayney Royal College of Anaesthetists

Dr Carole Boyle Chair, Specialist Advisory Committee for Special Care Dentistry

Dr Mary Clarke Royal College of Surgeons in Ireland

Dr David Craig Chair, Sedation Training Accreditation Committee

Dr Andrew Dickenson Committee of Postgraduate Dental Deans and Directors

Professor Jenny Gallagher Consultants in Dental Public Health Group

Professor Nick Girdler Faculty of Dental Surgery, Royal College of Surgeons of England

Dr Bryan Harvey Dental Defence Union

Mr Richard Hayward Faculty of General Dental Practice (UK)

Dr Christopher Holden Society for the Advancement of Anaesthesia in Dentistry

Mrs Isabelle Holroyd British Society of Paediatric Dentistry

Dr Stephen Jones Society for the Advancement of Anaesthesia in Dentistry

Dr Bryan Kerr Dental Sedation Teachers Group

Dr Sarah Manton Faculty of Dental Surgery, Royal College of Surgeons of Edinburgh

Mrs Kate Rivett Patient Representative, Joint Dental Faculties

Dr Stephanie Sammut Royal College of Physicians and Surgeons of Glasgow

Dr Kathy Wilson Faculty of Dental Surgery, Royal College of Surgeons of England (alternate member)

Mr Neil Sutcliffe Administrator and Committee Manager, Royal College of Surgeons of England

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Co-opted memberDr Yvonne Hurst Head of Education, Royal College of Surgeons of Edinburgh

ObserversDr Tom Schnittger College of Anaesthetists of Ireland (co-opted)

Corresponding membersDr Sara Hurley Chief Dental Officer (England)

Dr Colette Bridgman Chief Dental Officer (Wales)

Dr Simon Reid Chief Dental Officer (Northern Ireland)

Dr Tom Ferris Interim Chief Dental Officer (Scotland)

General Dental Council

General Medical Council

Copied inMr Jamie Woodward Faculty of General Dental Practice (UK)

The Dean Faculty of General Dental Practice (UK)

The Dean Faculty of General Surgery, Royal College of Surgeons of England

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IACSD reviewed the 2015 Standards on 20 June 2019. The committee decided that, in the absence of new clinical evidence or safety issues, it was not necessary to make any substantial changes to the original guidance. However, feedback suggested it would be helpful to incorporate and reference the IACSD frequently asked questions on the FDS RCSEng website. There are also a small number of minor typographical changes. The committee agreed that a detailed review and update of the IACSD Standards should be considered by the end of 2022.

This publication creates a national standard for conscious sedation in dentistry and replaces the previous documents Conscious Sedation in the Provision of Dental Care (2003),2 Standards forConscious Sedation in Dentistry (2007)3 andConscious Sedation in Dentistry (2012).4a

It is to be read in conjunction with Safe Sedation Practice for Healthcare Procedures published by the Academy of Medical Royal Colleges in October 20135, Sedation in Children And Young People published by the National Institute for Health and Care Excellence (NICE) in December 20106 and Conscious Sedation in Dentistry: Dental Clinical Guidance, 3rd Edn, SDCEP 20174b. There are differences in laws, regulations, ethical guidance and governance between different countries in the UK and Ireland; this report describes best practice but it is incumbent on individuals to be aware of the laws and regulations as they pertain in the country in which they work.

Where conscious sedation is used to facilitate dental treatment, it is essential that it is provided to the highest possible standards. Quality standards coupled with the specific needs of the patient have correctly

received increased emphasis and there is an imperative for the best possible quality of care. This can only be achieved through education and training of the workforce to defined standards and by ensuring that the environment in which care is delivered meets similarly defined standards. Clinical skills can only be maintained through rigorous and ongoing review of the care that has been provided as well as the continual pursuit of knowledge and skills. Robust education and training underpins safe and effective dental care for patients requiring dental sedation, and this therefore forms a significant element of this report.

Optimal care is patient-centred and focuses on the needs of the individual. For techniques of conscious sedation in dentistry, this document describes the methods available and the appropriate environment for their delivery. The foundation for this report is high quality training and robust assessment of outcomes. High quality care recognises the need for audit and reflection together with the requirement that skills once gained are subject to interval re-assessment and evaluation.

The implementation of this report is essential for the provision of clinical services that ensure appropriate management and patient safety. The first part of the report provides core information. Each heading is then expanded into the later sections to give essential details covering the delivery of dental care using conscious sedation. The clinical standards, training and assessments described in this document apply to all dentists, doctors and healthcare professionals who provide or directly support sedation for the delivery of dental care. (FAQ 1, 2, 11).

Foreword 2020

FOREWORD

The Intercollegiate Advisory Committee for Sedation in Dentistry (IACSD)1 defines standards for the provision of conscious sedation in dentistry in the UK.

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There is a continuum from the fully conscious state to the unconscious when all protective reflexes have been lost. The publication from the Academy of Medical Royal Colleges, Safe Sedation Practicce for Healthcare Procedures,5 gives the definitions of sedation and describes clearly this continuum from minimal sedation through to general anaesthesia, which is accompanied by increasing depression of the physiological systems. This increases the likelihood of adverse events and an increasing depth of sedation is accompanied by an escalation in the competency required to ensure safe sedation practice.

This document addresses conscious sedation, which is defined as:

… a technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation. The drugs and techniques used to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render loss of consciousness unlikely.4–7

The level of sedation must be such that the patient remains conscious and is able to both understand and respond to verbal commands either alone or accompanied by a light tactile stimulus.

In the case of individuals who are unable to respond to verbal contact even when fully conscious, the normal method used for communicating with them must be maintained.

The effective management of anxiety and pain is an essential part of the delivery of dental care. Behavioural management, the use of local analgesia and methods of conscious sedation are all central components of care for patients who are frequently anxious about receiving dental treatment. Conscious sedation, provided when appropriate, in a skilled manner and in the correct environment, is widely used, valuable and effective.

INTRODUCTION

Introduction

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This is based on establishing the best patient management and involves provision of information, counselling and reassurance as primary measures of anxiety control.

When pain control is required for a dental procedure to be carried out under conscious sedation, appropriate use of local analgesia is also required. Conscious sedation is not a substitute for effective behaviour management and local analgesia.

Behaviour management, local analgesia or general anaesthesia may each have a role in facilitating patient care. A practitioner must therefore make a careful, thorough assessment of the patient and his or her needs before deciding that the use of conscious sedation is indicated. The decision to use a particular approach must be based on a full assessment in respect of healthcare history, psychological needs and overall management. The use of conscious sedation may be indicated for special care patients, certain medical indications or difficult clinical situations.8

However, conscious sedation is designed only to facilitate the delivery of dental care. It is essential that patients who are to be managed using conscious sedation are assessed carefully and also receive a dental assessment. The treatment plan must be agreed with the patient and any carer; ideally, this should be done in advance of the procedure.

The patient should receive the treatment most appropriate for his or her oral condition and circumstances. Care pathways are seen as encouraging good practice and, where available, should be followed.

The age when an individual ceases to be a child in respect of the provision of dental care under sedation cannot be defined numerically. In relation to conscious sedation, the description of the Resuscitation Council (UK) is pertinent where a child is defined as being between 1 year of age and puberty.9 The lower end of the range for the onset of puberty is considered to be 12 years but may be earlier or

later when physical maturity is considered.10

Patients who have not reached puberty are physiologically immature and will require a sedation team member with paediatric resuscitation skills. Providers and commissioners will need to consider this when planning services for this group of patients.

Any child under 12 years of age with complex oral needs or any child under 12 years who cannot be managed with either:

a) behavioural management techniques/local analgesiaorb) local analgesia plus inhalation sedation

with the responsible dental practitioner having received appropriate training should be referred to a team having skills equivalent to those expected of a specialist/consultant in paediatric dentistry and a consultant in anaesthesia competent in sedation for dentistry for assessment and treatment in

Options for care

OPTIONS FOR CARE

There is a range of modalities that can assist in the management of anxiety to facilitate the provision of high quality dental care. Conscious sedation is just one option for the control of anxiety, and it is essential that all options are considered and explained to the patient (and, where appropriate, the carer) before a decision is reached.

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a facility equivalent to an NHS Acute Trust in England.* This would include care provided by a managed clinical network or a recognised care pathway.

Any young person aged 12–16 years with complex oral needs or any young person aged 12–16 years who cannot be managed with either:

a) behavioural management techniques/local analgesia

orb) local analgesia plus inhalation sedation

orc) local analgesia plus midazolam (all routes)

with the responsible dental practitioner having received appropriate training should be referred to a team having skills equivalent to those expected of a specialist/consultant in paediatric dentistry and a consultant in anaesthesia competent in sedation for dentistry for assessment and treatment in

a facility equivalent to an NHS Acute Trust in England.* This would include care provided by a managed clinical network or a recognised care pathway.(FAQ 18, 20, 21).

This report focuses on conscious sedation in dentistry, which is an adjunct to the delivery of oral healthcare for patients. Appropriate assessment and proper dental treatment planning for each patient are mandatory. This is important for all patients and symptomatic dental care is not in any patient’s long-term best interests. In particular, where dental needs are complex, the involvement of colleagues with additional skills is always likely to be beneficial and is sometimes essential.

There is a range of options available to support clinicians and patients in deciding on the best management and care of patients who are unable to receive routine care. Selection of the most appropriate pathway must be decided by patient need and some of these may be time-specific.

Some of the issues involved are anxiety, a pronounced gag reflex, a traumatic procedure, the level of patient co-operation, the nature of the clinical care required and the time needed to deliver treatment.

The options should be considered carefully and the selection at any one point in time will depend on a range of factors relating to the patient, for example the nature and urgency of care. The chosen option must be justified in the clinical records.

Figure 1 shows the major options for managing anxiety. Patients may require different support services at different points in their dental care, which are also dependent on the complexity of the treatment. Consideration should therefore also be given to the most appropriate modality for the patient next time dental treatment is to be carried out and whether this will require a different provider.

Where there are particular patient needs for the management of anxiety or other aspects that affect the individual’s ability to receive dental treatment (e.g. a pronounced gag reflex), referral to another provider may be in the patient’s best interests. When referring a patient, clear referrals must be made, the guidance described by the Dental Sedation Teachers Group should be followed8 and the responsibilities described by the General Dental Council (GDC) in the UK must be met.11

Behaviour management

Behavioural therapy

General anaesthesia

Conscious sedation

Patient

Figure 1The options for managing dental anxiety.

*Scotland: an NHS Board; Wales: a Health Board; Northern Ireland: a Health and Social Care Trust

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Patients and, when appropriate, those with parental responsibility and carers require information to be provided in a way that can be understood before the process of valid consent can be completed.6,12 Patients who are already sedated cannot be regarded as competent to take valid decisions regarding consent for treatment. Consent for dental treatment attempted under these circumstances is not valid.

Consent obtained on the day of treatment is not appropriate except when immediate treatment is in the best interests of the patient. Consent obtained prior to the day of treatment must also be re-confirmed on the actual day of treatment.

The capacity to consent depends on a person’s ability to understand and voluntarily weigh up options rather than age.12 A person is unable to make a decision if they cannot do one or more of the following:

• understand the information given to them that is relevant to the decision

• retain that information long enough to be able to make the decision

• use or weigh up the information as part of the decision-making process

• communicate their decision – this could be by talking or using sign language and includes simple muscle movements such as blinking an eye or squeezing a hand.13

The Mental Capacity Act 200512 states that if a person lacks mental capacity to make a particular decision, then whoever is making that decision or taking any action on that person’s behalf must do this in the person’s best interests. For the purposes of consent, ‘children’ refers to people aged below 16 years and ‘young people’ refers to people aged 16–17 years. All people aged 16 years of age and over are presumed in law to

have the capacity to consent to treatment unless there is evidence to the contrary.

Children aged under 16 can be legally competent if they have sufficient understanding and maturity to enable them to understand fully what is proposed. If the child is deemed not legally competent, consent will need to be obtained from someone with parental responsibility, unless it is an emergency.

Families of children under the age of 16 years should be involved in decisions about their care unless there is a very good reason for not doing so. However, if a competent child under 16 is insistent that their family should not be involved, their right to confidentiality must be respected, unless such an approach would put the child at serious risk of harm.14

PREPARATION FOR SEDATION

The patient requires clear and comprehensive information regarding the proposed treatment as part of the process of gaining valid consent. Valid consent is necessary for all patients receiving dental care under conscious sedation and this must be confirmed in writing. Consent should follow the principles set out in the GDC’s Standards for the Dental Team.11 Consent is a complex process, and different laws and regulations apply at different ages in different countries in the UK. Practitioners must be aware of the laws that apply in their own country.

Preparation for sedationConsent for treatment

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Written information for adult and child patients, those with parental responsibility, carers and escorts must be supplied. This is to be used in conjunction with the clinical pre-operative assessment and face-to-face discussions and explanation. It must include the range of techniques appropriate for both the relief of anxiety and the behaviour management appropriate for the dental treatment needs of the individual.

Adult patients will receive written information at the pre-operative visit. For child patients receiving sedation, information in written form for both the child and those with parental responsibility and carers will be supplied at the time of the clinical assessment.

Written information about the sedation procedures available and the specific technique planned for the adult or child patient will need to conform to the local health provider’s patient information policy. This will be subject to local stakeholder consultation and audit. Written patient information must be provided sufficiently in advance of the procedure to allow patients and carers time to absorb the information and comply with the instructions given.

Information regarding the sedation technique should contain a description of the sedation procedure that has been suggested and recommended as the most appropriate management technique for the individual patient, including its benefits, risks and alternatives.8

It should take into account the subjective feelings expected to be experienced by the patient during and after the sedation. The information must also include relevant contact details of the care provider as well as the out-of-hours contact details for emergency advice and services.

Instructions for the pre- and post-operative periods must be suitable for each age group of patients and their escorts and carers.

Adults and young peopleFor adult patients and young people, clear instructions must be provided regarding the practical arrangements to be followed pre- and post-operatively. These will include the responsibilities of the escort pre- and post-operatively. The patient must also receive a separate information sheet describing the responsibilities of the escort, which the patient must give to the escort. Practitioners should bear in mind the limitations of patients and escorts in following such instructions.

ChildrenFor those with parental responsibility for patients under 16 years of age, the information must include preparation of the child prior to the appointment as well as post-operative instructions for the sedation provided and the dental treatment performed.

For children, separate age appropriate information regarding the sedation procedure should also be provided. For very young children, it should be remembered

that this may need to be in a very simplified form, and that written information must be used in conjunction with (and not instead of) a face-to-face explanation and discussion of the sedation technique with the child or young person involved.

Written information forms only a part of the overall psychological preparation of an adult or child who is to receive dental care in combination with sedation. Psychological preparation in the form of cognitive behavioural therapy, distraction, guided imagery, hypnosis, demonstration play therapy and music therapy may form part of the preparation.15 The techniques used to reduce fear and anxiety will need to match the needs of the individual patient to facilitate a successful treatment outcome.

Further documents providing examples of intercollegiate guidance on content and style are presented in Section 4: Patient information and in Appendix 3.

The information provided should reflect the guidance given to the patient. There is a requirement for clear and accurate information to be provided for patients, those with parental responsibility, carers and escorts. Written patient information should be prepared in line with NHS guidance reflecting the needs of the different patient groups using the service, for example patients with learning disabilities or where English is not the first language.15

Patient information

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The need for fasting prior to dental treatment under conscious sedation continues to be the subject of significant discussion. The Academy of Medical Royal Colleges publication Safe Sedation Practice for Healthcare Procedures,5 with which this report is aligned, devotes a section to fasting, which is quoted in full:

‘Pre-operative fasting for sedation is controversial and considered unnecessary by some authorities within dentistry and emergency medicine for conscious sedation.[2,16] Airway reflexes are assumed to be maintained during moderate and minimal sedation, and lost during general anaesthesia. It is not clear where the point of loss of reflexes lies, or if such a point exists. The argument is that using minimal and moderate sedation, airway reflexes are maintained but this does not consider the potential for inadvertent over-sedation and the loss of protective airway reflexes.[17] In the United Kingdom the loss of verbal communication/deep sedation is deemed to

require the same level of care as general anaesthesia,[7] and many practitioners therefore follow accepted fasting guidance.[18,19]

Guidance from NICE on sedation of children[6] recommends fasting before sedation unless the sedation is limited to:

• minimal sedation• sedation with nitrous oxide (in

oxygen)• moderate sedation during

which the child or young person will maintain verbal contact with the healthcare professional

For elective procedures using any sedation other than the above (and specifically for deep sedation and moderate sedation during which the child or young person might not maintain verbal contact with the healthcare professional) the 2-4-6 fasting rule applies (that is, two hours for clear fluids, four hours for breast milk and six hours for solids).

For an emergency procedure in a child or young person who has not fasted, the decision to proceed with

sedation should be based on the urgency of the procedure and the target depth of sedation.

Careful consideration on a case-by-case basis of the patient’s presenting condition, co-morbidities, the nature of the procedure and the limitations of the environment, is important to evaluate the risks of aspiration.

Clinicians who choose to sedate patients without fasting should be prepared to justify this choice.’

Advice on eating and drinking prior to the appointment for treatment under any form of conscious sedation should be given to the patient verbally and in writing at the assessment visit. This must be recorded in the patient’s clinical records.

Fasting

PREPARATION FOR SEDATION

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The correct equipment and facilities for the delivery of the type of care required must be used, and must conform to accepted standards for health and safety. All appropriate equipment must be available in working order when sedation is being provided and during recovery. Equipment must be maintained

in accordance with the schedule described by the manufacturers. Records of the maintenance of equipment must be retained and made available for subsequent formal inspections.

The clinical setting must permit access for the emergency services and the transfer of the patient.

Further information on the requirements for the premises and the equipment required together with a patient pathway may be referenced in the form of a checklist. An example of this will be found at https://www.SAAD.org.uk/documents.20 (FAQ 19).

Clinical environment for sedation

The physical environment, supporting facilities and equipment must be appropriate for the delivery of dental care under sedation.2 All providers of conscious sedation services are responsible for ensuring that the environment in which care is delivered is appropriate for the needs and safety of patients, carers and staff. All centres providing conscious sedation for the delivery of dental care should be inspected to determine that the necessary standards are in place.

CLINICAL ENVIRONMENT FOR SEDATION

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Clinical skills are underpinned by validated education and training while knowledge and continuing competence must be maintained through appropriate continuing professional development.

Nature of the clinicalteam for sedation

NATURE OF THE CLINICAL TEAM FOR SEDATION

Table 1 in Section 2: Clinical sedation techniques describes the clinical team required for each conscious sedation technique. All members of the care team must have the relevant knowledge and skills for the technique being used, as defined by their scope of practice and competencies.

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1. The use of sedative drugs does not negate the need for good communication skills and a sympathetic manner.

2. No one technique is suitable for all patients. However, adopting the principle of minimum intervention, the simplest and safest technique that is likely to be effective, based on robust patient assessment and clinical need, should be used.

3. Titrating a drug/drugs to effect is critical to safely achieving a recognised sedation endpoint (i.e. conscious sedation) and avoiding inadvertent over-sedation. The initial dose must have taken full effect before an additional dose is given. Safe sedation demands knowledge for each drug of time of onset, peak effect and duration of action.

4. While over-sedation must be avoided, under-sedation will

have an adverse effect on the patient and the delivery of effective treatment.

5. As a general rule, single drugs are easier to titrate to effect and safer than sequential administration of two or more drugs. Drugs used in combination may produce synergistic effects, have differing times to onset and peak effect, and may be unpredictable or difficult to titrate to effect. Safety margins may be narrowed, increasing the likelihood of overdose, loss of consciousness, respiratory depression and the need for airway interventions. Benzodiazepines may be up to eight times more potent after prior administration of opioid and so must be titrated with care.21

6. Anaesthetic drugs and infusions (e.g. propofol) used as sedative agents have narrower therapeutic indices

and reduced margins of safety, potentially increasing the likelihood of adverse events.

7. Multiple/anaesthetic drug techniques should only be considered by those skilled in their use, where there is clear clinical justification, after having excluded simple techniques, and must only be used in an approved setting where team skills are sufficient to resuscitate and stabilise a patient until the arrival of the emergency services.

There is a range of techniques of conscious sedation available. The selection of a technique must be appropriate for the individual patient and not chosen simply for operator or sedationist convenience or at the insistence of a third party. The practitioner providing the sedation must be trained and competent in the technique used, and each individual in the team caring for the patient must also have the necessary validated skills.

Techniques of sedation

TECHNIQUES OF SEDATION

Essential principles of safe sedation practice

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The essential aspects of each technique are listed below and more detailed information is provided in Section 2: Clinical sedation techniques. For all conscious sedation techniques other than inhalation sedation with nitrous oxide/oxygen, competence in cannulation is mandatory.

Specific techniques

Oral pre-medication and oral sedation There is a difference between pre-medication and oral sedation. Oral pre-medication involves the self-administration of a small dose of an oral sedative to alleviate anxiety. This usually takes place outwith the dental practice. Subsequent doses of sedative drugs may need to be reduced accordingly. Oral sedation involves the administration of a much larger dose of an oral sedative at the dental practice. The monitoring and discharge requirements for oral sedation are the same as for intravenous sedation. Oral sedation must only be administered in the place where the dental treatment is provided and must only be carried out by practitioners who are already competent in intravenous sedation.

Nitrous oxide/oxygen sedation (inhalation sedation): A titrated dose of nitrous oxide in oxygen is the first choice inhalation sedation technique.

Midazolam (intravenous sedation): A titrated intravenous dose of midazolam is usually the first choice intravenous sedation technique.

Midazolam (oral sedation): Midazolam is now considered the first choice agent for oral sedation.

Oral techniques are not titratable and should only be used when titratable sedation techniques are inappropriate.

Temazepam (oral sedation): Historically, temazepam was the first choice oral sedative for use in dentistry. Its use has been largely superseded by midazolam. Oral techniques are not titratable and should only be used when titratable sedation techniques are inappropriate.

Midazolam (intranasal sedation): Intranasal sedation is one of a group of routes of administration referred to as transmucosal sedation. These techniques have become more popular in recent years, especially in special care dentistry. As with oral sedation, these techniques are not titratable and should only be used when titratable sedation techniques are inappropriate.

Opioid and midazolam (intravenous sedation): This is an intravenous technique where a single small dose of an opioid (usually fentanyl) is followed by a titrated dose of midazolam. It is used for patients for whom midazolam alone does not produce adequate anxiolysis.

Ketamine (oral/intravenous sedation): Ketamine is increasingly being used for paediatric dental

conscious sedation. However, until more evidence on its use and safety is published, it is difficult to offer detailed guidance.

Midazolam (patient-controlled sedation): The IACSD is unaware of anyone currently using patient-controlled midazolam for conscious sedation in dentistry in the UK but it is included here for completeness.

Propofol (patient-controlled sedation): There have been a number of studies published in which patient-controlled propofol conscious sedation has been examined. The availability of safe and reliable, licensed delivery systems needs to be investigated.

Propofol (target-controlled infusion sedation): Target-controlled infusions of propofol are widely used for sedation in many medical and dental fields. These techniques require the presence of a dedicated sedationist. They are particularly useful for both very long and very short procedures as well as for patients who have developed a tolerance to benzodiazepines.

TECHNIQUES OF SEDATION

19

Midazolam and propofol (intravenous sedation): This technique is particularly useful for longer dental procedures. The sedation is induced with a titrated dose of midazolam and then maintained with a continuous infusion of propofol. As with propofol administered alone, this technique requires a dedicated sedationist.

Sevoflurane (inhalation sedation): Techniques involving the use of a titrated dose of sevoflurane in oxygen or in nitrous oxide and oxygen have been studied in paediatric dental patients. These techniques appear to be more effective than a titrated dose of nitrous oxide in oxygen but have yet to achieve widespread acceptance. A dedicated

sedationist is required for these techniques owing to the lack of availability of a simple delivery system suitable for use in a dental environment.

20

As well as monitoring the depth of sedation and patient comfort, it is vital to provide clinical monitoring and electronic and mechanical monitoring appropriate to the technique and the medical status of the patient. There must be a written contemporaneous record of the monitoring of the patient that is in accordance with the clinical sedation technique used.

Clinical and instrumental monitoring relevant to the patient’s medical status and the clinical setting must be used. For inhalation sedation with nitrous oxide, clinical monitoring will usually suffice. As a minimum for all other techniques, monitoring should include pulse oximetry as well as non-invasive blood pressure monitoring pre-

operatively, at appropriate intervals during the procedure and post-operatively.5 All members of the clinical team must be capable of monitoring the condition of the patient.2 The monitoring requirements specific to each technique are recorded in Table 2 in Section 3: Peri-operative care. (FAQ 24).

PERI-OPERATIVE CARE

The principles of monitoring are described in Safe Sedation Practice for Healthcare Procedures.5 During conscious sedation the patient responds to verbal commands. Cognitive function and physical co-ordination may be impaired but airway reflexes, ventilatory and cardiovascular functions are usually unaffected. The sedationist or another appropriate person who has capability within his or her scope of practice must monitor the patient throughout the procedure and will wish to confirm at regular intervals that the patient is conscious. If this level of sedation is exceeded, the team caring for the patient must have the appropriate skills to manage the situation.

Peri-operative care

ComplicationsConscious sedation delivered appropriately by trained, competent individuals in a suitable environment can deliver benefits for patients. However, there can be risks, of which the patient should be made aware, and complications that the clinical team needs to manage.

‘Rescue’ is the term used to describe the management of

adverse events that may occur during the delivery of dental treatment under conscious sedation. It is essential that the team delivering care is able to recognise such adverse events and manage them appropriately and safely. These events may be medical, dental or related to the sedation.

The dentist’s responsibility

is to manage complications resultant from medical or dental emergencies. The sedationist, who may be a dentist, doctor or dental hygienist and therapist, must be able to manage any complication arising from the sedation itself and from medical emergencies.

The dentist, dental hygienist and therapist, sedationist and dental nurse must be competent

Monitoring

21

Recovery, discharge and aftercare

The presence of a suitable third party to take responsibility for the patient at the time of discharge is an essential requirement for sedation using anything other than inhalation sedation with nitrous oxide/oxygen in adults. Children under 16 years of age require an escort for inhalation sedation.

For all other forms of sedation for adults and children, an escort is required. If the attendance of an escort cannot be assured, treatment under sedation must not be provided.

Recovery from sedation remains the responsibility of the care team until the patient can be discharged into the care of the responsible adult escort. Recovery is a progression from the peak effects of the sedation.

During recovery, the patient must be supervised; a trained member of the dental team must be responsible for the patient and monitor the individual throughout this period. See Table 2 in Section 2: Clinical sedation techniques. All necessary equipment and drugs must be available to support recovery and to manage any complications that may arise.

The decision to discharge the patient is the responsibility of the sedationist, with each patient being assessed on an individual basis. Verbal and written instructions for the post-operative period must be provided for both the patient and the responsible adult escort. Examples of the written instructions are provided in Section 4: Patient information and in Appendix 3. They must include the post-operative risks, pain control and possible post-operative complications together with the aftercare arrangements and emergency contacts.

Patients should be formally assessed for suitability for discharge from the clinical area where sedation has taken place. Discharge criteria include:

1. The patient is orientated in time, place and person.

2. Vital signs are stable and within normal limits for the patient. Respiratory status is not compromised.

3. Pain and discomfort have been addressed.

4. Where relevant, haemostasis has been observed.

5. The cannula, where inserted, has been removed.

6. The responsible escort is present and arrangements

have been made for supervision as advised by the sedationist.

7. Written and verbal post-operative instructions appropriate for both the sedation and the dental treatment have been given to the patient and escort/carer.

8. Advice has been given regarding precautions in the post-sedation period. This must be related to the dental treatment and the use of any local analgesia, the type of sedation and their duration. The precautions should include not drinking alcohol, operating machinery, driving or making important decisions for a specified period of time.

9. Arrangements for post-operative analgesia have been made where appropriate.

10. Arrangements are in place for out-of-hours advice.

in life support. The role of each of member of the team must be clearly defined and the procedures to be followed known and rehearsed at regular intervals. There must be evidence of regular

scenario-based team training in the management of potential complications associated with conscious sedation. The provider of dental care and the provider of the sedation service must be

able to maintain life support for a patient until such time as the emergency services are able to attend.

22

CLINICAL GOVERNANCE AND AUDIT

Records of the audit process and outcomes from them must be maintained and be available for inspection. Regular high quality audit is an essential component of a service and is considered to be a core requirement for those delivering conscious sedation for patients.

In addition, clinical governance, clinical effectiveness and regular audit form a central part of risk management. In NHS institutions there are computerised reporting systems where clinical incidents must be recorded. Independent practitioners should parallel these processes to investigate all adverse events. Sedation teams must maintain high quality full clinical records and a written or electronic clinical log. Each clinical team must maintain continuous and contemporaneous records of the number and types of sedation cases performed as well as the rate of any complications that may have arisen.

Safe Sedation Practice for Healthcare Procedures5 describes a number of critical incidents

that should be reported and investigated locally. Midazolam over-sedation and failure to monitor oxygen saturation during sedation (other than during inhalation sedation with nitrous oxide/oxygen) are defined as ‘never events’ by the Department of Health in England.22 These must be reported centrally in England and Wales to the National Reporting and Learning System23 and, if applicable, to the body commissioning the care.

This report recommends the use of a national system for recording adverse clinical incidents by all dentists, doctors and healthcare professionals who provide or directly support sedation for the delivery of dental care. This should be used both in NHS services and in the independent sector. The Safe Anaesthesia Liaison Group (SALG)24 aims to highlight potential or existing patient safety issues that fall in the anaesthesia care pathway. Part of the remit of SALG is to encourage incident reporting for the purpose of learning, which is facilitated by the confidential nature of the reports.

It is recommended that the use of this well-established mechanism by all those engaged in the delivery of conscious sedation in dentistry is explored.

Clinical governance and audit

Conscious sedation procedures must be the subject of robust and regular audit in which all members of the team take part. The focus must be an ongoing review of procedures and processes with analysis of outcomes and modifications made to procedures and techniques as necessary.

23

Both knowledge and clinical skills must be maintained. It is the responsibility of individual team members to ensure that relevant continuing professional development to maintain knowledge, skills and competence is undertaken at appropriate intervals.25

For revalidation in a sedation technique, a practitioner must undergo a minimum of 12 hours of continuing professional development every 5 years that are relevant to the techniques practised. This applies to dentists, medical practitioners, recovery nurses, dental care professionals and all members of the team providing conscious sedation. Practitioners not regularly practising a technique must consider either the need for mentoring and/or retraining or discontinuing its use. (FAQ 10).

Educational courses intended to provide training in clinical delivery

of conscious sedation and to prepare the team for independent practice must be assessed, be externally quality assured and incorporate supervised clinical practice. The IACSD through the dental faculties of the UK surgical royal colleges will accredit all courses in conscious sedation for dentistry other than those run by UK universities, Health Education England, NHS Education for Scotland, the Wales Deanery, the Northern Ireland Medical and Dental Training Agency, and Schools of Anaesthesia where quality assurance mechanisms including supervised clinical practice are in place. The Certificate in Dental Sedation Nursing of the National Examining Board for Dental Nurses (or any equivalent qualification from other accredited awarding bodies) is the recognised pathway for dental nurses wishing to train in the care of patients being treated under conscious sedation.26

Furthermore, through the dental faculties of the UK surgical royal colleges, the IACSD will form a sub-committee to accredit other providers of clinical courses for conscious sedation in dentistry. The membership of this sub-committee will contain appropriate experience and clinical expertise in dental sedation techniques as well as the assessment and quality assurance of education and training. Accreditation for a course can be retained for three years assuming there are no substantive changes to the programme. Appendix 2 sets out the requirements for course accreditation. (FAQ 4, 12, 14).

The content to be covered in the education and training of the dental team is described in the syllabuses in Appendix 1. These are derived from current documents produced by specialist societies,27–29 expert groups4,26,29–32

and royal colleges.33 There is a further separate syllabus for

Education and trainingThis report defines the standards for education and training in conscious sedation in the UK, the details of which are provided in Section 5: Education and training and in Appendix 1. All members of the delivery and care team must have undertaken appropriate validated education and training and demonstrated an acceptable level of competence by means of a robust assessment process. Courses that are solely didactic and skills-based without supervised clinical practice, assessment and external quality assurance do not constitute sufficient training for unsupervised practice in those clinical techniques.

EDUCATION AND TRAINING

24

EDUCATION AND TRAINING

anaesthetists published by the Royal College of Anaesthetists.34

The syllabuses are preceded by a table of generic learning outcomes for training in conscious

sedation in dentistry. Each of the five syllabuses is a standalone element.

Syllabus 1: Dentists: Basic conscious sedation techniques for children, young people and adults

Syllabus 2: Dentists: Advanced conscious sedation for young people and adults

Syllabus 3: Dentists: Advanced conscious sedation for children

Syllabus 4: Dental hygienists and therapists: Inhalation sedation

Syllabus 5: Dental nurses: Assisting during conscious sedation

The generic learning outcomes and the five syllabuses are contained in Appendix 1.

25

SectionsThe further details of the report are provided in five sections:

1. Care pathways2. Sedation techniques3. Peri-operative care4. Patient information5. Education and training

SECTIONS

Section 1: Care pathwaysPrimary dental care provides the majority of NHS dentistry across the UK, with community/salaried and hospital dental services providing additional care when required because of patient need and complexity. The data on sedation delivered to support care in hospitals are combined with those for general anaesthesia and information on the level of sedation services is not obtainable separately. Sedation services are also available in conjunction with private dental care and these data are not accessible. A report in Northern Ireland, however, suggests that just over half of sedation services are provided in the private sector.35

The data from England indicate that there is currently a static overall volume of sedation services provided each year in primary dental care under the present system of commissioned NHS care. In 2013–2014, there were circa 136,000 courses of treatment involving the use of conscious sedation.36

In-depth analysis reveals that there is marked variation, suggesting

inequalities in access to NHS sedation services. There is variation in the rate of provision by region, age and socio-economic status. There is evidence of children and adults from all age groups having sedation as an adjunct to care with the peak age-band being children aged 6–12 years. Across almost all age groups, children and adults from more deprived areas make greater use of NHS sedation services. This indicates a clear social gradient that mirrors poor oral health and less frequent uptake of dental care. In Wales, the majority of sedation services are provided by the community dental service, with adults making up the majority of patients, which reflects the role of the community dental service in providing special care dentistry.

Research suggests that the need for sedation services may be higher than the level of current provision and that while most patients receiving sedation services do require this support, a minority may not.37–40

Patients should receive the appropriate support for care at the right time and in the right place. This report highlights the importance of having access to a range of supportive approaches to enable good ‘behaviour management’ through access to ‘behavioural therapies’ such as cognitive behavioural therapy41 as well as conscious sedation and general anaesthesia services. The provision of dental care in the NHS in the UK is moving towards the establishment of appropriate care pathways.42 The definition of care pathways describes a methodology for the mutual decision-making and organisation of care for a well-defined group of patients during a well-defined period.

A ‘whole systems approach’43 should be taken to examine the level of need nationally (and locally) across service providers, with a care pathway approach being used to ensure that dental professionals have access to the necessary support services for their patients across healthcare organisations. This will ensure that patients receive

26

SECTIONS

appropriate care at each stage of their dental journey. In support of this, planners and commissioners of services should audit the provision of these adjuncts to care, by assessing access, quality and capacity to meet need. The systems approach would examine the need of the people in the system and prioritise provision of services for those in greatest need. Information on local access to the full range of adjuncts should be clearly available for patients and dental

care providers, with the needs of the patients being paramount in a patient-centred healthcare system.43

By way of an example, a generic care pathway for child patients is shown in Figure 2. This provides guidance on the most appropriate management of anxiety to facilitate optimal dental care and to determine the environment in which such care should be delivered. In respect of the dental care of

children, additional clinical guidance for dentists is available.44–49

The use of this type of guidance provided by expert clinical groups is to be encouraged. It is anticipated that care pathways will become increasingly common in dentistry and that they will facilitate the commissioning of government-funded dental services, including those for conscious sedation in the provision of dental care.

Primary care dental practitioner providing dental care with simple behaviour management techniques in primary care

REFERRALChildren and young people (0-16 years) presenting with complex oral health needs.

Children under 12 years whose oral health needs are not met with care under LA or LA/IS. Young people (12-16 years) whose oral health needs are not met with care under LA or LA/IS or LA/midazolam (all routes).

Assessment by teams having skills equivalent to and expected of specialists or consultants in paediatric dentistry in CDS/secondary care

Primary care dental practitioner, with appropriate sedation training, providing young people (12-16

years) with single drug technique midazolam (IV, oral or transmucosal) in primary care

These units providing oral rehabilitation and surgical treatments for children and young people, in conjunction with a team having skills equivalent to and expected of a consultant in anaesthesia competent in sedation for dentistry

using advanced sedation techniques or elective general anaesthesia, in a facility with services equivalent to an NHS Acute Trust

Primary care dental practitionerproviding IS for all ages in primary care

These units providing IS for all ages and, with appropriate sedation training, single

drug technique midazolam (IV, oral or transmucosal) for young people

(12-16 years) in CDS/secondary care

First dental visit Primary care

CDS / secondary care

Figure 2A care pathway for children and young people aged 0–16 yearsCDS = community dental services (formerly: salaried dental services) – in Scotland: public dental service;IS = inhalation sedation; IV = intravenous; LA = local analgesia

27

The techniques available for conscious sedation in dentistry are tabulated below. The contents should be read in conjunction with the notes that follow the table. Table 1 specifies:

• the level of education and training required of the practitioner and quantifies the supervised clinical practice required to demonstrate competence

• the necessary life support skills for all team members

• the minimal monitoring requirements

• the nature of the clinical team required to deliver each modality

• the setting where the modality may be provided

Further details of the skills and knowledge required by the operator-sedationist and/or the sedationist and the other members of the team may be found in Appendix 1.

SectionsSection 2: Clinical sedation techniques

28

Initi

al th

eory

an

d sk

ills

trai

ning

Addi

tiona

l th

eory

and

sk

ills t

rain

ing

Reco

mm

ende

d m

inim

um

clin

ical

exp

erie

nce

in

mon

itore

d pr

actic

e to

ac

hiev

e co

mpe

tenc

y (n

umbe

r of c

ases

ap

prop

riate

to a

ge g

roup

)

Life

supp

ort

trai

ning

for

all t

eam

m

embe

rs

Oth

er re

scue

m

easu

res (

vi)

Mon

itorin

g (in

add

ition

to

clin

ical

)*O

pera

tor-

seda

tioni

st

(with

seco

nd

appr

opria

te

pers

on)

Dent

al

nurs

e tr

aini

ng

(viii

)

Envi

ronm

ent

(prim

ary

= 1;

seco

ndar

y =

2) (i

x)

Nitr

ous o

xide

/ ox

ygen

(i)(i

i)Y

N10

ILS

PILS

Resp

dep

Ai

rway

YCD

SN /

equi

vale

nt1/

2

Mid

azol

am, i

ntra

veno

us (i

)(ii)

YAd

ults

: N

Paed

s: Y

20IL

S PI

LSRe

sp d

ep

Airw

ayN

IBP

Puls

e ox

imet

ryY

CDSN

/ eq

uiva

lent

1/2

Tem

azep

am, o

ral (

i)(ii)

YAd

ults

: N

Paed

s: Y

10IL

S PI

LSRe

sp d

ep

Airw

ayN

IBP

Puls

e ox

imet

ryAd

ults

: Y

Paed

s: N

/ACD

SN /

equi

vale

nt1/

2

Mid

azol

am, o

ral (

i)(ii)

YAd

ults

: N

Paed

s: Y

10IL

S PI

LSRe

sp d

ep

Airw

ayN

IBP

Puls

e ox

imet

ryY

CDSN

/ eq

uiva

lent

1/2

Mid

azol

am, i

ntra

nasa

l (i)(

ii)Y

Adul

ts: N

Pa

eds:

Y10

ILS

PILS

Resp

dep

Ai

rway

NIB

P Pu

lse

oxim

etry

YCD

SN /

equi

vale

nt1/

2

Opi

oid

+ m

idaz

olam

(i)(i

i)(iii

)Y

Y20

ILS

PILS

Resp

dep

Ai

rway

NIB

P Pu

lse

oxim

etry

(C

ap) (

vii)

Adul

ts: Y

Pa

eds:

NCD

SN +

Ad

ult:

1/2

Paed

s: 2

Keta

min

e (a

ll ro

utes

) (i)(

ii)(iv

)Y

Y20

ILS

PILS

Resp

dep

Ai

rway

NIB

P Pu

lse

oxim

etry

(C

ap) (

vii)

NCD

SN +

Ad

ult:

1/2

Paed

s: 2

Mid

azol

am, P

CS (i

)(ii)(

v)Y

Y20

ILS

PILS

Resp

dep

Ai

rway

NIB

P Pu

lse

oxim

etry

(C

ap) (

vii)

Adul

ts: Y

Pa

eds:

N/A

CDSN

+

1/2

Prop

ofol

, PCS

(i)(i

i)(v)

YY

20IL

S PI

LSRe

sp d

ep

Airw

ayN

IBP

Puls

e ox

imet

ry

(Cap

) (vi

i)

Adul

ts: Y

Pa

eds:

N/A

CDSN

+1/

2

Prop

ofol

, TCI

(i)(i

i)Y

Y20

ILS

PILS

Resp

dep

Ai

rway

NIB

P Pu

lse

oxim

etry

(C

ap) (

vi)

N–

2

Mid

azol

am +

pro

pofo

l (i)(

ii)Y

Y20

ILS

PILS

Resp

dep

Ai

rway

NIB

P Pu

lse

oxim

etry

(C

ap) (

vii)

N–

2

Sevo

flura

ne (i

)(ii)

YY

20IL

S PI

LSRe

sp d

ep

Airw

ayN

IBP

Puls

e ox

imet

ry

(Cap

) (vi

i)

N–

2

Sevo

flura

ne +

nitr

ous

oxid

e / o

xyge

n (i)

(ii)

YY

20IL

S PI

LSRe

sp d

ep

Airw

ayN

IBP

Puls

e ox

imet

ry

(Cap

) (vi

i)

N–

2

Table 1Requirements for clinical sedation techniques. (FAQ 4, 16, 23, 24).

SECTIONS

Cap

= ca

pnog

raph

y; C

DSN

= C

ertif

icat

e in

Den

tal S

edat

ion

Nur

sing

; ILS

= Im

med

iate

Life

Sup

port

; N/A

= n

ot a

pplic

able

; NIB

P =

non-

inva

sive

blo

od p

ress

ure

mon

itorin

g; P

CS =

pa

tient

-con

trol

led

seda

tion;

PIL

S =

Paed

iatr

ic Im

med

iate

Life

Sup

port

; Res

p de

p =

resp

irato

ry d

epre

ssio

n; T

CI =

targ

et-c

ontr

olle

d in

fusi

on*S

ee a

lso

Sect

ion

3: P

eri-o

pera

tive

care

29

Notes:

i) AgePatients who have not reached puberty are physiologically immature and will require a sedation team member having paediatric resuscitation skills. Providers and commissioners will need to consider this when planning services for this group of patients.

Any child under 12 years of age with complex oral needs or any child under 12 years who cannot be managed with either:

a) behavioural management techniques/local analgesia

or

b) local analgesia plus inhalation sedation

with the responsible dental practitioner having received appropriate training should be referred to a team having skills equivalent to those expected of a specialist/consultant in paediatric dentistry and a consultant in anaesthesia competent in sedation for dentistry for assessment and treatment in a facility equivalent to an NHS Acute Trust in England.* This would include care provided by a managed clinical network or a recognised care pathway.

Any young person aged 12–16 years with complex oral needs or any young person aged 12–16 years who cannot be managed with either:

a) behavioural management techniques/local analgesia

or

b) local analgesia plus inhalation sedation

or

c) local analgesia plus midazolam (all routes)

with the responsible dental practitioner having received appropriate training should be referred to a team having skills equivalent to those expected of a specialist/consultant in paediatric dentistry and a consultant in anaesthesia competent in sedation for dentistry for assessment and treatment in a facility equivalent to an NHS Acute Trust in England.* This would include care provided by a managed clinical network or a recognised care pathway. (FAQ 18, 20, 21).

ii) TerminologyOver the last decade, the terms ‘standard’/‘alternative’ and ‘basic’/‘advanced’ have been used to differentiate the most commonly employed sedation techniques from those used to manage the small number of patients for whom the simpler techniques do not provide appropriate anxiolysis. For adults, the first five techniques in Table 1 are ‘standard’ or ‘basic’ (but note that competency in intravenous sedation is mandatory for oral and intranasal sedation). For children under 12 years of age, only nitrous oxide/oxygen is considered to be ‘basic’. The ‘basic’ techniques all have an excellent safety record and are of proven efficacy for a wide range of patients.

The vast majority of patients (probably >95%) may be managed using one of these simple and cost-effective techniques, which are suitable for use by an appropriately trained and experienced operator-sedationist. However, it is essential that both training and experience are relevant to the age group being managed. It should also be borne

*Scotland: an NHS Board; Wales: a Health Board; Northern Ireland: a Health and Social Care Trust

30

in mind that what are normally considered to be operator-sedationist techniques may sometimes be more effective and/or safer when the sedation is provided by a dedicated sedationist and a separate operator, for example when:

• the patient is medically compromised, has a physical disability or is emotionally challenging • either the operator or the sedationist is relatively inexperienced • the patient has a history of being particularly difficult to manage • the dental procedure is complex or prolonged • patients are at the extremes of age

iii) Opioid + midazolamThe use of a small single dose of an opioid (most commonly fentanyl) followed by titrated midazolam (intravenous) is considered suitable for the operator-sedationist working in a primary care setting on condition that the dentist and second appropriate person have successfully completed recognised training programmes, have an appropriate level of experience, and that only American Society of Anesthesiologists (ASA) grade I and II adults (>16 years of age) are treated.

iv) KetamineKetamine is increasingly being used for paediatric conscious sedation in the UK, either alone or in combination with midazolam. Evidence that paediatric patients may be better managed using ketamine alone is accumulating but until this is published, it is impossible to offer detailed guidance. It should therefore currently only be used by an appropriately trained and experienced dedicated sedationist who is not also carrying out the dental treatment. This applies to all age groups.

v) Patient-controlled sedationThe IACSD is unaware of anyone currently providing patient-controlled sedation for paediatric dental sedation. The availability of licensed delivery systems and further dentistry-specific research might clarify the safety and efficacy of this technique.

vi) Management of complicationsThe term ‘rescue’ derives from anaesthetic practice and means the ability to respond appropriately to correct the adverse physiological consequences that can sometimes accompany inadvertent over-sedation (i.e. hypoventilation, loss of airway and hypoxia), for example if the patient unintentionally becomes deeply sedated, overshooting the intended target state of conscious sedation. As applied to conscious sedation for dentistry, it is taken to mean that a dentist using conscious sedation must be able to manage deep sedation and its attendant risks.

Anyone providing conscious sedation must be able to manage any event that might reasonably arise. The changing requirements from the GDC and the Resuscitation Council (UK) are reflected in this report.50–53 All the IACSD syllabuses (Appendix 1) state that practitioners must be able to perform Immediate Life Support/Paediatric Immediate Life Support, depending on the patient’s age, and that they must be able to recognise and manage sedation-related complications (including over-sedation, respiratory depression/apnoea, unconscious patient, airway obstruction, vomiting, idiosyncratic responses, delayed recovery, failure of conscious sedation). ‘Deployable’ airway competencies (including basic airway manoeuvres, the use of airway adjuncts and the ability to administer positive pressure ventilation) are mandatory. The widespread establishment of high-fidelity clinical skill and resuscitation teaching centres has facilitated the acquisition of these mandatory skills. (FAQ 16, 17).

vii) CapnographySampled exhaled gas or transcutaneous capnography may be appropriate for some ‘at risk’ ASA grade III/IV dental patients, particularly those receiving supplemental oxygen during sedation. However, despite the growing pressure for it to be used universally in the UK, until the results of dentistry-specific research are available, its routine use for ASA grade I and II dental patients lacks high level scientific validation and cannot be recommended. (FAQ 25).

SECTIONS

31

viii) Dental nurse trainingDental sedation nurses (referred to historically as ‘the second appropriate person’) must be trained and experienced in the sedation technique being used. The National Examining Board for Dental Nurses (NEBDN) offers a qualification in dental sedation nursing (the Certificate in Dental Sedation Nursing [CDSN]) but, at present, less than 10% of sedation nurses have gained this award. Employers should encourage all sedation nurses to work towards this or an equivalent qualification. The CDSN is based on the relevant IACSD education and training syllabus contained in this report. ‘CDSN +’ indicates that additional drug/technique-specific training is required in addition to the CDSN. (FAQ 12, 13, 14, 15).

ix) EnvironmentIrrespective of the clinical setting, where multiple drugs (e.g. fentanyl/midazolam) or anaesthetic drugs (propofol, sevoflurane) are used to provide conscious sedation, the sedation team must have immediate access to the equivalent range of skills and facilities to be found in an NHS Acute Trust* for the prompt recognition and immediate management of adverse events. The classification of the environment as ‘primary’ and ‘secondary’ in Table 1 is convenient but must be interpreted sensibly as the facilities available in some primary care settings exceed those of some hospitals.

*Scotland: an NHS Board; Wales: a Health Board; Northern Ireland: a Health and Social Care Trust

32

SectionsSection 3: Peri-operative care

During conscious sedation the patient responds to verbal commands. Cognitive function and physical co-ordination may be impaired but airway reflexes, ventilatory and cardiovascular functions are little affected. The sedationist or other person who has capability within his or her scope of practice must monitor the patient throughout the procedure. As well as monitoring the depth of sedation and the patient’s comfort, there must be a written contemporaneous record of the clinical and electro-mechanical monitoring of physiological systems required for specific sedation techniques.

The recommendations in Table 2 apply to ASA grade I/II patients receiving conscious sedation for dental treatment. Clinical monitoring involves checking the level of consciousness/depth of sedation, airway patency, respiration (rate and depth), skin colour, capillary refill, pulse

rate, rhythm and volume while non-invasive blood pressure (NIBP) monitoring also records heart rate. NIBP is not essential in children. Intra-operative measurements may be useful in longer cases. Pulse oximetry provides a visual display and audible indication of arterial

oxygen saturation as well as heart rate and rhythm. Audible alarms must not be silenced. Additional monitoring (e.g. end-tidal or transcutaneous capnography, electrocardiography) may be appropriate for ASA grade III/IV patients, particularly those with chronic lung disease.

SECTIONS

33

Table 2Intra-operative care and monitoring. (FAQ 24).

NIBP = non-invasive blood pressure; PCS = patient-controlled sedation; TCI = target-controlled infusion

Pre-

oper

ativ

ely

(‘Bas

elin

e’)

Intr

a-op

erat

ivel

yPo

st-o

pera

tivel

y(S

tage

1: u

nabl

e to

wal

k to

reco

very

)Po

st-o

pera

tivel

y(S

tage

2: a

mbu

lant

with

esc

ort)

Nitr

ous o

xide

/ ox

ygen

Clin

ical

Clin

ical

Clin

ical

Clin

ical

Mid

azol

am, i

ntra

veno

usCl

inic

alN

IBP

Puls

e ox

imet

ry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

P

Tem

azep

am, o

ral

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

P

Mid

azol

am, o

ral

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

P

Mid

azol

am, i

ntra

nasa

lCl

inic

alN

IBP

Puls

e ox

imet

ry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

P

Opi

oid

+ m

idaz

olam

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

P

Keta

min

e (a

ll ro

utes

)Cl

inic

alN

IBP

Puls

e ox

imet

ry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

P

Mid

azol

am, P

CSCl

inic

alN

IBP

Puls

e ox

imet

ry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

P

Prop

ofol

, PCS

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

P

Prop

ofol

, TCI

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

P

Mid

azol

am +

pro

pofo

lCl

inic

alN

IBP

Puls

e ox

imet

ry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

P

Sevo

flura

ne +

nitr

ous

oxid

e / o

xyge

nCl

inic

alN

IBP

Puls

e ox

imet

ry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

PPu

lse

oxim

etry

Clin

ical

NIB

P

34

SectionsSection 4: Patient information

The report has emphasised the importance of full and comprehensive information being provided for patients, parents and carers. Examples of information for patients, those with parental responsibility and carers are provided both in this section and in Appendix 3. It is intended that these will form helpful guidance for dentists in the drafting of locally developed patient information, which must be given to patients in both verbal and written form. The issuing of correct and comprehensive patient information forms one essential aspect of valid consent.

Clear information must be provided that prepares patients for dental treatment under sedation. This information should explain the procedure, the pharmacological process, and the benefits and risks associated with the selected form of sedation.

It should be imparted as part of a face-to-face explanation to the patient at the time of clinical pre-operative assessment and must then be supported by the provision of written information. Best practice in the process of consent dictates that this information should be provided prior to the day of the procedure. In addition, information must be provided for patient escorts. For paediatric dentistry, information for those with parental responsibility and carers is also required, together with age appropriate information for the child or older adolescent.

Examples for children, young people, adults, parents and those with parental responsibility are given in Appendix 3. All the examples have been reviewed by both clinicians and lay representatives.

The examples meet the requirements of plain English and have been approved by the dental faculties of the surgical royal colleges and the Royal College of Anaesthetists. They can be reproduced in their entirety with this acknowledgement. The examples may also be amended to meet the specific requirements of the clinician, in which case their approval by the royal colleges is no longer valid.

In Wales, there must be compliance with the Welsh Language Act.

The following core information must be included in any locally developed patient information:

What is conscious sedation?

This information must:• explain the need for a robust

medical assessment to ascertain a full medical, dental and social history prior to treatment

• give advice on other options and alternatives

• explain the fact that consciousness is maintained, and the difference between the effect of sedation and general anaesthesia

• explain the consent process• give clear guidance on fasting• explain what to expect during

the recovery period• explain clearly the requirement

for a competent escort at discharge home

• describe the risks and benefits of the proposed type of sedation

SECTIONS

35

What is inhalation sedation?

This information should:• describe the use and

administration of nitrous oxide/oxygen through a nosepiece

• explain the likelihood of any particular effects this might have and the need for care on discharge

• describe clearly the associated risks and the consent process

For paediatric patients, under the age of 16 years, information should be provided for parents or those with parental responsibility.

What is intravenous sedation?

This information should:• give the reasons for the use of

intravenous sedation• explain its method of

administration• describe the process and the

specific drug(s) to be used• describe clearly the associated

risks and the consent process• confirm the need for a patient

escort

In addition to information for adults, age appropriate information should be provided for older adolescents. Information must also be provided for parents or those with parental responsibility.

For intravenous sedation with multiple agents, there must be (in addition to the previously stated

information) a clear explanation of the rationale for the technique. Explicit information regarding heightened risk to enable valid consent must be included.

What is oral sedation?

The information should:• explain the nature of oral

sedation to include the unpredictability of effect

• clarify that the sedative drug is given under the direct supervision of the sedationist, and reinforce the distinction between oral sedation and pre-medication

• confirm the need for intravenous access during the procedure

• describe clearly the associated risks and the consent process

• confirm the need for a patient escort

In addition to information for adults, information must also be provided for parents or those with parental responsibility.

What is transmucosal sedation?

The information should:• explain the administration of

the drugs via a nasal spray• explain the time to effect of the

sedation and confirm the need for intravenous access during treatment

• describe clearly the risks and benefits as well as the consent process, with consideration being given to the specific

requirements regarding consent and limited capacity

• confirm the need for a patient escort

The information provided to patients must reflect the clinical guidance in relation to risk, consent, fasting and age appropriate sedation as stated in this report. (FAQ 26).

36

SectionsSection 5: Education and training

The following generic learning outcomes and syllabuses have been produced as a guide for both those currently practising or planning to practise conscious sedation for dentistry as well as those who provide or plan to provide education and training in conscious sedation for dentistry. These apply not only to the dental team but also to medical practitioners wishing to provide conscious sedation for dental procedures. Anaesthetists will follow the syllabus of the Royal College of Anaesthetists. It is envisaged that practitioners will map their education and training to the generic learning outcomes, knowledge, skills and attitudes described in the relevant syllabus, and that course providers (both existing and prospective) will use the information for the development, evaluation and review of their curricula.

The generic learning outcomes provide a high level description of the knowledge, skills and attitudes applicable to all members of the multi-disciplinary team, and encapsulate the broader context in which conscious sedation is delivered in clinical dental practice. As such, these learning outcomes apply to all five syllabuses.

Each syllabus describes the detailed knowledge, skills and attitudes required of specific members of the multi-disciplinary team providing care for dental patients requiring conscious sedation and may relate to a particular area of practice. They contain the following sections:

1. General professional conduct 1.1 Maintaining good clinical

practice 1.2 Relationships with

patients, parents and carers2. Sedation-related content

Courses should be provided by nationally recognised institutions and bodies, and teachers should be appropriately experienced dental sedationists in the techniques that are being taught. Courses designed to lead to independent clinical practice require accreditation, the requirements for which are described in Appendix 2.

Training providers must ensure that all trainees understand the

importance of complying with contemporary guidance relating to the environment, facilities and equipment required for each sedation technique.

Different legal and regulatory frameworks in the devolved authorities may necessitate amendments to some sections of the syllabuses (e.g. consent).

The learning outcomes are specific to the particular drugs listed. The development in the future of new treatment modalities and the regular review of existing ones will necessitate revision of the existing syllabuses as well as provision of specific education and training courses.

SECTIONS

37

It is not envisaged that one course will offer training in the use of all drugs/drug combinations.

Although written for dental professionals, the principles in this document apply to all who administer conscious sedation for dentistry. The syllabuses define the knowledge, skills, attitudes and behaviours required of dental and medical practitioners wishing to train in the administration of conscious sedation for dentistry. This includes those anaesthetists

not in possession of a Certificate of Completion of Training and documented evidence of satisfactory completion of equivalent training in conscious sedation for dentistry under the auspices of a Royal College of Anaesthetists approved training programme.

Appendix 1 contains:

• the generic learning outcomes• Syllabus 1: Dentists: Basic

conscious sedation techniques

for children, young people and adults

• Syllabus 2: Dentists: Advanced conscious sedation for young people and adults

• Syllabus 3: Dentists: Advanced conscious sedation for children

• Syllabus 4: Dental therapists and dental hygienists: Inhalation sedation

• Syllabus 5: Dental nurses: Assisting during conscious sedation

38

Appendix 1:

APPENDICES

The following table describes the generic learning outcomes that should apply to all members of the multi-professional team involved in providing care for dental patients requiring conscious sedation, commensurate with their scope and level of practice. (FAQ 4, 18, 20, 21).

Training in conscious sedation: Generic learning outcomes

39

Dom

ains

of p

ract

ice

Gene

ric le

arni

ng o

utco

mes

On

succ

essf

ul co

mpl

etio

n of

the

prog

ram

me,

pra

ctiti

oner

s sho

uld,

in k

eepi

ng w

ith th

eir s

cope

and

leve

l of p

ract

ice,

be

able

to:

Sugg

este

d te

achi

ng a

nd

lear

ning

met

hod(

s)Su

gges

ted

asse

ssm

ent

met

hod(

s)

Know

ledg

e an

d cr

itica

l un

ders

tand

ing

Dem

onst

rate

an

unde

rsta

ndin

g of

the

role

of c

onsc

ious

seda

tion

tech

niqu

es in

den

tistr

y

Und

erst

and

the

rang

e of

con

trol

of p

ain

and

anxi

ety

tech

niqu

es

Und

erst

and

the

impo

rtanc

e an

d in

fluen

ce th

at th

e pa

tient

’s ge

nera

l hea

lth m

ay h

ave

on th

e us

e of

con

scio

us se

datio

n

Dem

onst

rate

the

know

ledg

e to

pra

ctis

e ef

fect

ive

cons

ciou

s sed

atio

n

Und

erst

and

the

impo

rtanc

e of

com

plyi

ng w

ith c

onte

mpo

rary

gui

danc

e re

latin

g to

the

envi

ronm

ent,

faci

litie

s and

equ

ipm

ent r

equi

red

for

cons

ciou

s sed

atio

n

Dem

onst

rate

a c

ritic

al u

nder

stan

ding

of t

he is

sues

invo

lved

in th

e sc

ient

ific

basi

s of c

onsc

ious

seda

tion

CBL

SDL

ST

FA MSF

PDP

WBA

Inte

llect

ual s

kills

Und

erst

and

limita

tions

, ben

efits

and

risk

s of c

onsc

ious

seda

tion

tech

niqu

es

Reco

gnis

e ow

n lim

itatio

ns, r

efle

ct o

n ex

perie

nces

and

app

reci

ate

the

need

for c

ontin

uing

edu

catio

n

Expl

ain

the

conc

ept o

f mul

ti-di

scip

linar

y ca

re o

f pat

ient

s and

team

wor

k

CBL

SDL

ST

FA MSF

PDP

WBA

Prac

tical

skill

sAs

sess

pat

ient

s who

requ

ire c

onsc

ious

seda

tion

for d

entis

try

Prac

tise

effe

ctiv

e an

d sa

fe c

onsc

ious

seda

tion

Asse

ss re

cove

ry o

f pat

ient

s fro

m c

onsc

ious

seda

tion

Rem

ain

calm

, dec

isiv

e an

d pu

rpos

eful

whi

le h

andl

ing

diffi

culti

es o

r com

plic

atio

ns

ACI

CA CBL

SDL

ST

FA MSF

PDP

WBA

Pers

onal

att

itude

Empa

this

e w

ith p

atie

nts a

nd d

emon

stra

te th

e ab

ility

to c

omm

unic

ate

effe

ctiv

ely

with

pat

ient

s, p

aren

ts, c

arer

s and

col

leag

ues

CA CBL

SDL

ST

MSF

PDP

WBA

Key:

Te

achi

ng a

nd le

arni

ng m

etho

ds

AC

I = a

udit/

criti

cal i

ncid

ent a

naly

sis;

CA

= cl

inic

al a

ttach

men

t; CB

L =

case

-bas

ed le

arni

ng; S

DL =

self-

dire

cted

lear

ning

; ST

= st

ruct

ured

teac

hing

As

sess

men

t met

hods

FA =

form

al a

sses

smen

t; M

SF =

mul

ti-so

urce

feed

back

; PDP

= p

erso

nal d

evel

opm

ent p

ortfo

lio; W

BA =

wor

kpla

ce-b

ased

ass

essm

ent

The

sylla

buse

s tha

t fol

low

are

des

igne

d to

pro

vide

den

tists

, den

tal t

hera

pist

s/hy

gien

ists

and

den

tal n

urse

s with

the

educ

atio

nal e

xper

ienc

e (in

clud

ing

the

know

ledg

e, c

ritic

al u

nder

stan

ding

, int

elle

ctua

l ski

lls, p

ract

ical

skill

s and

pe

rson

al a

ttitu

de) t

o en

able

them

to p

rovi

de e

ffect

ive,

hig

h qu

ality

con

scio

us se

datio

n fo

r den

tal p

atie

nts.

40

Appendix 1:

1. General professional content

1.1 Maintaining good clinical practice

Each learning outcome should be prefaced by: ‘On completion of training, the trainee in basic conscious sedation techniques for children, young people and adults…’

Syllabus 1: Dentists: Basic conscious sedation techniques for children, young people and adults

APPENDICES

41

Subj

ect

Know

ledg

e …

shou

ld b

e ab

le to

des

crib

e:Sk

ills

… sh

ould

be

able

to:

Attit

udes

and

beh

avio

urs

… sh

ould

:Te

achi

ng a

nd le

arni

ng

met

hod(

s)As

sess

men

t m

etho

d(s)

Prof

essi

onal

app

roac

hth

e re

quire

men

ts o

f an

effe

ctiv

e de

ntal

se

datio

nist

the

diffe

rent

mod

els o

f wor

king

as p

art

of a

team

prov

ide

basi

c co

nsci

ous s

edat

ion

tech

niqu

esbe

have

in a

pro

fess

iona

l man

ner

CBL

MSF

PDP

Life

-long

lear

ning

the

requ

irem

ents

for c

ontin

uing

pr

ofes

sion

al d

evel

opm

ent

reco

gnis

e an

d ta

ke a

dvan

tage

of l

earn

ing

oppo

rtun

ities

for a

ll m

embe

rs o

f the

team

pr

ovid

ing

basi

c co

nsci

ous s

edat

ion

mai

ntai

n a

pers

onal

dev

elop

men

t por

tfolio

and

as

sist

oth

ers i

n do

ing

so

mon

itor o

wn

perfo

rman

ce th

roug

h au

dit a

nd

feed

back

com

ply

with

Gen

eral

Den

tal C

ounc

il re

quire

men

ts fo

r rev

alid

atio

nCB

L

SDL

ST

PDP

WBA

Evid

ence

the

prin

cipl

es o

f evi

denc

e-ba

sed

prac

tice

criti

cally

app

rais

e ev

iden

ce

prov

ide

cons

truc

tive

feed

back

use

evid

ence

in su

ppor

t of p

atie

nt c

are

and

to

defe

nd d

ecis

ions

take

nST

WBA

Writ

ten

reco

rds

the

prin

cipl

es a

nd g

uide

lines

for g

ood

clin

ical

not

e ke

epin

g

the

reas

ons f

or c

onfid

entia

lity

com

mun

icat

e ef

fect

ivel

y th

roug

h w

ritte

n re

cord

s

appl

y th

e pr

inci

ples

of c

onfid

entia

lity

in th

e co

ntex

t of w

ritte

n re

cord

s

take

acc

ount

of c

onfid

entia

lity

requ

irem

ents

an

d le

gal r

equi

rem

ents

rela

ting

to w

ritte

n,

elec

tron

ic a

nd d

igita

l rec

ords

, and

thei

r tra

nspo

rt a

nd st

orag

e

CBL

ST

WBA

Use

of in

form

atio

n te

chno

logy

the

prin

cipl

es o

f ret

rieva

l and

util

isat

ion

of d

ata

reco

rded

in c

linic

al sy

stem

sap

ply

the

prin

cipl

es o

f con

fiden

tialit

y in

the

cont

ext o

f inf

orm

atio

n te

chno

logy

take

acc

ount

of t

he le

gal a

spec

ts re

latin

g to

ho

ldin

g el

ectr

onic

and

dig

ital r

ecor

ds

dem

onst

rate

a p

ositi

ve a

nd p

roac

tive

attit

ude

to n

ew te

chno

logy

ACI

ST

WBA

Org

anis

atio

nal f

ram

ewor

k fo

r clin

ical

gov

erna

nce

and

its a

pplic

atio

n in

pra

ctic

e

the

elem

ents

of c

linic

al g

over

nanc

e

the

prin

cipl

es o

f clin

ical

gov

erna

nce,

in

part

icul

ar re

late

d to

infe

ctio

n co

ntro

l

part

icip

ate

activ

ely

in c

linic

al g

over

nanc

e

part

icip

ate

in a

udit

repo

rt se

rious

unt

owar

d in

cide

nts

reco

gnis

e th

e im

porta

nce

of te

amw

ork

in im

plem

entin

g a

clin

ical

gov

erna

nce

fram

ewor

k

reco

gnis

e an

d ta

ke a

ccou

nt o

f the

lear

ning

fro

m se

rious

unt

owar

d in

cide

nts

ACI

SDL

ST

PDP

WBA

Risk

ass

essm

ent a

nd ri

sk

man

agem

ent

the

prin

cipl

es o

f ris

k as

sess

men

tca

rry

out r

isk

asse

ssm

ents

deve

lop

and

appl

y re

leva

nt p

roce

dure

s

deve

lop

and

mon

itor a

ctio

n pl

ans t

o ob

viat

e fu

rthe

r ris

k

reco

gnis

e th

e va

lue

of ri

sk a

sses

smen

tsAC

I

CBL

WBA

Audi

t (ge

nera

l)th

e pr

inci

ples

of i

nter

nal a

nd e

xter

nal

qual

ity a

ssur

ance

the

audi

t pro

cess

initi

ate

and

com

plet

e au

dit p

roje

cts

dem

onst

rate

impr

ovem

ent a

s the

resu

lt of

aud

it

reco

gnis

e th

e be

nefit

of a

udit

to p

atie

nt c

are

and

indi

vidu

al p

erfo

rman

ceAC

I

ST

PDP

WBA

Guid

elin

esth

e co

nten

t of g

uide

lines

app

licab

le

to th

e pr

actic

e an

d de

liver

y of

bas

ic

cons

ciou

s sed

atio

n te

chni

ques

inte

rpre

t and

app

ly g

uide

lines

app

licab

le to

the

prac

tice

and

deliv

ery

of b

asic

con

scio

us se

datio

n te

chni

ques

show

rega

rd fo

r ind

ivid

ual p

atie

nt n

eeds

w

hen

utili

sing

gui

delin

esAC

I

CBL

ST

PDP

WBA

42

Patie

nt sa

fety

the

prin

cipl

es o

f Im

med

iate

Life

Sup

port

the

man

agem

ent o

f med

ical

em

erge

ncie

s in

the

dent

al su

rger

y

the

prin

cipl

es o

f man

agem

ent o

f fitn

ess

to p

ract

ise

case

s

the

role

of o

rgan

isat

ions

cha

rged

with

en

surin

g pa

tient

safe

ty

perfo

rm Im

med

iate

Life

Sup

port

inst

igat

e m

anag

emen

t of m

edic

al

emer

genc

ies i

n th

e de

ntal

surg

ery

show

rega

rd fo

r pat

ient

safe

ty

reco

gnis

e th

e im

porta

nce

of te

am

train

ing

in th

e m

anag

emen

t of m

edic

al

emer

genc

ies i

n th

e de

ntal

surg

ery

CBL

ST

WBA

Rele

vanc

e of

out

side

bo

dies

the

role

of:

-Gen

eral

Den

tal C

ounc

il -D

epar

tmen

t of H

ealth

-ro

yal c

olle

ges

-spe

cial

ist s

ocie

ties

-def

ence

soci

etie

s -p

atie

nt a

dvoc

acy

grou

ps

com

mun

icat

e w

ith a

nd in

volv

e th

ese

bodi

es in

app

ropr

iate

situ

atio

nsde

mon

stra

te a

ccep

tanc

e of

pro

fess

iona

l re

gula

tion

shar

e be

st p

ract

ice

part

icip

ate

in p

eer r

evie

w

SDL

ST

PDP

WBA

Key:

Te

achi

ng a

nd le

arni

ng m

etho

ds

ACI =

aud

it/cr

itica

l inc

iden

t ana

lysi

s; C

A =

clin

ical

atta

chm

ent;

CBL

= ca

se-b

ased

lear

ning

; SDL

= se

lf-di

rect

ed le

arni

ng; S

T =

stru

ctur

ed te

achi

ng

As

sess

men

t met

hods

FA =

form

al a

sses

smen

t; M

SF =

mul

ti-so

urce

feed

back

; PDP

= p

erso

nal d

evel

opm

ent p

ortfo

lio; W

BA =

wor

kpla

ce-b

ased

ass

essm

ent

APPENDICES

43

Subj

ect

Know

ledg

e …

shou

ld b

e ab

le to

des

crib

e:Sk

ills

… sh

ould

be

able

to:

Attit

udes

and

beh

avio

urs

… sh

ould

:Te

achi

ng a

nd le

arni

ng m

etho

d(s)

Asse

ssm

ent m

etho

d(s)

Info

rmed

cons

ent

the

prin

cipl

es o

f val

id c

onse

nt

the

prin

cipl

es o

f the

Men

tal C

apac

ity

Act 2

00512

and

the

Depr

ivat

ion

of

Libe

rty

Safe

guar

ds54

(Sco

tland

: Ad

ults

with

Inca

paci

ty (S

cotla

nd)

Act 2

00055

and

Adu

lts w

ith

Inca

paci

ty (S

cotla

nd) A

men

dmen

t Re

gula

tions

201

2)56

the

proc

ess f

or g

aini

ng va

lid c

onse

nt

obta

in v

alid

con

sent

in re

latio

n to

yo

ung

peop

le a

nd a

dults

hav

ing

basi

c co

nsci

ous s

edat

ion

tech

niqu

es

asse

ss c

apac

ity a

nd o

btai

n as

sent

w

here

app

ropr

iate

wor

k w

ith o

ther

age

ncie

s to

obta

in a

be

st in

tere

st d

ecis

ion

and

agre

emen

t to

trea

t in

circ

umst

ance

s whe

re th

ere

is la

ck o

f cap

acity

shar

e in

form

atio

n ap

prop

riate

ly

whe

n ne

cess

ary

to sa

fegu

ard

vuln

erab

le a

dults

resp

ect p

atie

nts’

and

par

ents

’/ca

rers

’ aut

onom

y an

d w

ishe

s,

incl

udin

g th

eir r

ight

to re

fuse

tr

eatm

ent e

ven

whe

n tr

eatm

ent

wou

ld b

e in

thei

r bes

t int

eres

ts

CBL

SDL

ST

WBA

Conf

iden

tialit

yre

leva

nt st

rate

gies

to e

nsur

e co

nfid

entia

lity

the

situ

atio

ns w

hen

conf

iden

tialit

y m

ight

be

brok

en

appl

y th

e pr

inci

ples

of c

onfid

entia

lity

in re

latio

n to

clin

ical

car

ere

spec

t the

righ

t to

conf

iden

tialit

yCB

L

SDL

ST

WBA

Lega

l iss

ues

the

lega

l iss

ues r

elat

ing

to th

e pr

actic

e an

d de

liver

y of

bas

ic

cons

ciou

s sed

atio

n te

chni

ques

wor

k w

ithin

rele

vant

lega

l fra

mew

orks

dem

onst

rate

em

path

y w

hile

ac

ting

in th

e pa

tient

’s/fa

mily

’s be

st

inte

rest

s

CBL

SDL

ST

WBA

Key:

Te

achi

ng a

nd le

arni

ng m

etho

ds

ACI =

aud

it/cr

itica

l inc

iden

t ana

lysi

s; C

A =

clin

ical

atta

chm

ent;

CBL

= ca

se-b

ased

lear

ning

; SDL

= se

lf-di

rect

ed le

arni

ng; S

T =

stru

ctur

ed te

achi

ng

As

sess

men

t met

hods

FA

= fo

rmal

ass

essm

ent;

MSF

= m

ulti-

sour

ce fe

edba

ck; P

DP =

per

sona

l dev

elop

men

t por

tfolio

; WBA

= w

orkp

lace

-bas

ed a

sses

smen

t

1.2

Rela

tions

hips

with

pat

ient

s, p

aren

ts a

nd ca

rers

Each

lear

ning

out

com

e sh

ould

be

pref

aced

by:

‘On

com

plet

ion

of tr

aini

ng, t

he tr

aine

e in

bas

ic co

nsci

ous s

edat

ion

tech

niqu

es fo

r chi

ldre

n, y

oung

peo

ple

and

adul

ts…

’

44

Subj

ect

Know

ledg

e …

shou

ld b

e ab

le to

des

crib

e:Sk

ills

… sh

ould

be

able

to:

Attit

udes

and

beh

avio

urs

… sh

ould

:Te

achi

ng a

nd

lear

ning

met

hod(

s)As

sess

men

t m

etho

d(s)

Dent

al a

nxie

tyth

e hi

stor

y of

pai

n an

d an

xiet

y co

ntro

l in

dent

istr

y

the

caus

es, s

igns

and

sym

ptom

s of d

enta

l anx

iety

and

ph

obia

the

spec

trum

of a

nxie

ty m

anag

emen

t tec

hniq

ues,

incl

udin

g be

havi

oura

l/non

-pha

rmac

olog

ical

met

hods

, con

scio

us

seda

tion

and

gene

ral a

naes

thes

ia

the

dist

inct

ion

betw

een

cons

ciou

s sed

atio

n an

d ge

nera

l an

aest

hesi

a

tech

niqu

es fo

r com

mun

icat

ing

with

peo

ple

of a

ll ag

es a

nd

abili

ties

reco

gnis

e ad

vanc

es in

pai

n an

d an

xiet

y co

ntro

l in

dent

istr

y

reco

gnis

e th

e ca

uses

, sig

ns a

nd sy

mpt

oms

of d

enta

l anx

iety

and

pho

bia

appl

y th

eir k

now

ledg

e of

the

spec

trum

of

anxi

ety

man

agem

ent t

echn

ique

s, in

clud

ing

beha

viou

ral/n

on-p

harm

acol

ogic

al

met

hods

, con

scio

us se

datio

n an

d ge

nera

l an

aest

hesi

a

com

mun

icat

e w

ith p

eopl

e of

all

ages

and

ab

ilitie

s

reco

gnis

e th

e va

lue

of e

ffect

ive

pain

an

d an

xiet

y co

ntro

l in

dent

istr

y

dem

onst

rate

a c

arin

g at

titud

e to

an

xiou

s pat

ient

s

dem

onst

rate

a w

illin

gnes

s to

empl

oy th

e m

ost a

ppro

pria

te

anxi

ety

man

agem

ent t

echn

ique

for

indi

vidu

al p

atie

nts

SDL

ST

FA PDP

WBA

Anat

omy

and

phys

iolo

gyan

atom

y an

d ph

ysio

logy

rele

vant

to th

e us

e of

con

scio

us

seda

tion

for d

entis

try,

par

ticul

arly

: - c

ardi

ovas

cula

r - r

espi

rato

ry

- neu

rolo

gica

l

the

anat

omic

al a

nd p

hysi

olog

ical

diff

eren

ces b

etw

een

child

ren,

you

ng p

eopl

e an

d ad

ults

as w

ell a

s how

thes

e re

late

to th

e us

e of

con

scio

us se

datio

n

asse

ssm

ent o

f pre

viou

s and

cur

rent

airw

ay p

robl

ems

to a

ntic

ipat

e po

tent

ial d

iffic

ultie

s dur

ing

seda

tion

or if

ve

ntila

tion

is re

quire

d

appl

y th

eir k

now

ledg

e of

ana

tom

ical

st

ruct

ures

and

phy

siol

ogic

al re

spon

ses i

n pl

anni

ng a

nd p

rovi

ding

con

scio

us se

datio

n

appl

y th

eir k

now

ledg

e of

the

anat

omic

al

and

phys

iolo

gica

l diff

eren

ces b

etw

een

child

ren,

you

ng p

eopl

e an

d ad

ults

in

plan

ning

and

pro

vidi

ng c

onsc

ious

seda

tion

carr

y ou

t airw

ay a

sses

smen

t and

an

ticip

ate

pote

ntia

l diff

icul

ties d

urin

g se

datio

n or

if v

entil

atio

n is

requ

ired

SDL

ST

FA PDP

WBA

Phar

mac

olog

yth

e ap

plie

d ph

arm

acol

ogy

of d

rugs

use

d in

bas

ic c

onsc

ious

se

datio

n fo

r chi

ldre

n, y

oung

peo

ple

and

adul

ts, f

or

exam

ple:

- n

itrou

s oxi

de/o

xyge

n - b

enzo

diaz

epin

es

the

term

inol

ogy

desc

ribin

g le

vels

of s

edat

ion

(min

imal

, co

nsci

ous,

mod

erat

e, d

eep)

and

gen

eral

ana

esth

esia

impo

rtant

dru

g in

tera

ctio

ns:

- bet

wee

n se

datio

n dr

ugs

- of s

edat

ion

drug

s with

oth

er p

resc

ribed

med

icat

ion

diffe

renc

es in

the

phar

mac

okin

etic

and

pha

rmac

odyn

amic

ef

fect

s whe

n dr

ugs a

re a

dmin

iste

red

by d

iffer

ent r

oute

s

appl

y th

eir k

now

ledg

e of

pha

rmac

olog

y of

th

e dr

ugs u

sed

in se

datio

n to

the

prac

tical

si

tuat

ion

in su

ch a

way

as t

o se

lect

dru

gs

that

are

safe

and

app

ropr

iate

for t

he

indi

vidu

al p

atie

nt

appl

y th

eir k

now

ledg

e of

seda

tion

drug

s an

d pr

escr

ibed

med

icat

ion

to a

void

dru

g in

tera

ctio

ns in

the

clin

ical

sett

ing

dem

onst

rate

a w

illin

gnes

s to

use

this

kno

wle

dge

in tr

eatm

ent

plan

ning

as w

ell a

s in

the

prov

isio

n of

bas

ic c

onsc

ious

seda

tion

tech

niqu

es in

adu

lts, a

dole

scen

ts

and

child

ren

SDL

ST

FA PDP

WBA

APPENDICES

2.

Seda

tion-

rela

ted

cont

ent

Each

lear

ning

out

com

e sh

ould

be

pref

aced

by:

‘On

com

plet

ion

of tr

aini

ng, t

he tr

aine

e in

bas

ic co

nsci

ous s

edat

ion

tech

niqu

es fo

r chi

ldre

n, y

oung

peo

ple

and

adul

ts…

’

45

Patie

nt a

sses

smen

tho

w to

obt

ain

accu

rate

and

det

aile

d in

form

atio

n ab

out p

ast a

nd c

urre

nt m

edic

al/s

urgi

cal

cond

ition

s (e.

g. c

urre

nt a

nd p

revi

ous m

edic

atio

n,

alle

rgie

s)

take

a d

etai

led

med

ical

, fam

ily, s

ocia

l and

de

ntal

his

tory

to id

entif

y m

edic

al a

nd su

rgic

al

cond

ition

s tha

t im

pact

on

safe

del

iver

y of

co

nsci

ous s

edat

ion

dem

onst

rate

a w

illin

gnes

s to

use

this

kn

owle

dge

in d

iagn

osis

and

trea

tmen

t pl

anni

ng a

s wel

l as i

n th

e pr

ovis

ion

of

cons

ciou

s sed

atio

n

SDL

ST CA

FA PDP

WBA

whe

n to

ask

for s

peci

alis

t med

ical

adv

ice

or

clar

ifica

tion

of th

e pa

tient

’s m

edic

al h

isto

ry

and

whe

n to

liai

se w

ith p

erso

nnel

from

oth

er

disc

iplin

es

seek

spec

ialis

t med

ical

adv

ice

or c

larif

icat

ion

of th

e pa

tient

’s m

edic

al h

isto

ry a

nd li

aise

with

pe

rson

nel f

rom

oth

er d

isci

plin

es

iden

tify

serio

us p

robl

ems t

hat m

ight

impa

ct o

n sa

fe d

eliv

ery

of c

onsc

ious

seda

tion

and

know

w

hen

to a

sk fo

r cla

rific

atio

n

be w

illin

g to

seek

spec

ialis

t med

ical

adv

ice

or c

larif

icat

ion

of th

e pa

tient

’s m

edic

al

hist

ory

and

to li

aise

with

per

sonn

el fr

om

othe

r dis

cipl

ines

how

info

rmat

ion

abou

t med

ical

pro

blem

s as

soci

ated

with

pre

viou

s con

scio

us se

datio

n or

an

aest

hesi

a m

ay in

fluen

ce fu

ture

man

agem

ent

the

rele

vanc

e of

the

patie

nt’s

ASA

stat

us

pote

ntia

l pro

blem

s rel

atin

g to

the

adm

inis

tratio

n of

con

scio

us se

datio

n fo

r you

nger

and

old

er

patie

nts

asse

ss p

oten

tial p

robl

ems r

elat

ing

to th

e ad

min

istra

tion

of c

onsc

ious

seda

tion

for y

oung

er

and

olde

r pat

ient

s

the

use

of w

eigh

t and

hei

ght d

ata,

gro

wth

cha

rts

and

norm

al ra

nges

to e

stim

ate

a ch

ild’s

stag

e of

ph

ysic

al d

evel

opm

ent

the

sign

ifica

nce

of th

e m

atur

ity o

f airw

ay

deve

lopm

ent a

nd a

ny p

robl

ems t

hat m

ight

aris

e du

e to

airw

ay a

bnor

mal

ities

how

the

patie

nt’s

psyc

holo

gica

l and

de

velo

pmen

tal s

tatu

s may

influ

ence

m

anag

emen

t

carr

y ou

t a p

hysi

cal e

xam

inat

ion

to id

entif

y ch

ildre

n:

- with

serio

us p

robl

ems t

hat m

ight

impa

ct o

n th

e sa

fe d

eliv

ery

of c

onsc

ious

seda

tion

- who

are

not

in th

e no

rmal

rang

e

how

the

plan

ned

dent

al p

roce

dure

may

influ

ence

th

e ch

oice

of c

onsc

ious

seda

tion

tech

niqu

ese

lect

the

mos

t app

ropr

iate

con

scio

us se

datio

n te

chni

que

for t

he p

lann

ed d

enta

l pro

cedu

re

the

asse

ssm

ent o

f the

suita

bilit

y of

per

iphe

ral

vein

s for

can

nula

tion

asse

ss th

e su

itabi

lity

of p

erip

hera

l vei

ns fo

r ca

nnul

atio

n

cons

ider

atio

n of

the

evid

ence

and

gui

danc

e re

latin

g to

fast

ing

reco

gnis

e w

hen

fast

ing

is d

esira

ble

the

prov

isio

n of

pre

- and

pos

t-sed

atio

n in

stru

ctio

ns fo

r pat

ient

s and

esc

orts

in a

n ag

e ap

prop

riate

form

at

prov

ide

pre-

and

pos

t-sed

atio

n in

stru

ctio

ns fo

r pa

tient

s and

esc

orts

in a

n ag

e ap

prop

riate

form

at

appr

opria

te c

omm

unic

atio

n te

chni

ques

for

child

ren,

you

ng p

eopl

e an

d ad

ults

com

mun

icat

e ef

fect

ivel

y w

ith c

hild

ren,

you

ng

peop

le a

nd a

dults

46

Seda

tion

drug

sele

ctio

nth

e pr

oces

s of s

elec

ting

a sa

fe, e

ffect

ive

and

appr

opria

te se

datio

n te

chni

que

in te

rms

of b

oth

the

drug

sele

ctio

n an

d th

e ro

ute

of

adm

inis

tratio

n

choo

se a

safe

, effe

ctiv

e an

d ap

prop

riate

seda

tion

tech

niqu

e in

term

s of b

oth

the

drug

sele

ctio

n an

d th

e ro

ute

of a

dmin

istra

tion

take

acc

ount

of t

he in

dica

tions

and

co

ntra

indi

catio

ns fo

r con

scio

us se

datio

n as

wel

l as t

he v

ario

us a

gent

s and

rout

es o

f ad

min

istra

tion

whe

n pl

anni

ng in

divi

dual

pa

tient

car

e

ACI

CA CBL

SDL

ST

FA MSF

PDP

WBA

the

indi

catio

ns a

nd c

ontra

indi

catio

ns fo

r co

nsci

ous s

edat

ion

usin

g:

- ben

zodi

azep

ines

- n

itrou

s oxi

de/o

xyge

n

the

sele

ctio

n of

the

mos

t app

ropr

iate

age

nts f

or

each

pat

ient

taki

ng in

to a

ccou

nt:

- pro

pose

d de

ntal

trea

tmen

t - a

ge a

nd b

ody

wei

ght

- deg

ree

of a

nxie

ty

- med

ical

his

tory

- p

hysi

cal e

xam

inat

ion

- soc

ial h

isto

ry

- hea

lthca

re e

nviro

nmen

t - h

ealth

care

team

seda

tion

train

ing

and

ex

perie

nce

the

prin

cipl

e of

‘min

imum

inte

rven

tion’

(the

use

of

the

smal

lest

am

ount

of a

sing

le d

rug

or th

e le

ast n

umbe

r of d

rugs

that

is li

kely

to p

rodu

ce

clin

ical

ly e

ffect

ive,

safe

con

scio

us se

datio

n)

reco

gnis

e th

e in

dica

tions

and

con

train

dica

tions

fo

r con

scio

us se

datio

n us

ing:

- b

enzo

diaz

epin

es

- nitr

ous o

xide

/oxy

gen

sele

ct th

e m

ost a

ppro

pria

te a

gent

s for

eac

h pa

tient

taki

ng in

to a

ccou

nt:

- pro

pose

d de

ntal

trea

tmen

t - a

ge a

nd b

ody

wei

ght

- deg

ree

of a

nxie

ty

- med

ical

his

tory

- p

hysi

cal e

xam

inat

ion

- soc

ial h

isto

ry

- hea

lthca

re e

nviro

nmen

t - h

ealth

care

team

seda

tion

train

ing

and

expe

rienc

e

adm

inis

ter s

edat

ion

acco

rdin

g to

the

prin

cipl

e of

‘m

inim

um in

terv

entio

n’ (t

he u

se o

f the

smal

lest

am

ount

of a

sing

le d

rug

or th

e le

ast n

umbe

r of

drug

s tha

t is l

ikel

y to

pro

duce

clin

ical

ly e

ffect

ive,

sa

fe c

onsc

ious

seda

tion)

APPENDICES

47

Adm

inis

trat

ion

of se

datio

nth

e ph

ysic

al si

gns o

f bot

h co

nsci

ous (

mod

erat

e)

and

deep

seda

tion

as w

ell a

s how

to re

cogn

ise

the

cons

ciou

s sed

atio

n en

dpoi

nt

clin

ical

ly m

onito

r the

pat

ient

, inc

ludi

ng th

e de

pth

of se

datio

nsh

ow c

ontin

uous

rega

rd fo

r pa

tient

safe

tyAC

I

CA CBL

SDL

ST

FA MSF

PDP

WBA

the

equi

pmen

t req

uire

d fo

r adm

inis

tratio

n of

in

trave

nous

and

inha

latio

n se

datio

nse

lect

the

equi

pmen

t req

uire

d fo

r adm

inis

tratio

n of

intra

veno

us a

nd

inha

latio

n se

datio

n

loca

l ana

esth

etic

dru

gs a

nd te

chni

ques

sele

ct th

e m

ost a

ppro

pria

te lo

cal a

naes

thet

ic d

rug

and

tech

niqu

e fo

r in

divi

dual

pat

ient

s

the

sele

ctio

n of

a p

erip

hera

l vei

n fo

r can

nula

tion,

th

e si

gns a

nd sy

mpt

oms o

f ext

rava

scul

ar

inje

ctio

n, a

nd th

e sa

fe re

mov

al a

nd d

ispo

sal o

f an

intra

veno

us c

annu

la

how

to c

heck

an

inha

latio

n se

datio

n m

achi

ne

and

scav

engi

ng sy

stem

sele

ct a

suita

ble

perip

hera

l vei

n fo

r can

nula

tion,

dem

onst

rate

the

sign

s an

d sy

mpt

oms o

f ext

rava

scul

ar in

ject

ion

as w

ell a

s the

safe

rem

oval

an

d di

spos

al o

f an

intra

veno

us c

annu

la

chec

k th

e fu

nctio

ning

and

safe

ty fe

atur

es o

f an

inha

latio

n se

datio

n m

achi

ne a

nd sc

aven

ging

syst

em

how

to c

onne

ct a

bre

athi

ng sy

stem

, sel

ect a

n ap

prop

riate

nas

al m

ask,

and

adj

ust t

he g

as

flow

rate

and

mix

ture

on

an in

hala

tion

seda

tion

mac

hine

conn

ect a

bre

athi

ng sy

stem

, sel

ect a

n ap

prop

riate

nas

al m

ask,

and

ad

just

the

gas f

low

rate

and

mix

ture

on

an in

hala

tion

seda

tion

mac

hine

how

to c

linic

ally

mon

itor a

pat

ient

to d

eter

min

e th

e le

vel o

f con

scio

usne

ss, c

o-op

erat

ion,

re

spira

tion,

hea

rt ra

te a

nd sk

in c

olou

r, an

d ho

w

to re

spon

d ap

prop

riate

ly to

cha

nges

clin

ical

ly m

onito

r pat

ient

s to

dete

rmin

e th

e le

vel o

f con

scio

usne

ss,

co-o

pera

tion,

resp

iratio

n, h

eart

rate

and

skin

col

our,

and

resp

ond

appr

opria

tely

to c

hang

es

the

use

of a

ppro

pria

te e

lect

rical

mon

itorin

g te

chni

ques

(SaO

2, NIB

P, E

CG, e

nd-ti

dal C

O2, B

IS)

and

how

to re

spon

d to

cha

nges

sele

ct a

nd d

emon

stra

te th

e us

e of

app

ropr

iate

ele

ctric

al m

onito

ring

tech

niqu

es (S

aO2, N

IBP,

ECG

, end

-tida

l CO

2, BIS

) and

resp

ond

to

chan

ges

com

mon

ele

ctric

al m

onito

ring

arte

fact

s and

m

alfu

nctio

nsre

cogn

ise

com

mon

ele

ctric

al m

onito

ring

arte

fact

s and

mal

func

tions

appr

opria

te d

rug

dosa

ge(s

)se

lect

and

dem

onst

rate

use

of a

ppro

pria

te d

rug

dosa

ge(s

)

appr

opria

te a

dmin

istra

tion

tech

niqu

esse

lect

and

dem

onst

rate

use

of a

ppro

pria

te se

datio

n ag

ent

adm

inis

tratio

n te

chni

ques

how

to re

cogn

ise

the

cons

ciou

s sed

atio

n en

dpoi

ntde

mon

stra

te re

cogn

ition

of t

he c

onsc

ious

seda

tion

endp

oint

and

avo

id

goin

g be

yond

it

cons

ciou

s sed

atio

n te

chni

ques

, inc

ludi

ng:

- inh

alat

ion

- int

rave

nous

- o

ral

- tra

nsm

ucos

al (i

ntra

nasa

l, bu

ccal

)

dem

onst

rate

safe

use

of c

onsc

ious

seda

tion,

incl

udin

g:

- inh

alat

ion

- int

rave

nous

- o

ral

- tra

nsm

ucos

al (i

ntra

nasa

l, bu

ccal

)

indi

catio

ns, a

dvan

tage

s and

dis

adva

ntag

es

of a

dmin

iste

ring

intra

- and

pos

t-ope

rativ

e su

pple

men

tal o

xyge

n us

ing

nasa

l can

nula

s

adm

inis

ter i

ntra

- and

pos

t-ope

rativ

e su

pple

men

tal o

xyge

n

the

effe

ctiv

enes

s of c

onsc

ious

seda

tion

asse

ss th

e ef

fect

iven

ess o

f con

scio

us se

datio

n

48

Good

pra

ctic

e / m

edic

o-le

gal

requ

irem

ents

the

med

ico-

lega

l req

uire

men

ts re

latin

g to

adm

inis

terin

g se

datio

n dr

ugs

act i

n ac

cord

ance

with

the

med

ico-

lega

l req

uire

men

ts

rela

ting

to a

dmin

iste

ring

seda

tion

drug

sco

nsul

t and

col

labo

rate

with

col

leag

ues

in o

ther

spec

ialti

es w

here

nec

essa

ry

reco

gnis

e th

e ro

le o

f the

ope

rato

r and

ot

her m

embe

rs o

f the

den

tal s

edat

ion

team

in th

e m

anag

emen

t of p

atie

nts

show

rega

rd fo

r ind

ivid

ual p

atie

nt,

fam

ily a

nd/o

r car

er n

eeds

ACI

CA CBL

SDL

ST

FA MSF

PDP

WBA

the

oper

ator

’s le

gal r

equi

rem

ents

whe

n th

ere

is a

sepa

rate

op

erat

or a

nd se

datio

nist

act i

n ac

cord

ance

with

the

oper

ator

’s le

gal r

equi

rem

ents

w

hen

ther

e is

a se

para

te o

pera

tor a

nd se

datio

nist

the

train

ing

and

resp

onsi

bilit

ies o

f the

per

son

(usu

ally

an

appr

opria

tely

trai

ned

and

expe

rienc

ed d

enta

l nur

se) w

ho

assi

sts a

n op

erat

or-s

edat

ioni

st

act i

n ac

cord

ance

with

the

requ

irem

ents

rela

ting

to th

e pe

rson

(usu

ally

an

appr

opria

tely

trai

ned

and

expe

rienc

ed d

enta

l nur

se) w

ho a

ssis

ts a

n op

erat

or-

seda

tioni

st

the

situ

atio

ns in

whi

ch a

sepa

rate

ope

rato

r and

seda

tioni

st

are

appr

opria

tere

cogn

ise

the

situ

atio

ns in

whi

ch a

sepa

rate

ope

rato

r an

d se

datio

nist

are

requ

ired,

and

act

acc

ordi

ngly

the

know

ledg

e an

d ex

perie

nce

anot

her p

ract

ition

er m

ust

have

to b

e ab

le to

pro

vide

safe

con

scio

us se

datio

n fo

r a

dent

ist w

ithou

t tra

inin

g in

con

scio

us se

datio

n

sele

ct a

n ap

prop

riate

indi

vidu

al to

pro

vide

con

scio

us

seda

tion

that

is o

utsi

de th

e op

erat

or’s

com

pete

nce

whe

n it

is sa

fe to

dis

char

ge a

pat

ient

and

whe

n ot

her

actio

ns m

ight

be

requ

ired

reco

gnis

e w

hen

it is

safe

to d

isch

arge

a p

atie

nt a

nd

whe

n ot

her a

ctio

ns m

ight

be

requ

ired

post

-ope

rativ

e an

d af

terc

are

inst

ruct

ions

app

ropr

iate

to

eac

h in

divi

dual

, tak

ing

into

acc

ount

thei

r soc

ial

circ

umst

ance

s

prov

ide

patie

nts w

ith a

ppro

pria

te d

isch

arge

and

po

st-o

pera

tive

inst

ruct

ions

in a

form

at th

at th

ey c

an

unde

rsta

nd

seda

tion-

rela

ted

com

plic

atio

ns, i

nclu

ding

: - o

ver-s

edat

ion

- res

pira

tory

dep

ress

ion

- unc

onsc

ious

pat

ient

- a

irway

obs

truc

tion

- vom

iting

- a

naph

ylax

is

- del

ayed

reco

very

- f

ailu

re o

f con

scio

us se

datio

n

reco

gnis

e se

datio

n-re

late

d co

mpl

icat

ions

, inc

ludi

ng:

- ove

r-sed

atio

n - r

espi

rato

ry d

epre

ssio

n - u

ncon

scio

us p

atie

nt

- airw

ay o

bstr

uctio

n - v

omiti

ng

- ana

phyl

axis

- d

elay

ed re

cove

ry

- fai

lure

of c

onsc

ious

seda

tion

reco

gnis

e th

e im

porta

nce

of te

am

train

ing

in th

e m

anag

emen

t of

seda

tion/

med

ical

em

erge

ncie

s in

the

dent

al su

rger

y

the

man

agem

ent o

f sed

atio

n-re

late

d co

mpl

icat

ions

usi

ng

appr

opria

te p

roce

dure

s in

a st

epw

ise

man

ner,

incl

udin

g:

- ove

r-sed

atio

n - r

espi

rato

ry d

epre

ssio

n - a

irway

obs

truc

tion

- vom

iting

- a

naph

ylax

is

- del

ayed

reco

very

- f

ailu

re o

f con

scio

us se

datio

n

man

age

seda

tion-

rela

ted

com

plic

atio

ns u

sing

ap

prop

riate

pro

cedu

res i

n a

step

wis

e m

anne

r, in

clud

ing:

- o

ver-s

edat

ion

- res

pira

tory

dep

ress

ion

- airw

ay o

bstr

uctio

n - v

omiti

ng

- ana

phyl

axis

- d

elay

ed re

cove

ry

- fai

lure

of c

onsc

ious

seda

tion

curr

ent g

uide

lines

on:

- g

aini

ng v

alid

con

sent

- t

eam

wor

k - c

linic

al h

oldi

ng/r

estra

int

- end

ing

hold

ing/

rest

rain

t if r

equi

red

- app

ropr

iate

reco

rd k

eepi

ng

- con

trol

led

drug

s - ‘

off-l

icen

ce’ u

se o

f dru

gs

appl

y cu

rren

t gui

delin

es o

n:

- gai

ning

val

id c

onse

nt

- tea

mw

ork

- clin

ical

hol

ding

/res

train

t - e

ndin

g ho

ldin

g/re

stra

int i

f req

uire

d - a

ppro

pria

te re

cord

kee

ping

- c

ontr

olle

d dr

ugs

- ‘of

f-lic

ence

’ use

of d

rugs

show

rega

rd fo

r ind

ivid

ual p

atie

nt

need

s whe

n ut

ilisi

ng g

uide

lines

APPENDICES

49

Trai

ning

and

cont

inui

ng

prof

essi

onal

dev

elop

men

t (C

PD)

the

train

ing

requ

ired

so th

at th

e de

ntal

team

can

sa

fely

pro

vide

bas

ic c

onsc

ious

seda

tion

dem

onst

rate

thro

ugh

safe

pra

ctic

e th

at th

e tra

inin

g re

quire

d so

that

the

dent

al te

am c

an

safe

ly p

rovi

de b

asic

con

scio

us se

datio

n is

co

ntem

pora

neou

s

ACI

CA CBL

SDL

ST

FA MSF

PDP

WBA

the

requ

irem

ents

for C

PD to

kee

p up

to d

ate

with

de

velo

pmen

ts in

con

scio

us se

datio

n te

chni

ques

an

d th

eir a

pplic

atio

n to

den

tistr

y

dem

onst

rate

thro

ugh

deba

te, s

afe

prac

tice

and

lead

ersh

ip th

at C

PD is

up

to d

ate

with

de

velo

pmen

ts in

con

scio

us se

datio

n te

chni

ques

as

wel

l as t

heir

appl

icat

ion

to d

entis

try

keep

up

to d

ate

with

dev

elop

men

ts in

co

nsci

ous s

edat

ion

tech

niqu

es a

nd th

eir

appl

icat

ion

to d

entis

try

curr

ent I

mm

edia

te L

ife S

uppo

rtpe

rform

Imm

edia

te L

ife S

uppo

rt

how

to c

ritic

ally

eva

luat

e th

e lit

erat

ure

on

cons

ciou

s sed

atio

n dr

ugs a

nd te

chni

ques

criti

cally

eva

luat

e th

e lit

erat

ure

on c

onsc

ious

se

datio

n dr

ugs a

nd te

chni

ques

to re

ach

a de

cisi

on o

n its

val

idity

be p

repa

red

to c

ritic

ally

eva

luat

e th

e lit

erat

ure

on se

datio

n dr

ugs a

nd

tech

niqu

es, a

nd ta

ke a

ccou

nt o

f thi

s ev

iden

ce in

the

prov

isio

n of

con

scio

us

seda

tion

the

impo

rtanc

e of

rele

vant

clin

ical

aud

itbe

act

ivel

y in

volv

ed in

rele

vant

clin

ical

aud

it

Key:

Te

achi

ng a

nd le

arni

ng m

etho

ds

ACI =

aud

it/cr

itica

l inc

iden

t ana

lysi

s; C

A =

clin

ical

atta

chm

ent;

CBL

= ca

se-b

ased

lear

ning

; SDL

= se

lf-di

rect

ed le

arni

ng; S

T =

stru

ctur

ed te

achi

ng

As

sess

men

t met

hods

FA =

form

al a

sses

smen

t; M

SF =

mul

ti-so

urce

feed

back

; PDP

= p

erso

nal d

evel

opm

ent p

ortfo

lio; W

BA =

wor

kpla

ce-b

ased

ass

essm

ent

50

Appendix 1:

1. General professional content

1.1 Maintaining good clinical practice

Each learning outcome should be prefaced by: ‘On completion of training, the trainee in advanced conscious sedation techniques for young people and adults…’

Syllabus 2: Dentists: Advanced conscious sedation for young people and adults

APPENDICES

51

Subj

ect

Know

ledg

e …

shou

ld b

e ab

le to

des

crib

e:Sk

ills

… sh

ould

be

able

to:

Attit

udes

and

beh

avio

urs

… sh

ould

:Te

achi

ng a

nd le

arni

ng

met

hod(

s)As

sess

men

t m

etho

d(s)

Prof

essi

onal

app

roac

hth

e re

quire

men

ts o

f an

effe

ctiv

e le

ader

the

diffe

rent

mod

els o

f lea

ders

hip

prov

ide

spec

ialis

t lea

ders

hip

in th

e pr

ovis

ion

of a

dvan

ced

cons

ciou

s se

datio

n te

chni

ques

beha

ve in

a p

rofe

ssio

nal m

anne

rCB

LM

SF

PDP

Life

-long

lear

ning

the

requ

irem

ents

for c

ontin

uing

pr

ofes

sion

al d

evel

opm

ent

reco

gnis

e le

arni

ng o

ppor

tuni

ties a

nd

iden

tify

them

for m

embe

rs o

f the

ad

vanc

ed c

onsc

ious

seda

tion

team

mai

ntai

n a

pers

onal

dev

elop

men

t po

rtfo

lio a

nd a

ssis

t oth

ers i

n do

ing

so

mon

itor o

wn

perfo

rman

ce th

roug

h au

dit

and

feed

back

com

ply

with

Gen

eral

Den

tal C

ounc

il/Ge

nera

l Med

ical

Cou

ncil

requ

irem

ents

fo

r rev

alid

atio

n

CBL

SDL

ST

PDP

WBA

Evid

ence

the

prin

cipl

es o

f evi

denc

e-ba

sed

prac

tice

criti

cally

app

rais

e ev

iden

ce

prov

ide

cons

truc

tive

feed

back

use

evid

ence

in su

ppor

t of p

atie

nt c

are

and

to d

efen

d de

cisi

ons t

aken

STW

BA

Writ

ten

reco

rds

the

prin

cipl

es a

nd g

uide

lines

for g

ood

clin

ical

not

e ke

epin

g

the

reas

ons f

or c

onfid

entia

lity

com

mun

icat

e ef

fect

ivel

y th

roug

h w

ritte

n re

cord

s

appl

y th

e pr

inci

ples

of c

onfid

entia

lity

in

the

cont

ext o

f writ

ten

reco

rds

take

acc

ount

of c

onfid

entia

lity

requ

irem

ents

and

lega

l req

uire

men

ts

rela

ting

to w

ritte

n, e

lect

roni

c an

d di

gita

l re

cord

s, a

nd th

eir t

rans

port

and

stor

age

CBL

ST

WBA

Use

of in

form

atio

n te

chno

logy

the

prin

cipl

es o

f ret

rieva

l and

util

isat

ion

of d

ata

reco

rded

in c

linic

al sy

stem

sap

ply

the

prin

cipl

es o

f con

fiden

tialit

y in

th

e co

ntex

t of i

nfor

mat

ion

tech

nolo

gyta

ke a

ccou

nt o

f the

lega

l asp

ects

rela

ting

to h

oldi

ng e

lect

roni

c an

d di

gita

l rec

ords

dem

onst

rate

a p

ositi

ve a

nd p

roac

tive

attit

ude

to n

ew te

chno

logy

ACI

ST

WBA

Org

anis

atio

nal f

ram

ewor

k fo

r clin

ical

go

vern

ance

and

its a

pplic

atio

n in

pr

actic

e

the

elem

ents

of c

linic

al g

over

nanc

e

the

prin

cipl

es o

f clin

ical

gov

erna

nce,

in

part

icul

ar re

late

d to

infe

ctio

n co

ntro

l

part

icip

ate

activ

ely

in c

linic

al

gove

rnan

ce

part

icip

ate

in a

udit

repo

rt se

rious

unt

owar

d in

cide

nts

reco

gnis

e th

e im

porta

nce

of te

amw

ork

in im

plem

entin

g a

clin

ical

gov

erna

nce

fram

ewor

k

reco

gnis

e an

d ta

ke a

ccou

nt o

f the

le

arni

ng fr

om se

rious

unt

owar

d in

cide

nts

ACI

SDL

ST

PDP

WBA

Risk

ass

essm

ent a

nd ri

sk

man

agem

ent

the

prin

cipl

es o

f ris

k as

sess

men

tca

rry

out r

isk

asse

ssm

ents

deve

lop

and

appl

y re

leva

nt p

roce

dure

s

deve

lop

and

mon

itor a

ctio

n pl

ans t

o ob

viat

e fu

rthe

r ris

k

reco

gnis

e th

e va

lue

of ri

sk a

sses

smen

tsAC

I

CBL

WBA

Audi

t (ge

nera

l)th

e pr

inci

ples

of i

nter

nal a

nd e

xter

nal

qual

ity a

ssur

ance

the

audi

t pro

cess

initi

ate

and

com

plet

e au

dit p

roje

cts

dem

onst

rate

impr

ovem

ent a

s the

resu

lt of

aud

it

reco

gnis

e th

e be

nefit

of a

udit

to p

atie

nt

care

and

indi

vidu

al p

erfo

rman

ceAC

I

ST

PDP

WBA

52

Guid

elin

esth

e co

nten

t of g

uide

lines

app

licab

le

to th

e pr

actic

e an

d de

liver

y of

bas

ic a

s w

ell a

s adv

ance

d co

nsci

ous s

edat

ion

tech

niqu

es

inte

rpre

t and

app

ly g

uide

lines

ap

plic

able

to th

e pr

actic

e an

d de

liver

y of

bas

ic a

s wel

l as a

dvan

ced

cons

ciou

s se

datio

n te

chni

ques

show

rega

rd fo

r ind

ivid

ual p

atie

nt

need

s whe

n ut

ilisi

ng g

uide

lines

ACI

CBL

ST

PDP

WBA

Patie

nt sa

fety

the

prin

cipl

es o

f Im

med

iate

Life

Sup

port

the

man

agem

ent o

f med

ical

em

erge

ncie

s in

the

dent

al su

rger

y

the

prin

cipl

es o

f man

agem

ent o

f fitn

ess

to p

ract

ise

case

s

the

role

of o

rgan

isat

ions

cha

rged

with

en

surin

g pa

tient

safe

ty

perfo

rm Im

med

iate

Life

Sup

port

inst

igat

e m

anag

emen

t of m

edic

al

emer

genc

ies i

n th

e de

ntal

surg

ery

show

rega

rd fo

r pat

ient

safe

ty

reco

gnis

e th

e im

porta

nce

of te

am

train

ing

in th

e m

anag

emen

t of

med

ical

em

erge

ncie

s in

the

dent

al

surg

ery

CBL

ST

WBA

Rele

vanc

e of

out

side

bod

ies

the

role

of:

- Gen

eral

Den

tal C

ounc

il - D

epar

tmen

t of H

ealth

- r

oyal

col

lege

s - s

peci

alis

t soc

ietie

s - d

efen

ce so

ciet

ies

- pat

ient

adv

ocac

y gr

oups

com

mun

icat

e w

ith a

nd in

volv

e th

ese

bodi

es in

app

ropr

iate

situ

atio

nsde

mon

stra

te a

ccep

tanc

e of

pr

ofes

sion

al re

gula

tion

shar

e be

st p

ract

ice

part

icip

ate

in p

eer r

evie

w

SDL

ST

PDP

WBA

Key:

Te

achi

ng a

nd le

arni

ng m

etho

dsAC

I = a

udit/

criti

cal i

ncid

ent a

naly

sis;

CA

= cl

inic

al a

ttach

men

t; CB

L =

case

-bas

ed le

arni

ng; S

DL =

self-

dire

cted

lear

ning

; ST

= st

ruct

ured

teac

hing

Asse

ssm

ent m

etho

dsFA

= fo

rmal

ass

essm

ent;

MSF

= m

ulti-

sour

ce fe

edba

ck; P

DP =

per

sona

l dev

elop

men

t por

tfolio

; WBA

= w

orkp

lace

-bas

ed a

sses

smen

t

APPENDICES

53

Subj

ect

Know

ledg

e

… sh

ould

be

able

to d

escr

ibe:

Skill

s

… sh

ould

be

able

to:

Attit

udes

and

beh

avio

urs

… sh

ould

:

Teac

hing

and

le

arni

ng m

etho

d(s)

Asse

ssm

ent

met

hod(

s)

Info

rmed

cons

ent

the

prin

cipl

es o

f val

id c

onse

nt

the

prin

cipl

es o

f the

Men

tal C

apac

ity

Act 2

00512

and

the

Depr

ivat

ion

of

Libe

rty

Safe

guar

ds54

(Sco

tland

: Adu

lts

with

Inca

paci

ty (S

cotla

nd) A

ct 2

00055

an

d Ad

ults

with

Inca

paci

ty (S

cotla

nd)

Amen

dmen

t Reg

ulat

ions

201

2)56

the

proc

ess f

or g

aini

ng v

alid

con

sent

obta

in v

alid

con

sent

in re

latio

n to

you

ng

peop

le a

nd a

dults

hav

ing

adva

nced

co

nsci

ous s

edat

ion

tech

niqu

es

asse

ss c

apac

ity a

nd o

btai

n as

sent

whe

re

appr

opria

te

wor

k w

ith o

ther

age

ncie

s to

obta

in a

be

st in

tere

st d

ecis

ion

and

agre

emen

t to

trea

t in

circ

umst

ance

s whe

re th

ere

is

lack

of c

apac

ity

shar

e in

form

atio

n ap

prop

riate

ly w

hen

nece

ssar

y to

safe

guar

d vu

lner

able

ad

ults

resp

ect p

atie

nts’

and

par

ents

’/car

ers’

au

tono

my

and

wis

hes,

incl

udin

g th

eir

right

to re

fuse

trea

tmen

t eve

n w

hen

trea

tmen

t wou

ld b

e in

thei

r bes

t in

tere

sts

CBL

SDL

ST

WBA

Conf

iden

tialit

yre

leva

nt st

rate

gies

to e

nsur

e co

nfid

entia

lity

the

situ

atio

ns w

hen

conf

iden

tialit

y m

ight

be

brok

en

appl

y th

e pr

inci

ples

of c

onfid

entia

lity

in

rela

tion

to c

linic

al c

are

resp

ect t

he ri

ght t

o co

nfid

entia

lity

CBL

SDL

ST

WBA

Lega

l iss

ues

the

lega

l iss

ues r

elat

ing

to th

e pr

actic

e an

d de

liver

y of

bas

ic a

s wel

l as a

dvan

ced

cons

ciou

s sed

atio

n te

chni

ques

wor

k w

ithin

rele

vant

lega

l fra

mew

orks

dem

onst

rate

em

path

y w

hile

act

ing

in

the

patie

nt’s/

fam

ily’s

best

inte

rest

sCB

L

SDL

ST

WBA

Key:

Te

achi

ng a

nd le

arni

ng m

etho

dsAC

I = a

udit/

criti

cal i

ncid

ent a

naly

sis;

CA

= cl

inic

al a

ttach

men

t; CB

L =

case

-bas

ed le

arni

ng; S

DL =

self-

dire

cted

lear

ning

; ST

= st

ruct

ured

teac

hing

Asse

ssm

ent m

etho

ds

FA =

form

al a

sses

smen

t; M

SF =

mul

ti-so

urce

feed

back

; PDP

= p

erso

nal d

evel

opm

ent p

ortfo

lio; W

BA =

wor

kpla

ce-b

ased

ass

essm

ent

1.2

Rela

tions

hips

with

pat

ient

s, p

aren

ts a

nd ca

rers

Each

lear

ning

out

com

e sh

ould

be

pref

aced

by:

‘On

com

plet

ion

of tr

aini

ng, t

he tr

aine

e in

adv

ance

d co

nsci

ous

seda

tion

tech

niqu

es fo

r you

ng p

eopl

e an

d ad

ults

…’

54

Subj

ect

Know

ledg

e …

shou

ld b

e ab

le to

des

crib

e:Sk

ills

… sh

ould

be

able

to:

Attit

udes

and

beh

avio

urs

… sh

ould

:Te

achi

ng

and

lear

ning

m

etho

d(s)

Asse

ssm

ent

met

hod(

s)

Phar

mac

olog

yth

e ap

plie

d ph

arm

acol

ogy

of d

rugs

use

d in

seda

tion

for a

dults

an

d ad

oles

cent

s, in

par

ticul

ar:

- nitr

ous o

xide

/oxy

gen

- ben

zodi

azep

ines

- p

ropo

fol

- opi

oids

- k

etam

ine

- sev

oflu

rane

appl

y th

eir k

now

ledg

e of

the

phar

mac

olog

y of

dr

ugs u

sed

in se

datio

n to

the

prac

tical

situ

atio

n in

such

a w

ay a

s to

sele

ct d

rugs

that

are

safe

and

ap

prop

riate

for t

he in

divi

dual

pat

ient

dem

onst

rate

a w

illin

gnes

s to

use

this

kno

wle

dge

in d

iagn

osis

and

tr

eatm

ent p

lann

ing

as w

ell a

s in

the

prov

isio

n of

adv

ance

d co

nsci

ous

seda

tion

tech

niqu

es in

adu

lts a

nd

adol

esce

nts

SDL

ST

FA PDP

WBA

impo

rtant

dru

g in

tera

ctio

ns:

- bet

wee

n se

datio

n dr

ugs

- of s

edat

ion

drug

s with

oth

er p

resc

ribed

med

icat

ion

the

phar

mac

okin

etic

s of i

nfus

ions

diffe

renc

es in

the

phar

mac

okin

etic

and

pha

rmac

odyn

amic

ef

fect

s whe

n se

datio

n dr

ugs a

re c

o-ad

min

iste

red

appl

y th

eir k

now

ledg

e of

seda

tion

drug

s and

pr

escr

ibed

med

icat

ion

to a

void

dru

g in

tera

ctio

ns

in th

e cl

inic

al se

ttin

g

Patie

nt a

sses

smen

tho

w to

obt

ain

accu

rate

and

det

aile

d in

form

atio

n ab

out p

ast

and

curr

ent m

edic

al/s

urgi

cal c

ondi

tions

(e.g

. cur

rent

and

pr

evio

us m

edic

atio

n, a

llerg

ies)

the

use

of w

eigh

t and

hei

ght d

ata

to id

entif

y pa

tient

s who

are

ou

tsid

e th

e no

rmal

rang

es

how

info

rmat

ion

abou

t med

ical

pro

blem

s ass

ocia

ted

with

pr

evio

us c

onsc

ious

seda

tion

or a

naes

thes

ia m

ay in

fluen

ce

futu

re m

anag

emen

t

the

rele

vanc

e of

the

patie

nt’s

ASA

stat

us

the

sign

ifica

nce

of th

e m

atur

ity o

f airw

ay d

evel

opm

ent a

nd

any

prob

lem

s tha

t mig

ht a

rise

due

to a

irway

abn

orm

aliti

es

how

the

patie

nt’s

psyc

holo

gica

l and

dev

elop

men

tal s

tatu

s m

ay in

fluen

ce m

anag

emen

t

take

a d

etai

led

med

ical

, fam

ily, s

ocia

l and

de

ntal

his

tory

to id

entif

y se

rious

med

ical

and

su

rgic

al c

ondi

tions

that

impa

ct o

n sa

fe d

eliv

ery

of se

datio

n

carr

y ou

t a p

hysi

cal e

xam

inat

ion

to id

entif

y pa

tient

s:

- with

serio

us p

robl

ems t

hat m

ight

impa

ct o

n th

e sa

fe d

eliv

ery

of c

onsc

ious

seda

tion

- who

are

not

in th

e no

rmal

rang

e

know

whe

n to

ask

for s

peci

alis

t med

ical

adv

ice

or

clar

ifica

tion

of th

e pa

tient

’s m

edic

al h

isto

ry

iden

tify

serio

us p

robl

ems t

hat m

ight

impa

ct o

n sa

fe d

eliv

ery

of c

onsc

ious

seda

tion

and

know

w

hen

to a

sk fo

r cla

rific

atio

n

dem

onst

rate

a w

illin

gnes

s to

use

this

kno

wle

dge

in d

iagn

osis

and

tr

eatm

ent p

lann

ing

as w

ell a

s in

the

prov

isio

n of

adv

ance

d co

nsci

ous

seda

tion

tech

niqu

es in

adu

lts a

nd

adol

esce

nts

SDL

ST CA

FA PDP

WBA

cons

ider

atio

n of

the

evid

ence

and

gui

danc

e re

latin

g to

fast

ing

reco

gnis

e w

hen

fast

ing

is d

esira

ble

the

prov

isio

n of

pre

- and

pos

t-sed

atio

n in

stru

ctio

ns fo

r pa

tient

s and

car

ers i

n an

age

app

ropr

iate

form

atpr

ovid

e pr

e- a

nd p

ost-s

edat

ion

inst

ruct

ions

for

patie

nts a

nd c

arer

s in

an a

ge a

ppro

pria

te fo

rmat

appr

opria

te c

omm

unic

atio

n te

chni

ques

com

mun

icat

e ef

fect

ivel

y

APPENDICES

2.

Seda

tion-

rela

ted

cont

ent

Each

lear

ning

out

com

e sh

ould

be

pref

aced

by:

‘On

com

plet

ion

of tr

aini

ng, t

he tr

aine

e in

adv

ance

d co

nsci

ous

seda

tion

tech

niqu

es fo

r you

ng p

eopl

e an

d ad

ults

…’

55

Seda

tion

drug

se

lect

ion

the

indi

catio

ns a

nd c

ontra

indi

catio

ns fo

r con

scio

us se

datio

n in

yo

ung

peop

le a

nd a

dults

usi

ng:

- ben

zodi

azep

ines

- p

ropo

fol

- opi

oids

the

sele

ctio

n of

the

mos

t app

ropr

iate

age

nts f

or e

ach

patie

nt

taki

ng in

to a

ccou

nt:

- pro

pose

d de

ntal

trea

tmen

t - a

ge a

nd b

ody

wei

ght

- deg

ree

of a

nxie

ty

- med

ical

his

tory

- p

hysi

cal e

xam

inat

ion

- soc

ial h

isto

ry

- hea

lthca

re e

nviro

nmen

t - h

ealth

care

team

seda

tion

train

ing

and

expe

rienc

e

the

prin

cipl

e of

‘min

imum

inte

rven

tion’

(the

use

of t

he sm

alle

st

amou

nt o

f a si

ngle

dru

g or

the

leas

t num

ber o

f dru

gs th

at is

like

ly

to p

rodu

ce c

linic

ally

effe

ctiv

e, sa

fe c

onsc

ious

seda

tion)

reco

gnis

e th

e in

dica

tions

and

con

train

dica

tions

for

cons

ciou

s sed

atio

n in

you

ng p

eopl

e an

d ad

ults

usi

ng:

- ben

zodi

azep

ines

- p

ropo

fol

- opi

oids

sele

ct th

e m

ost a

ppro

pria

te a

gent

s for

eac

h pa

tient

ta

king

into

acc

ount

: - p

ropo

sed

dent

al tr

eatm

ent

- age

and

bod

y w

eigh

t - d

egre

e of

anx

iety

- m

edic

al h

isto

ry

- phy

sica

l exa

min

atio

n - s

ocia

l his

tory

- h

ealth

care

env

ironm

ent

- hea

lthca

re te

am se

datio

n tra

inin

g an

d ex

perie

nce

adm

inis

ter s

edat

ion

acco

rdin

g to

the

prin

cipl

e of

‘m

inim

um in

terv

entio

n’ (t

he u

se o

f the

smal

lest

am

ount

of a

sing

le d

rug

or th

e le

ast n

umbe

r of d

rugs

th

at is

like

ly to

pro

duce

clin

ical

ly e

ffect

ive,

safe

co

nsci

ous s

edat

ion)

take

acc

ount

of t

he

indi

catio

ns a

nd

cont

rain

dica

tions

for

cons

ciou

s sed

atio

n in

you

ng

peop

le a

nd a

dults

as w

ell

as th

e va

rious

age

nts a

nd

rout

es o

f adm

inis

tratio

n w

hen

plan

ning

indi

vidu

al

patie

nt c

are

ACI

CA CBL

SDL

ST

FA MSF

PDP

WBA

Adm

inis

trat

ion

of

seda

tion

appr

opria

te c

linic

al a

nd e

lect

rical

mon

itorin

g te

chni

ques

(SaO

2, N

IBP,

ECG

, end

-tida

l CO

2, BIS

)se

lect

and

dem

onst

rate

use

of a

ppro

pria

te c

linic

al

and

elec

tric

al m

onito

ring

tech

niqu

es (S

aO2, N

IBP,

EC

G, e

nd-ti

dal C

O2, B

IS)

show

con

tinuo

us re

gard

for

patie

nt sa

fety

ACI

CA CBL

SDL

ST

FA MSF

PDP

WBA

appr

opria

te d

rug

dosa

ge(s

)se

lect

and

dem

onst

rate

use

of a

ppro

pria

te d

rug

dosa

ge(s

)

appr

opria

te a

dmin

istra

tion

tech

niqu

es (i

n th

e co

rrec

t ord

er) o

f ad

vanc

ed se

datio

n dr

ugs

sele

ct a

nd d

emon

stra

te u

se o

f app

ropr

iate

ad

min

istra

tion

tech

niqu

es (i

n th

e co

rrec

t ord

er) o

f ad

vanc

ed se

datio

n dr

ugs

how

to re

cogn

ise

the

cons

ciou

s sed

atio

n en

dpoi

ntde

mon

stra

te re

cogn

ition

of t

he c

onsc

ious

seda

tion

endp

oint

and

avo

id g

oing

bey

ond

it

the

safe

adm

inis

tratio

n of

pro

pofo

l by

one

or m

ore

of th

e fo

llow

ing

tech

niqu

es:

- man

ual t

itrat

ion

- pat

ient

-con

trol

led

infu

sion

- t

arge

t-con

trol

led

infu

sion

- t

he o

pera

tion

of in

fusi

on d

evic

es

dem

onst

rate

the

safe

adm

inis

tratio

n of

pro

pofo

l by

one

or m

ore

of th

e fo

llow

ing

tech

niqu

es:

- man

ual t

itrat

ion

- pat

ient

-con

trol

led

infu

sion

- t

arge

t-con

trol

led

infu

sion

- o

pera

te in

fusi

on d

evic

es

indi

catio

ns, a

dvan

tage

s and

dis

adva

ntag

es o

f adm

inis

terin

g in

tra-

and

post

-ope

rativ

e su

pple

men

tal o

xyge

n us

ing

nasa

l can

nula

sad

min

iste

r int

ra- a

nd p

ost-o

pera

tive

supp

lem

enta

l ox

ygen

the

effe

ctiv

enes

s of c

onsc

ious

seda

tion

asse

ss th

e ef

fect

iven

ess o

f con

scio

us se

datio

n

56

Good

pra

ctic

e / m

edic

o-le

gal r

equi

rem

ents

the

med

ico-

lega

l req

uire

men

ts re

latin

g to

ad

min

iste

ring

mor

e th

an o

ne in

trave

nous

age

nt a

nd/

or p

ropo

fol i

nfus

ions

the

oper

ator

’s le

gal r

equi

rem

ents

whe

n th

ere

is a

se

para

te o

pera

tor a

nd se

datio

nist

the

situ

atio

ns in

whi

ch th

ere

is a

requ

irem

ent f

or a

se

para

te o

pera

tor a

nd se

datio

nist

the

pers

on sp

ecifi

catio

n fo

r an

indi

vidu

al to

pro

vide

co

nsci

ous s

edat

ion

that

is o

utsi

de th

e op

erat

or’s

com

pete

nce

act i

n ac

cord

ance

with

the

med

ico-

lega

l req

uire

men

ts re

latin

g to

ad

min

iste

ring

mor

e th

an o

ne in

trave

nous

age

nt a

nd/o

r pro

pofo

l in

fusi

ons

act i

n ac

cord

ance

with

the

oper

ator

’s le

gal r

equi

rem

ents

whe

n th

ere

is a

sepa

rate

ope

rato

r and

seda

tioni

st

reco

gnis

e th

e si

tuat

ions

in w

hich

ther

e is

a re

quire

men

t for

a

sepa

rate

ope

rato

r and

seda

tioni

st, a

nd a

ct a

ccor

ding

ly

sele

ct a

n ap

prop

riate

indi

vidu

al to

pro

vide

con

scio

us se

datio

n th

at is

out

side

the

oper

ator

’s co

mpe

tenc

e

reco

gnis

e w

hen

it is

safe

to d

isch

arge

a p

atie

nt a

nd w

hen

othe

r ac

tions

mig

ht b

e re

quire

d

cons

ult a

nd c

olla

bora

te w

ith c

olle

ague

s in

oth

er sp

ecia

lties

whe

re n

eces

sary

reco

gnis

e th

e ro

le o

f the

ope

rato

r and

ot

her m

embe

rs o

f the

den

tal s

edat

ion

team

in th

e m

anag

emen

t of p

atie

nts

show

rega

rd fo

r ind

ivid

ual p

atie

nt,

fam

ily a

nd/o

r car

er n

eeds

reco

gnis

e th

e im

porta

nce

of te

am

train

ing

in th

e m

anag

emen

t of s

edat

ion/

med

ical

em

erge

ncie

s in

the

dent

al

surg

ery

ACI

CA CBL

SDL

ST

FA MSF

PDP

WBA

patie

nt d

isch

arge

and

pos

t-ope

rativ

e in

stru

ctio

nspr

ovid

e pa

tient

s with

app

ropr

iate

dis

char

ge a

nd p

ost-o

pera

tive

inst

ruct

ions

in a

form

at th

at th

ey c

an u

nder

stan

d

seda

tion-

rela

ted

com

plic

atio

ns, i

nclu

ding

: - o

ver-s

edat

ion

- res

pira

tory

dep

ress

ion

- unc

onsc

ious

pat

ient

- a

irway

obs

truc

tion

- vom

iting

- a

naph

ylax

is

- del

ayed

reco

very

- f

ailu

re o

f con

scio

us se

datio

n

reco

gnis

e se

datio

n-re

late

d co

mpl

icat

ions

, inc

ludi

ng:

- ove

r-sed

atio

n - r

espi

rato

ry d

epre

ssio

n - u

ncon

scio

us p

atie

nt

- airw

ay o

bstr

uctio

n - v

omiti

ng

- ana

phyl

axis

- d

elay

ed re

cove

ry

- fai

lure

of c

onsc

ious

seda

tion

the

man

agem

ent o

f sed

atio

n-re

late

d co

mpl

icat

ions

us

ing

appr

opria

te p

roce

dure

s in

a st

epw

ise

man

ner,

incl

udin

g:

- ove

r-sed

atio

n - r

espi

rato

ry d

epre

ssio

n - a

irway

obs

truc

tion

- vom

iting

- a

naph

ylax

is

- del

ayed

reco

very

- f

ailu

re o

f con

scio

us se

datio

n

man

age

seda

tion-

rela

ted

com

plic

atio

ns u

sing

app

ropr

iate

pr

oced

ures

in a

step

wis

e m

anne

r, in

clud

ing:

- o

ver-s

edat

ion

- res

pira

tory

dep

ress

ion

- airw

ay o

bstr

uctio

n - v

omiti

ng

- ana

phyl

axis

- d

elay

ed re

cove

ry

- fai

lure

of c

onsc

ious

seda

tion

curr

ent g

uide

lines

on:

- g

aini

ng v

alid

con

sent

team

wor

k - c

linic

al h

oldi

ng/r

estra

int

- end

ing

hold

ing/

rest

rain

t if r

equi

red

- app

ropr

iate

reco

rd k

eepi

nge

appl

y cu

rren

t gui

delin

es o

n:

- gai

ning

val

id c

onse

nt

- tea

mw

ork

- clin

ical

hol

ding

/res

train

t - e

ndin

g ho

ldin

g/re

stra

int i

f req

uire

d - a

ppro

pria

te re

cord

kee

ping

show

rega

rd fo

r ind

ivid

ual p

atie

nt n

eeds

w

hen

utili

sing

gui

delin

es

APPENDICES

57

Trai

ning

and

co

ntin

uing

pr

ofes

sion

al

deve

lopm

ent

(CPD

)

the

train

ing

requ

ired

so th

at th

e de

ntal

te

am c

an sa

fely

pro

vide

adv

ance

d co

nsci

ous s

edat

ion

tech

niqu

es fo

r yo

ung

peop

le a

nd a

dults

dem

onst

rate

thro

ugh

safe

pra

ctic

e th

at th

e tra

inin

g re

quire

d so

that

the

dent

al te

am c

an

safe

ly p

rovi

de a

dvan

ced

cons

ciou

s sed

atio

n te

chni

ques

for y

oung

peo

ple

and

adul

ts is

co

ntem

pora

neou

s

keep

up

to d

ate

with

dev

elop

men

ts in

co

nsci

ous s

edat

ion

tech

niqu

es a

nd th

eir

appl

icat

ion

to d

entis

try

ACI

CA CBL

SDL

ST

FA MSF

PDP

WBA

the

requ

irem

ents

for C

PD to

kee

p up

to d

ate

with

dev

elop

men

ts in

co

nsci

ous s

edat

ion

tech

niqu

es a

nd th

eir

appl

icat

ion

to d

entis

try

dem

onst

rate

thro

ugh

deba

te, s

afe

prac

tice

and

lead

ersh

ip th

at C

PD is

up

to d

ate

with

de

velo

pmen

ts in

con

scio

us se

datio

n te

chni

ques

as

wel

l as t

heir

appl

icat

ion

to d

entis

try

how

to c

ritic

ally

eva

luat

e th

e lit

erat

ure

on c

onsc

ious

seda

tion

drug

s and

te

chni

ques

criti

cally

eva

luat

e th

e lit

erat

ure

on c

onsc

ious

se

datio

n dr

ugs a

nd te

chni

ques

to re

ach

a de

cisi

on o

n its

val

idity

be p

repa

red

to c

ritic

ally

eva

luat

e th

e lit

erat

ure

on se

datio

n dr

ugs a

nd te

chni

ques

, and

take

ac

coun

t of t

his e

vide

nce

in th

e pr

ovis

ion

of

cons

ciou

s sed

atio

n

the

impo

rtanc

e of

rele

vant

clin

ical

aud

itbe

act

ivel

y in

volv

ed in

rele

vant

clin

ical

aud

it

Key:

Te

achi

ng a

nd le

arni

ng m

etho

dsAC

I = a

udit/

criti

cal i

ncid

ent a

naly

sis;

CA

= cl

inic

al a

ttach

men

t; CB

L =

case

-bas

ed le

arni

ng; S

DL =

self-

dire

cted

lear

ning

; ST

= st

ruct

ured

teac

hing

Asse

ssm

ent m

etho

ds

FA =

form

al a

sses

smen

t; M

SF =

mul

ti-so

urce

feed

back

; PDP

= p

erso

nal d

evel

opm

ent p

ortfo

lio; W

BA =

wor

kpla

ce-b

ased

ass

essm

ent

58

Appendix 1:

1. General professional content

1.1 Maintaining good clinical practice

Each learning outcome should be prefaced by: ‘On completion of training, the trainee in advanced conscious sedation techniques for children…’

APPENDICES

Syllabus 3: Dentists: Advancedconscious sedation for children

59

Subj

ect

Know

ledg

e …

shou

ld b

e ab

le to

des

crib

e:Sk

ills

… sh

ould

be

able

to:

Attit

udes

and

beh

avio

urs

… sh

ould

:Te

achi

ng a

nd le

arni

ng m

etho

d(s)

Asse

ssm

ent m

etho

d(s)

Prof

essi

onal

ap

proa

chth

e re

quire

men

ts o

f an

effe

ctiv

e le

ader

the

diffe

rent

mod

els o

f lea

ders

hip

prov

ide

spec

ialis

t lea

ders

hip

in th

e pr

ovis

ion

of a

dvan

ced

cons

ciou

s se

datio

n te

chni

ques

for c

hild

ren

beha

ve in

a p

rofe

ssio

nal m

anne

rCB

LM

SF

PDP

Life

-long

lear

ning

the

requ

irem

ents

for c

ontin

uing

pr

ofes

sion

al d

evel

opm

ent

reco

gnis

e le

arni

ng o

ppor

tuni

ties a

nd

iden

tify

them

for m

embe

rs o

f the

ad

vanc

ed c

onsc

ious

seda

tion

team

mai

ntai

n a

pers

onal

dev

elop

men

t po

rtfo

lio a

nd a

ssis

t oth

ers i

n do

ing

so

mon

itor o

wn

perfo

rman

ce th

roug

h au

dit

and

feed

back

com

ply

with

Gen

eral

Den

tal C

ounc

il/Ge

nera

l Med

ical

Cou

ncil

requ

irem

ents

fo

r rev

alid

atio

n

CBL

SDL

ST

PDP

WBA

Evid

ence

the

prin

cipl

es o

f evi

denc

e-ba

sed

prac

tice

criti

cally

app

rais

e ev

iden

ce

prov

ide

cons

truc

tive

feed

back

use

evid

ence

in su

ppor

t of p

atie

nt c

are

and

to d

efen

d de

cisi

ons t

aken

STW

BA

Writ

ten

reco

rds

the

prin

cipl

es a

nd g

uide

lines

for g

ood

clin

ical

not

e ke

epin

g

the

reas

ons f

or c

onfid

entia

lity

com

mun

icat

e ef

fect

ivel

y th

roug

h w

ritte

n re

cord

s

appl

y th

e pr

inci

ples

of c

onfid

entia

lity

in

the

cont

ext o

f writ

ten

reco

rds

take

acc

ount

of c

onfid

entia

lity

requ

irem

ents

and

lega

l req

uire

men

ts

rela

ting

to w

ritte

n, e

lect

roni

c an

d di

gita

l re

cord

s, a

nd th

eir t

rans

port

and

stor

age

CBL

ST

WBA

Use

of in

form

atio

n te

chno

logy

the

prin

cipl

es o

f ret

rieva

l and

util

isat

ion

of d

ata

reco

rded

in c

linic

al sy

stem

sap

ply

the

prin

cipl

es o

f con

fiden

tialit

y in

th

e co

ntex

t of i

nfor

mat

ion

tech

nolo

gyta

ke a

ccou

nt o

f the

lega

l asp

ects

rela

ting

to h

oldi

ng e

lect

roni

c an

d di

gita

l rec

ords

dem

onst

rate

a p

ositi

ve a

nd p

roac

tive

attit

ude

to n

ew te

chno

logy

ACI

ST

WBA

Org

anis

atio

nal

fram

ewor

k fo

r clin

ical

go

vern

ance

and

its

app

licat

ion

in

prac

tice

the

elem

ents

of c

linic

al g

over

nanc

e

the

prin

cipl

es o

f clin

ical

gov

erna

nce,

in

part

icul

ar re

late

d to

infe

ctio

n co

ntro

l

part

icip

ate

activ

ely

in c

linic

al

gove

rnan

ce

part

icip

ate

in a

udit

repo

rt se

rious

unt

owar

d in

cide

nts

reco

gnis

e th

e im

porta

nce

of te

amw

ork

in im

plem

entin

g a

clin

ical

gov

erna

nce

fram

ewor

k

reco

gnis

e an

d ta

ke a

ccou

nt o

f the

le

arni

ng fr

om se

rious

unt

owar

d in

cide

nts

ACI

SDL

ST

PDP

WBA

Risk

ass

essm

ent

and

risk

man

agem

ent

the

prin

cipl

es o

f ris

k as

sess

men

tca

rry

out r

isk

asse

ssm

ents

deve

lop

and

appl

y re

leva

nt p

roce

dure

s

deve

lop

and

mon

itor a

ctio

n pl

ans t

o ob

viat

e fu

rthe

r ris

k

reco

gnis

e th

e va

lue

of ri

sk a

sses

smen

tsAC

I

CBL

WBA

Audi

t (ge

nera

l)th

e pr

inci

ples

of i

nter

nal a

nd e

xter

nal

qual

ity a

ssur

ance

the

audi

t pro

cess

initi

ate

and

com

plet

e au

dit p

roje

cts

dem

onst

rate

impr

ovem

ent a

s the

resu

lt of

aud

it

reco

gnis

e th

e be

nefit

of a

udit

to p

atie

nt

care

and

indi

vidu

al p

erfo

rman

ceAC

I

ST

PDP

WBA

60

Guid

elin

esth

e co

nten

t of g

uide

lines

app

licab

le

to th

e pr

actic

e an

d de

liver

y of

bas

ic a

s w

ell a

s adv

ance

d co

nsci

ous s

edat

ion

tech

niqu

es

inte

rpre

t and

app

ly g

uide

lines

ap

plic

able

to th

e pr

actic

e an

d de

liver

y of

bas

ic a

s wel

l as a

dvan

ced

cons

ciou

s se

datio

n te

chni

ques

show

rega

rd fo

r ind

ivid

ual p

atie

nt n

eeds

w

hen

utili

sing

gui

delin

esAC

I

CBL

ST

PDP

WBA

Patie

nt sa

fety

the

prin

cipl

es o

f Pae

diat

ric Im

med

iate

Li

fe S

uppo

rt

the

man

agem

ent o

f med

ical

em

erge

ncie

s in

the

dent

al su

rger

y

the

prin

cipl

es o

f man

agem

ent o

f fitn

ess

to p

ract

ise

case

s

the

role

of o

rgan

isat

ions

cha

rged

with

en

surin

g pa

tient

safe

ty

perfo

rm P

aedi

atric

Imm

edia

te L

ife

Supp

ort

inst

igat

e m

anag

emen

t of m

edic

al

emer

genc

ies i

n th

e de

ntal

surg

ery

show

rega

rd fo

r pat

ient

safe

ty

reco

gnis

e th

e im

porta

nce

of te

am

train

ing

in th

e m

anag

emen

t of m

edic

al

emer

genc

ies i

n th

e de

ntal

surg

ery

CBL

ST

WBA

Rele

vanc

e of

out

side

bo

dies

the

role

of:

- Gen

eral

Den

tal C

ounc

il - D

epar

tmen

t of H

ealth

- r

oyal

col

lege

s - s

peci

alis

t soc

ietie

s - d

efen

ce so

ciet

ies

- pat

ient

adv

ocac

y gr

oups

com

mun

icat

e w

ith a

nd in

volv

e th

ese

bodi

es in

app

ropr

iate

situ

atio

nsde

mon

stra

te a

ccep

tanc

e of

pro

fess

iona

l re

gula

tion

shar

e be

st p

ract

ice

part

icip

ate

in p

eer r

evie

w

SDL

ST

PDP

WBA

Key:

Te

achi

ng a

nd le

arni

ng m

etho

dsAC

I = a

udit/

criti

cal i

ncid

ent a

naly

sis;

CA

= cl

inic

al a

ttach

men

t; CB

L =

case

-bas

ed le

arni

ng; S

DL =

self-

dire

cted

lear

ning

; ST

= st

ruct

ured

teac

hing

Asse

ssm

ent m

etho

dsFA

= fo

rmal

ass

essm

ent;

MSF

= m

ulti-

sour

ce fe

edba

ck; P

DP =

per

sona

l dev

elop

men

t por

tfolio

; WBA

= w

orkp

lace

-bas

ed a

sses

smen

t

APPENDICES

61

1.2

Rela

tions

hips

with

pat

ient

s, p

aren

ts a

nd ca

rers

Each

lear

ning

out

com

e sh

ould

be

pref

aced

by:

‘On

com

plet

ion

of tr

aini

ng, t

he tr

aine

e in

adv

ance

d co

nsci

ous

seda

tion

tech

niqu

es fo

r chi

ldre

n…’

Subj

ect

Know

ledg

e …

shou

ld b

e ab

le to

des

crib

e:Sk

ills

… sh

ould

be

able

to:

Attit

udes

and

beh

avio

urs

… sh

ould

:Te

achi

ng a

nd le

arni

ng m

etho

d(s)

Asse

ssm

ent m

etho

d(s)

Info

rmed

cons

ent

the

prin

cipl

es o

f val

id c

onse

nt

the

prin

cipl

es o

f the

Men

tal C

apac

ity

Act 2

00512

and

the

Depr

ivat

ion

of

Libe

rty

Safe

guar

ds54

(Sco

tland

: Adu

lts

with

Inca

paci

ty (S

cotla

nd) A

ct 2

00055

an

d Ad

ults

with

Inca

paci

ty (S

cotla

nd)

Amen

dmen

t Reg

ulat

ions

201

2)56

the

proc

ess f

or g

aini

ng v

alid

con

sent

obta

in v

alid

con

sent

in re

latio

n to

ch

ildre

n an

d yo

ung

peop

le h

avin

g ad

vanc

ed c

onsc

ious

seda

tion

tech

niqu

es

asse

ss c

apac

ity a

nd o

btai

n as

sent

whe

re

appr

opria

te

wor

k w

ith o

ther

age

ncie

s to

obta

in a

be

st in

tere

st d

ecis

ion

and

agre

emen

t to

trea

t in

circ

umst

ance

s whe

re th

ere

is

lack

of c

apac

ity

shar

e in

form

atio

n ap

prop

riate

ly w

hen

nece

ssar

y to

safe

guar

d vu

lner

able

ch

ildre

n an

d yo

ung

peop

le

resp

ect p

atie

nts’

and

par

ents

’/car

ers’

au

tono

my

and

wis

hes,

incl

udin

g th

eir

right

to re

fuse

trea

tmen

t eve

n w

hen

trea

tmen

t wou

ld b

e in

thei

r bes

t in

tere

sts

CBL

SDL

ST

WBA

Conf

iden

tialit

yre

leva

nt st

rate

gies

to e

nsur

e co

nfid

entia

lity

the

situ

atio

ns w

hen

conf

iden

tialit

y m

ight

be

brok

en

appl

y th

e pr

inci

ples

of c

onfid

entia

lity

in

rela

tion

to c

linic

al c

are

resp

ect t

he ri

ght t

o co

nfid

entia

lity

CBL

SDL

ST

WBA

Lega

l iss

ues

the

lega

l iss

ues r

elat

ing

to th

e pr

actic

e an

d de

liver

y of

bas

ic a

s wel

l as a

dvan

ced

cons

ciou

s sed

atio

n te

chni

ques

wor

k w

ithin

rele

vant

lega

l fra

mew

orks

dem

onst

rate

em

path

y w

hile

act

ing

in

the

patie

nt’s/

fam

ily’s

best

inte

rest

sCB

L

SDL

ST

WBA

Key:

Te

achi

ng a

nd le

arni

ng m

etho

ds

ACI =

aud

it/cr

itica

l inc

iden

t ana

lysi

s; C

A =

clin

ical

atta

chm

ent;

CBL

= ca

se-b

ased

lear

ning

; SDL

= se

lf-di

rect

ed le

arni

ng; S

T =

stru

ctur

ed te

achi

ng

Asse

ssm

ent m

etho

ds

FA

= fo

rmal

ass

essm

ent;

MSF

= m

ulti-

sour

ce fe

edba

ck; P

DP =

per

sona

l dev

elop

men

t por

tfolio

; WBA

= w

orkp

lace

-bas

ed a

sses

smen

t

62

Subj

ect

Know

ledg

e …

shou

ld b

e ab

le to

des

crib

e:Sk

ills

… sh

ould

be

able

to:

Attit

udes

and

beh

avio

urs

… sh

ould

:Te

achi

ng a

nd le

arni

ng m

etho

d(s)

Asse

ssm

ent m

etho

d(s)

Anat

omy

and

phys

iolo

gyth

e an

atom

ical

and

phy

siol

ogic

al

diffe

renc

es b

etw

een

child

ren

and

adul

ts a

s wel

l as h

ow th

is re

late

s to

the

use

of a

dvan

ced

cons

ciou

s sed

atio

n te

chni

ques

asse

ssm

ent o

f pre

viou

s and

cur

rent

ai

rway

pro

blem

s to

antic

ipat

e po

tent

ial

diffi

culti

es d

urin

g se

datio

n or

if

vent

ilatio

n is

requ

ired

appl

y th

eir k

now

ledg

e of

the

anat

omic

al

and

phys

iolo

gica

l diff

eren

ces b

etw

een

child

ren

and

adul

ts in

pla

nnin

g an

d pr

ovid

ing

adva

nced

con

scio

us se

datio

n te

chni

ques

in c

hild

ren

carr

y ou

t airw

ay a

sses

smen

t and

an

ticip

ate

pote

ntia

l bre

athi

ng d

iffic

ultie

s du

ring

seda

tion

or if

ven

tilat

ion

is

requ

ired

SDL

ST

FA PDP

WBA

Phar

mac

olog

yth

e ap

plie

d ph

arm

acol

ogy

of d

rugs

use

d in

seda

tion

for c

hild

ren,

for e

xam

ple:

- n

itrou

s oxi

de/o

xyge

n - b

enzo

diaz

epin

es

- pro

pofo

l - o

pioi

ds

- ket

amin

e - s

evof

lura

ne

the

term

inol

ogy

desc

ribin

g le

vels

of

seda

tion

(min

imal

, con

scio

us, m

oder

ate,

de

ep) a

nd g

ener

al a

naes

thes

ia

appl

y th

eir k

now

ledg

e of

the

phar

mac

olog

y of

dru

gs u

sed

in se

datio

n to

the

prac

tical

situ

atio

n in

such

a w

ay

as to

sele

ct se

datio

n dr

ugs t

hat a

re sa

fe

and

appr

opria

te fo

r the

indi

vidu

al c

hild

dem

onst

rate

a w

illin

gnes

s to

use

this

kn

owle

dge

in d

iagn

osis

and

trea

tmen

t pl

anni

ng a

s wel

l as i

n th

e pr

ovis

ion

of a

dvan

ced

cons

ciou

s sed

atio

n te

chni

ques

in c

hild

ren

SDL

ST CA

FA PDP

WBA

impo

rtant

dru

g in

tera

ctio

ns:

- bet

wee

n se

datio

n dr

ugs

- of s

edat

ion

drug

s with

oth

er p

resc

ribed

m

edic

atio

n - o

f sed

atio

n an

d re

crea

tiona

l dru

gs

diffe

renc

es in

the

phar

mac

okin

etic

and

ph

arm

acod

ynam

ic e

ffect

s whe

n dr

ugs

are

adm

inis

tere

d by

diff

eren

t rou

tes,

in

fusi

on a

nd/o

r in

com

bina

tion

appl

y th

eir k

now

ledg

e of

seda

tion

drug

s,

pres

crib

ed m

edic

atio

n an

d re

crea

tiona

l dr

ugs t

o av

oid

inte

ract

ions

in th

e cl

inic

al

sett

ing

safe

max

imum

dos

es o

f loc

al

anae

sthe

tics f

or c

hild

ren

dem

onst

rate

the

safe

and

effe

ctiv

e us

e of

loca

l ana

esth

etic

s in

child

ren

2.

Seda

tion-

rela

ted

cont

ent

Each

lear

ning

out

com

e sh

ould

be

pref

aced

by:

‘On

com

plet

ion

of tr

aini

ng, t

he tr

aine

e in

adv

ance

d co

nsci

ous

seda

tion

tech

niqu

es fo

r chi

ldre

n…’

APPENDICES

63

Patie

nt

asse

ssm

ent

how

to o

btai

n ac

cura

te a

nd d

etai

led

info

rmat

ion

abou

t pas

t and

cur

rent

m

edic

al/s

urgi

cal c

ondi

tions

(e.g

. cur

rent

an

d pr

evio

us m

edic

atio

n, a

llerg

ies)

the

use

of w

eigh

t and

hei

ght d

ata,

gr

owth

cha

rts a

nd n

orm

al ra

nges

to

estim

ate

a ch

ild’s

stag

e of

phy

sica

l de

velo

pmen

t

how

chi

ldre

n ch

ange

as t

hey

appr

oach

ad

ulth

ood

how

info

rmat

ion

abou

t med

ical

pr

oble

ms a

ssoc

iate

d w

ith p

revi

ous

cons

ciou

s sed

atio

n or

ana

esth

esia

may

in

fluen

ce fu

ture

man

agem

ent

the

rele

vanc

e of

the

patie

nt’s

ASA

stat

us

the

sign

ifica

nce

of th

e m

atur

ity o

f airw

ay

deve

lopm

ent a

nd a

ny p

robl

ems t

hat

mig

ht a

rise

due

to a

irway

abn

orm

aliti

es

take

a d

etai

led

med

ical

, fam

ily, s

ocia

l an

d de

ntal

his

tory

to id

entif

y se

rious

m

edic

al a

nd su

rgic

al c

ondi

tions

that

im

pact

on

safe

del

iver

y of

seda

tion

carr

y ou

t a p

hysi

cal e

xam

inat

ion

to

iden

tify

child

ren:

- w

ith se

rious

pro

blem

s tha

t mig

ht

impa

ct o

n th

e sa

fe d

eliv

ery

of c

onsc

ious

se

datio

n - w

ho a

re n

ot in

the

norm

al ra

nge

know

whe

n to

ask

for s

peci

alis

t med

ical

ad

vice

or c

larif

icat

ion

of th

e pa

tient

’s m

edic

al h

isto

ry

dem

onst

rate

a w

illin

gnes

s to

use

this

kn

owle

dge

in d

iagn

osis

and

trea

tmen

t pl

anni

ng a

s wel

l as i

n th

e pr

ovis

ion

of a

dvan

ced

cons

ciou

s sed

atio

n te

chni

ques

in c

hild

ren

SDL

ST CA

FA PDP

WBA

how

the

patie

nt’s

psyc

holo

gica

l and

de

velo

pmen

tal s

tatu

s may

influ

ence

m

anag

emen

t

iden

tify

serio

us p

robl

ems t

hat m

ight

im

pact

on

safe

del

iver

y of

con

scio

us

seda

tion

and

know

whe

n to

ask

for

clar

ifica

tion

cons

ider

atio

n of

the

evid

ence

and

gu

idan

ce re

latin

g to

fast

ing

reco

gnis

e w

hen

fast

ing

is d

esira

ble

the

prov

isio

n of

pre

- and

pos

t-sed

atio

n in

stru

ctio

ns fo

r par

ents

and

chi

ldre

n in

an

age

app

ropr

iate

form

at

prov

ide

pre-

and

pos

t-sed

atio

n in

stru

ctio

ns fo

r par

ents

and

chi

ldre

n in

an

age

app

ropr

iate

form

at

appr

opria

te c

omm

unic

atio

n te

chni

ques

fo

r chi

ldre

nco

mm

unic

ate

effe

ctiv

ely

with

chi

ldre

n

64

Seda

tion

drug

se

lect

ion

the

proc

ess o

f sel

ectin

g a

safe

, ef

fect

ive

and

appr

opria

te se

datio

n te

chni

que

for t

he c

hild

in te

rms o

f bot

h th

e dr

ug se

lect

ion

and

the

rout

e of

ad

min

istra

tion

the

indi

catio

ns a

nd c

ontra

indi

catio

ns

for c

onsc

ious

seda

tion

drug

s in

child

ren,

in

clud

ing:

- n

itrou

s oxi

de/o

xyge

n - b

enzo

diaz

epin

es

- pro

pofo

l - o

pioi

ds

- ket

amin

e - s

evof

lura

ne

choo

se a

safe

, effe

ctiv

e an

d ap

prop

riate

se

datio

n te

chni

que

for t

he c

hild

in te

rms

of b

oth

the

drug

sele

ctio

n an

d th

e ro

ute

of a

dmin

istra

tion

reco

gnis

e th

e in

dica

tions

and

co

ntra

indi

catio

ns fo

r con

scio

us se

datio

n dr

ugs i

n ch

ildre

n, in

clud

ing:

- n

itrou

s oxi

de/o

xyge

n - b

enzo

diaz

epin

es

- pro

pofo

l - o

pioi

ds

- ket

amin

e - s

evof

lura

ne

take

acc

ount

of t

he in

dica

tions

and

co

ntra

indi

catio

ns fo

r con

scio

us se

datio

n in

ch

ildre

n as

wel

l as t

he v

ario

us a

gent

s and

rout

es

of a

dmin

istra

tion

whe

n pl

anni

ng in

divi

dual

pa

tient

car

e

ACI

CA CBL

SDL

ST

FA MSF

PDP

WBA

the

indi

catio

ns a

nd c

ontra

indi

catio

ns

for c

onsc

ious

seda

tion

in c

hild

ren

usin

g di

ffere

nt ro

utes

of a

dmin

istra

tion,

in

clud

ing:

- i

nhal

atio

n - i

ntra

veno

us

- ora

l - t

rans

muc

osal

- i

ntra

mus

cula

r

reco

gnis

e th

e in

dica

tions

and

co

ntra

indi

catio

ns fo

r con

scio

us se

datio

n in

chi

ldre

n us

ing

diffe

rent

rout

es o

f ad

min

istra

tion,

incl

udin

g:

- inh

alat

ion

- int

rave

nous

- o

ral

- tra

nsm

ucos

al

- int

ram

uscu

lar

the

sele

ctio

n of

the

mos

t app

ropr

iate

ag

ents

for e

ach

child

pat

ient

taki

ng in

to

acco

unt:

- pro

pose

d de

ntal

trea

tmen

t - a

ge a

nd b

ody

wei

ght

- deg

ree

of a

nxie

ty

- med

ical

his

tory

- p

hysi

cal e

xam

inat

ion

- soc

ial h

isto

ry

- hea

lthca

re e

nviro

nmen

t - h

ealth

care

team

seda

tion

train

ing

and

expe

rienc

e

sele

ct th

e m

ost a

ppro

pria

te a

gent

s for

ea

ch p

atie

nt ta

king

into

acc

ount

: - p

ropo

sed

dent

al tr

eatm

ent

- age

and

bod

y w

eigh

t - d

egre

e of

anx

iety

- m

edic

al h

isto

ry

- phy

sica

l exa

min

atio

n - s

ocia

l his

tory

- h

ealth

care

env

ironm

ent

- hea

lthca

re te

am se

datio

n tra

inin

g an

d ex

perie

nce

the

prin

cipl

e of

‘min

imum

inte

rven

tion’

(th

e us

e of

the

smal

lest

am

ount

of

a si

ngle

dru

g or

the

leas

t num

ber o

f dr

ugs t

hat i

s lik

ely

to p

rodu

ce c

linic

ally

ef

fect

ive,

safe

con

scio

us se

datio

n)

adm

inis

ter s

edat

ion

acco

rdin

g to

the

prin

cipl

e of

‘min

imum

inte

rven

tion’

(the

us

e of

the

smal

lest

am

ount

of a

sing

le

drug

or t

he le

ast n

umbe

r of d

rugs

that

is

likel

y to

pro

duce

clin

ical

ly e

ffect

ive,

safe

co

nsci

ous s

edat

ion)

APPENDICES

65

Adm

inis

trat

ion

of se

datio

nth

e ph

ysic

al si

gns o

f bot

h co

nsci

ous

(mod

erat

e) a

nd d

eep

seda

tion

as w

ell a

s ho

w to

reco

gnis

e th

e co

nsci

ous s

edat

ion

endp

oint

the

use

of a

ppro

pria

te c

linic

al a

nd

elec

tric

al m

onito

ring

tech

niqu

es (S

aO2,

NIB

P, E

CG, e

nd-ti

dal C

O2, B

IS)

a m

etho

d of

ass

essi

ng a

ppro

pria

te d

rug

dosa

ge(s

)

an a

ppro

pria

te m

etho

d of

adm

inis

terin

g dr

ug(s

) to

prod

uce

cons

ciou

s sed

atio

n

appr

opria

te c

ombi

natio

ns o

f dru

gs,

incl

udin

g th

e co

rrec

t seq

uenc

e of

ad

min

istra

tion

the

tech

niqu

es fo

r adm

inis

terin

g pr

opof

ol b

y:

- man

ual t

itrat

ion

- pat

ient

-con

trol

led

infu

sion

- t

arge

t-con

trol

led

infu

sion

the

oper

atio

n of

infu

sion

dev

ices

indi

catio

ns, a

dvan

tage

s and

di

sadv

anta

ges o

f adm

inis

terin

g in

tra-

and

post

-ope

rativ

e su

pple

men

tal

oxyg

en u

sing

nas

al c

annu

las

the

effe

ctiv

enes

s of c

onsc

ious

seda

tion

clin

ical

ly m

onito

r the

pat

ient

, inc

ludi

ng

the

dept

h of

seda

tion

sele

ct a

nd d

emon

stra

te u

se o

f ap

prop

riate

clin

ical

and

ele

ctric

al

mon

itorin

g te

chni

ques

(SaO

2, NIB

P, E

CG,

end-

tidal

CO

2, BIS

)

sele

ct a

nd d

emon

stra

te u

se o

f ap

prop

riate

dru

g do

sage

(s)

sele

ct a

nd d

emon

stra

te u

se o

f ap

prop

riate

met

hod

of d

rug

adm

inis

tratio

n

dem

onst

rate

reco

gniti

on o

f the

co

nsci

ous s

edat

ion

endp

oint

and

avo

id

goin

g be

yond

it

dem

onst

rate

safe

use

of t

he te

chni

ques

fo

r adm

inis

terin

g pr

opof

ol b

y:

- man

ual t

itrat

ion

- pat

ient

-con

trol

led

infu

sion

- t

arge

t-con

trol

led

infu

sion

oper

ate

infu

sion

dev

ices

adm

inis

ter i

ntra

- and

pos

t-ope

rativ

e su

pple

men

tal o

xyge

n

asse

ss th

e ef

fect

iven

ess o

f con

scio

us

seda

tion

show

con

tinuo

us re

gard

for p

atie

nt sa

fety

ACI

CA CBL

SDL

ST

FA MSF

PDP

WBA

66

Good

pra

ctic

e / m

edic

o-le

gal

requ

irem

ents

the

med

ico-

lega

l req

uire

men

ts re

latin

g to

pa

edia

tric

seda

tion

usin

g dr

ugs o

ther

than

ni

trou

s oxi

de/o

xyge

n

the

oper

ator

’s le

gal r

equi

rem

ents

whe

n th

ere

is a

sepa

rate

ope

rato

r and

seda

tioni

st

the

situ

atio

ns in

whi

ch th

ere

is a

requ

irem

ent

for a

sepa

rate

ope

rato

r and

seda

tioni

st

the

know

ledg

e an

d ex

perie

nce

anot

her

prac

titio

ner m

ust h

ave

to b

e ab

le to

pro

vide

sa

fe c

onsc

ious

seda

tion

for a

den

tist w

ithou

t tra

inin

g in

con

scio

us se

datio

n

patie

nt d

isch

arge

, pos

t-ope

rativ

e an

d af

terc

are

inst

ruct

ions

app

ropr

iate

to e

ach

indi

vidu

al, t

akin

g in

to a

ccou

nt th

eir s

ocia

l ci

rcum

stan

ces

act i

n ac

cord

ance

with

the

med

ico-

lega

l req

uire

men

ts re

latin

g to

pa

edia

tric

seda

tion

usin

g dr

ugs o

ther

than

nitr

ous o

xide

/oxy

gen

act i

n ac

cord

ance

with

the

oper

ator

’s le

gal r

equi

rem

ents

whe

n th

ere

is a

sepa

rate

ope

rato

r and

seda

tioni

st

reco

gnis

e th

e si

tuat

ions

in w

hich

ther

e is

a re

quire

men

t for

a

sepa

rate

ope

rato

r and

seda

tioni

st, a

nd a

ct a

ccor

ding

ly

sele

ct a

n ap

prop

riate

indi

vidu

al to

pro

vide

con

scio

us se

datio

n th

at

is b

eyon

d th

e op

erat

or’s

com

pete

nce

reco

gnis

e w

hen

a pa

tient

is fi

t for

dis

char

ge, t

akin

g in

to a

ccou

nt

thei

r soc

ial c

ircum

stan

ces a

nd w

heth

er o

ther

arra

ngem

ents

for p

ost-

oper

ativ

e ca

re a

re re

quire

cons

ult a

nd c

olla

bora

te w

ith

colle

ague

s in

othe

r spe

cial

ties

whe

re n

eces

sary

reco

gnis

e th

e ro

le o

f the

ope

rato

r an

d ot

her m

embe

rs o

f the

den

tal

seda

tion

team

in th

e m

anag

emen

t of

pat

ient

s

ACI

CA CBL

SDL

ST

FA MSF

PDP

WBA

prov

ide

patie

nts,

fam

ilies

and

/or c

arer

s with

app

ropr

iate

dis

char

ge

and

post

-ope

rativ

e in

stru

ctio

ns in

a fo

rmat

that

they

can

und

erst

and

show

rega

rd fo

r ind

ivid

ual p

atie

nt,

fam

ily a

nd/o

r car

er n

eeds

seda

tion-

rela

ted

com

plic

atio

ns, i

nclu

ding

: - o

ver-s

edat

ion

- res

pira

tory

dep

ress

ion

- unc

onsc

ious

pat

ient

- a

irway

obs

truc

tion

- vom

iting

- a

naph

ylax

is

- del

ayed

reco

very

- f

ailu

re o

f con

scio

us se

datio

n

reco

gnis

e se

datio

n-re

late

d co

mpl

icat

ions

, inc

ludi

ng:

- ove

r-sed

atio

n - r

espi

rato

ry d

epre

ssio

n - u

ncon

scio

us p

atie

nt

- airw

ay o

bstr

uctio

n - v

omiti

ng

- ana

phyl

axis

- d

elay

ed re

cove

ry

- fai

lure

of c

onsc

ious

seda

tion

the

man

agem

ent o

f sed

atio

n-re

late

d co

mpl

icat

ions

usi

ng a

ppro

pria

te p

roce

dure

s in

a st

epw

ise

man

ner,

incl

udin

g:

- ove

r-sed

atio

n - r

espi

rato

ry d

epre

ssio

n - a

irway

obs

truc

tion

- vom

iting

- a

naph

ylax

is

- del

ayed

reco

very

- f

ailu

re o

f con

scio

us se

datio

n

man

age

seda

tion-

rela

ted

com

plic

atio

ns u

sing

app

ropr

iate

pr

oced

ures

in a

step

wis

e m

anne

r, in

clud

ing:

- o

ver-s

edat

ion

- res

pira

tory

dep

ress

ion

- airw

ay o

bstr

uctio

n - v

omiti

ng

- ana

phyl

axis

- d

elay

ed re

cove

ry

- fai

lure

of c

onsc

ious

seda

tion

reco

gnis

e th

e im

porta

nce

of te

am

train

ing

in th

e re

cogn

ition

and

m

anag

emen

t of s

edat

ion/

med

ical

em

erge

ncie

s in

the

dent

al su

rger

y (in

clud

ing

reco

very

are

as)

curr

ent g

uide

lines

on:

- g

aini

ng v

alid

con

sent

- t

eam

wor

k - c

linic

al h

oldi

ng/r

estra

int

- end

ing

hold

ing/

rest

rain

t if r

equi

red

- app

ropr

iate

reco

rd k

eepi

ng

- con

trol

led

drug

s - ‘

off-l

icen

ce’ u

se o

f dru

gs

appl

y cu

rren

t gui

delin

es o

n:

- gai

ning

val

id c

onse

nt

- tea

mw

ork

- clin

ical

hol

ding

/res

train

t - e

ndin

g ho

ldin

g/re

stra

int i

f req

uire

d - a

ppro

pria

te re

cord

kee

ping

- c

ontr

olle

d dr

ugs

- ‘of

f-lic

ence

’ use

of d

rugs

show

rega

rd fo

r ind

ivid

ual p

atie

nt

need

s whe

n ut

ilisi

ng g

uide

lines

APPENDICES

67

Trai

ning

and

co

ntin

uing

pr

ofes

sion

al

deve

lopm

ent

(CPD

)

the

train

ing

requ

ired

by th

e de

ntal

te

am (d

entis

t, do

ctor

, den

tal c

are

prof

essi

onal

) so

that

the

seda

tioni

st

can

safe

ly p

rovi

de a

dvan

ced

cons

ciou

s se

datio

n te

chni

ques

for c

hild

ren

curr

ent P

aedi

atric

Imm

edia

te L

ife

Supp

ort

the

requ

irem

ents

for C

PD to

kee

p up

to

dat

e w

ith re

cent

dev

elop

men

ts in

co

nsci

ous s

edat

ion

tech

niqu

es a

nd th

eir

appl

icat

ion

to d

entis

try

how

to c

ritic

ally

eva

luat

e th

e lit

erat

ure

on c

onsc

ious

seda

tion

drug

s and

te

chni

ques

the

impo

rtanc

e of

rele

vant

clin

ical

aud

it

dem

onst

rate

thro

ugh

safe

pra

ctic

e th

at th

e tra

inin

g re

quire

d by

the

dent

al te

am (d

entis

t, do

ctor

, den

tal c

are

prof

essi

onal

) so

that

the

seda

tioni

st c

an sa

fely

pro

vide

ad

vanc

ed c

onsc

ious

seda

tion

tech

niqu

es fo

r chi

ldre

n is

co

ntem

pora

neou

s

perfo

rm P

aedi

atric

Imm

edia

te L

ife S

uppo

rt

dem

onst

rate

thro

ugh

deba

te, s

afe

prac

tice

and

lead

ersh

ip

that

CPD

is u

p to

dat

e w

ith d

evel

opm

ents

in c

onsc

ious

se

datio

n te

chni

ques

as w

ell a

s the

ir ap

plic

atio

n to

den

tistr

y

criti

cally

eva

luat

e th

e lit

erat

ure

on c

onsc

ious

seda

tion

drug

s an

d te

chni

ques

to re

ach

a de

cisi

on o

n its

val

idity

be a

ctiv

ely

invo

lved

in re

leva

nt c

linic

al a

udit

keep

up

to d

ate

with

dev

elop

men

ts in

co

nsci

ous s

edat

ion

tech

niqu

es a

nd th

eir

appl

icat

ion

to d

entis

try

be p

repa

red

to c

ritic

ally

eva

luat

e th

e lit

erat

ure

on se

datio

n dr

ugs a

nd

tech

niqu

es, a

nd ta

ke a

ccou

nt o

f thi

s ev

iden

ce in

the

prov

isio

n of

con

scio

us

seda

tion

in c

hild

ren

and

adol

esce

nts

ACI

CA CBL

SDL

ST

FA MSF

PDP

WBA

Ke

y:

Teac

hing

and

lear

ning

met

hods

AC

I = a

udit/

criti

cal i

ncid

ent a

naly

sis;

CA

= cl

inic

al a

ttach

men

t; CB

L =

case

-bas

ed le

arni

ng; S

DL =

self-

dire

cted

lear

ning

; ST

= st

ruct

ured

teac

hing

Asse

ssm

ent m

etho

ds

FA =

form

al a

sses

smen

t; M

SF =

mul

ti-so

urce

feed

back

; PDP

= p

erso

nal d

evel

opm

ent p

ortfo

lio; W

BA =

wor

kpla

ce-b

ased

ass

essm

ent

68

SYLLABUS 4

Appendix 1:

1. General professional content

1.1 Maintaining good clinical practice

Each learning outcome should be prefaced by: ‘On completion of training, the trainee in inhalation sedation for children, young people and adults…’

APPENDICES

Syllabus 4: Dental therapists and dental hygienists: Inhalation sedation

69

Subj

ect

Know

ledg

e …

shou

ld b

e ab

le to

des

crib

e:Sk

ills

… sh

ould

be

able

to:

Attit

udes

and

beh

avio

urs

… sh

ould

:Te

achi

ng a

nd

lear

ning

met

hod(

s)As

sess

men

t m

etho

d(s)

Prof

essi

onal

ap

proa

chth

e re

quire

men

ts fo

r an

effe

ctiv

e de

ntal

seda

tioni

st

the

diffe

rent

mod

els o

f wor

king

as p

art o

f a te

am

prov

ide

inha

latio

n se

datio

nbe

have

in a

pro

fess

iona

l man

ner

CBL

MSF

PDP

Life

-long

le

arni

ngth

e re

quire

men

ts fo

r con

tinui

ng p

rofe

ssio

nal

deve

lopm

ent

reco

gnis

e an

d ta

ke a

dvan

tage

of l

earn

ing

oppo

rtun

ities

fo

r all

mem

bers

of t

he te

am p

rovi

ding

inha

latio

n se

datio

n

mai

ntai

n a

pers

onal

dev

elop

men

t por

tfolio

and

ass

ist

othe

rs in

doi

ng so

mon

itor o

wn

perfo

rman

ce th

roug

h au

dit a

nd fe

edba

ck

com

ply

with

Gen

eral

Den

tal C

ounc

il re

quire

men

ts fo

r rev

alid

atio

nCB

LSD

LST

PDP

WBA

Evid

ence

the

prin

cipl

es o

f evi

denc

e-ba

sed

prac

tice

criti

cally

app

rais

e ev

iden

ce

prov

ide

cons

truc

tive

feed

back

use

evid

ence

in su

ppor

t of p

atie

nt c

are

and

to

defe

nd d

ecis

ions

take

nST

WBA

Writ

ten

reco

rds

the

prin

cipl

es a

nd g

uide

lines

for g

ood

clin

ical

not

e ke

epin

g

the

reas

ons f

or c

onfid

entia

lity

com

mun

icat

e ef

fect

ivel

y th

roug

h w

ritte

n re

cord

s

appl

y th

e pr

inci

ples

of c

onfid

entia

lity

in th

e co

ntex

t of

writ

ten

reco

rds

take

acc

ount

of c

onfid

entia

lity

requ

irem

ents

and

le

gal r

equi

rem

ents

rela

ting

to w

ritte

n, e

lect

roni

c an

d di

gita

l rec

ords

, and

thei

r tra

nspo

rt a

nd

stor

age

CBL

STW

BA

Use

of

info

rmat

ion

tech

nolo

gy

the

prin

cipl

es o

f ret

rieva

l and

util

isat

ion

of d

ata

reco

rded

in c

linic

al sy

stem

sap

ply

the

prin

cipl

es o

f con

fiden

tialit

y in

the

cont

ext o

f in

form

atio

n te

chno

logy

take

acc

ount

of t

he le

gal a

spec

ts re

latin

g to

ho

ldin

g el

ectr

onic

and

dig

ital r

ecor

ds

dem

onst

rate

a p

ositi

ve a

nd p

roac

tive

attit

ude

to

new

tech

nolo

gy

ACI

STW

BA

Org

anis

atio

nal

fram

ewor

k fo

r clin

ical

go

vern

ance

an

d its

ap

plic

atio

n in

pr

actic

e

the

elem

ents

of c

linic

al g

over

nanc

e

the

prin

cipl

es o

f clin

ical

gov

erna

nce,

in p

artic

ular

re

late

d to

infe

ctio

n co

ntro

l

part

icip

ate

activ

ely

in c

linic

al g

over

nanc

e

part

icip

ate

in a

udit

repo

rt se

rious

unt

owar

d in

cide

nts

reco

gnis

e th

e im

porta

nce

of te

amw

ork

in

impl

emen

ting

a cl

inic

al g

over

nanc

e fra

mew

ork

reco

gnis

e an

d ta

ke a

ccou

nt o

f the

lear

ning

from

se

rious

unt

owar

d in

cide

nts

ACI

SDL

ST

PDP

WBA

Risk

as

sess

men

t an

d ris

k m

anag

emen

t

the

prin

cipl

es o

f ris

k as

sess

men

tca

rry

out r

isk

asse

ssm

ents

appl

y re

leva

nt p

roce

dure

s

mon

itor a

ctio

n pl

ans t

o ob

viat

e fu

rthe

r ris

k

reco

gnis

e th

e va

lue

of ri

sk a

sses

smen

tsAC

ICB

LW

BA

Audi

t (ge

nera

l)th

e pr

inci

ples

of i

nter

nal a

nd e

xter

nal q

ualit

y as

sura

nce

the

audi

t pro

cess

have

invo

lvem

ent i

n th

e co

mpl

etio

n of

aud

it pr

ojec

ts

dem

onst

rate

impr

ovem

ent a

s the

resu

lt of

aud

it

reco

gnis

e th

e be

nefit

of a

udit

to p

atie

nt c

are

and

indi

vidu

al p

erfo

rman

ceAC

IST

PDP

WBA

Guid

elin

esth

e co

nten

t of g

uide

lines

app

licab

le to

the

prac

tice

and

deliv

ery

of in

hala

tion

seda

tion

tech

niqu

esap

ply

guid

elin

es a

pplic

able

to th

e pr

actic

e an

d de

liver

y of

inha

latio

n se

datio

n te

chni

ques

show

rega

rd fo

r ind

ivid

ual p

atie

nt n

eeds

whe

n ut

ilisi

ng g

uide

lines

ACI

CBL

ST

PDP

WBA

70

Patie

nt sa

fety

the

prin

cipl

es o

f Im

med

iate

Life

Sup

port

and

/or P

aedi

atric

Im

med

iate

Life

Sup

port

the

man

agem

ent o

f med

ical

em

erge

ncie

s in

the

dent

al su

rger

y

the

prin

cipl

es o

f man

agem

ent o

f fitn

ess t

o pr

actis

e ca

ses

the

role

of o

rgan

isat

ions

cha

rged

with

ens

urin

g pa

tient

safe

ty

perfo

rm Im

med

iate

Life

Sup

port

and

/or P

aedi

atric

Im

med

iate

Life

Sup

port

inst

igat

e m

anag

emen

t of m

edic

al e

mer

genc

ies i

n th

e de

ntal

surg

ery

show

rega

rd fo

r pat

ient

safe

ty

reco

gnis

e th

e im

porta

nce

of te

am tr

aini

ng in

the

man

agem

ent o

f med

ical

em

erge

ncie

s in

the

dent

al

surg

ery

CBL

ST

WBA

Rele

vanc

e of

out

side

bo

dies

the

role

of:

- Gen

eral

Den

tal C

ounc

il - D

epar

tmen

t of H

ealth

- r

oyal

col

lege

s - s

peci

alis

t soc

ietie

s - d

efen

ce so

ciet

ies

- pat

ient

adv

ocac

y gr

oups

com

mun

icat

e w

ith a

nd in

volv

e th

ese

bodi

es in

ap

prop

riate

situ

atio

nsde

mon

stra

te a

ccep

tanc

e of

pr

ofes

sion

al re

gula

tion

shar

e be

st p

ract

ice

part

icip

ate

in p

eer r

evie

w

SDL

ST

PDP

WBA

Key:

Te

achi

ng a

nd le

arni

ng m

etho

ds

ACI =

aud

it/cr

itica

l inc

iden

t ana

lysi

s; C

A =

clin

ical

atta

chm

ent;

CBL

= ca

se-b

ased

lear

ning

; SDL

= se

lf-di

rect

ed le

arni

ng; S

T =

stru

ctur

ed te

achi

ng

As

sess

men

t met

hods

FA =

form

al a

sses

smen

t; M

SF =

mul

ti-so

urce

feed

back

; PDP

= p

erso

nal d

evel

opm

ent p

ortfo

lio; W

BA =

wor

kpla

ce-b

ased

ass

essm

ent

SYLLABUS 4APPENDICES

71

1.2

Rela

tions

hips

with

pat

ient

s, p

aren

ts a

nd ca

rers

Ea

ch le

arni

ng o

utco

me

shou

ld b

e pr

efac

ed b

y: ‘O

n co

mpl

etio

n of

trai

ning

, the

trai

nee

in in

hala

tion

seda

tion

for c

hild

ren,

you

ng p

eopl

e an

d ad

ults

…’

Subj

ect

Know

ledg

e …

shou

ld b

e ab

le to

des

crib

e:Sk

ills

… sh

ould

be

able

to:

Attit

udes

and

beh

avio

urs

… sh

ould

:Te

achi

ng a

nd le

arni

ng

met

hod(

s)As

sess

men

t m

etho

d(s)

Info

rmed

cons

ent

the

prin

cipl

es o

f val

id c

onse

nt

the

prin

cipl

es o

f the

Men

tal C

apac

ity

Act 2

00512

and

the

Depr

ivat

ion

of

Libe

rty

Safe

guar

ds54

(Sco

tland

: Adu

lts

with

Inca

paci

ty (S

cotla

nd) A

ct 2

00055

and

Adul

ts w

ith In

capa

city

(Sco

tland

) Am

endm

ent R

egul

atio

ns 2

012)

56

the

proc

ess f

or g

aini

ng v

alid

con

sent

obta

in v

alid

con

sent

in re

latio

n to

chi

ldre

n, y

oung

peo

ple

and

adul

ts h

avin

g in

hala

tion

seda

tion

tech

niqu

es

asse

ss c

apac

ity a

nd o

btai

n as

sent

whe

re a

ppro

pria

te

wor

k w

ith o

ther

age

ncie

s to

obta

in a

bes

t int

eres

t de

cisi

on a

nd a

gree

men

t to

trea

t in

circ

umst

ance

s whe

re

ther

e is

lack

of c

apac

ity

shar

e in

form

atio

n ap

prop

riate

ly w

hen

nece

ssar

y to

sa

fegu

ard

vuln

erab

le p

atie

nts

resp

ect p

atie

nts’

and

par

ents

’/car

ers’

au

tono

my

and

wis

hes,

incl

udin

g th

eir

right

to re

fuse

trea

tmen

t eve

n w

hen

trea

tmen

t wou

ld b

e in

thei

r bes

t in

tere

sts

CBL

SDL

ST

WBA

Conf

iden

tialit

yre

leva

nt st

rate

gies

to e

nsur

e co

nfid

entia

lity

the

situ

atio

ns w

hen

conf

iden

tialit

y m

ight

be

brok

en

appl

y th

e pr

inci

ples

of c

onfid

entia

lity

in re

latio

n to

cl

inic

al c

are

resp

ect t

he ri

ght t

o co

nfid

entia

lity

dem

onst

rate

em

path

y w

hile

act

ing

in

the

patie

nt’s/

fam

ily’s

best

inte

rest

s

CBL

SDL

ST

WBA

Lega

l iss

ues

the

lega

l iss

ues r

elat

ing

to th

e pr

actic

e an

d de

liver

y of

inha

latio

n se

datio

n te

chni

ques

wor

k w

ithin

rele

vant

lega

l fra

mew

orks

CBL

SDL

ST

WBA

Key:

Te

achi

ng a

nd le

arni

ng m

etho

dsAC

I = a

udit/

criti

cal i

ncid

ent a

naly

sis;

CA

= cl

inic

al a

ttach

men

t; CB

L =

case

-bas

ed le

arni

ng; S

DL =

self-

dire

cted

lear

ning

; ST

= st

ruct

ured

teac

hing

Asse

ssm

ent m

etho

dsFA

= fo

rmal

ass

essm

ent;

MSF

= m

ulti-

sour

ce fe

edba

ck; P

DP =

per

sona

l dev

elop

men

t por

tfolio

; WBA

= w

orkp

lace

-bas

ed a

sses

smen

t

72

2.

Seda

tion-

rela

ted

cont

ent

Each

lear

ning

out

com

e sh

ould

be

pref

aced

by:

‘On

com

plet

ion

of tr

aini

ng, t

he tr

aine

e in

inha

latio

n se

datio

n fo

r ch

ildre

n, y

oung

peo

ple

and

adul

ts…

’

Subj

ect

Know

ledg

e …

shou

ld b

e ab

le to

des

crib

e:Sk

ills

… sh

ould

be

able

to:

Attit

udes

and

beh

avio

urs

… sh

ould

:Te

achi

ng

and

lear

ning

m

etho

d(s)

Asse

ssm

ent

met

hod(

s)

Dent

al a

nxie

tyth

e hi

stor

y of

pai

n an

d an

xiet

y co

ntro

l in

dent

istr

y

the

caus

es, s

igns

and

sym

ptom

s of d

enta

l anx

iety

and

pho

bia

the

spec

trum

of a

nxie

ty m

anag

emen

t tec

hniq

ues,

incl

udin

g be

havi

oura

l/non

-pha

rmac

olog

ical

met

hods

, con

scio

us se

datio

n an

d ge

nera

l ana

esth

esia

the

dist

inct

ion

betw

een

cons

ciou

s sed

atio

n an

d ge

nera

l an

aest

hesi

a

tech

niqu

es fo

r com

mun

icat

ing

with

peo

ple

of a

ll ag

es a

nd a

bilit

ies

reco

gnis

e ad

vanc

es in

pai

n an

d an

xiet

y co

ntro

l in

dent

istr

y

reco

gnis

e th

e ca

uses

, sig

ns a

nd sy

mpt

oms o

f den

tal

anxi

ety

and

phob

ia

appl

y th

eir k

now

ledg

e of

the

spec

trum

of a

nxie

ty

man

agem

ent t

echn

ique

s, in

clud

ing

beha

viou

ral/n

on-

phar

mac

olog

ical

met

hods

, con

scio

us se

datio

n an

d ge

nera

l ana

esth

esia

com

mun

icat

e w

ith p

eopl

e of

all

ages

and

abi

litie

s

reco

gnis

e th

e va

lue

of

effe

ctiv

e pa

in a

nd a

nxie

ty

cont

rol i

n de

ntis

try

dem

onst

rate

a c

arin

g at

titud

e to

anx

ious

pa

tient

s

dem

onst

rate

a w

illin

gnes

s to

em

ploy

the

mos

t ap

prop

riate

anx

iety

m

anag

emen

t tec

hniq

ue

for i

ndiv

idua

l pat

ient

s

SDL

ST

FA PDP

WBA

Anat

omy

and

phys

iolo

gyan

atom

y an

d ph

ysio

logy

rele

vant

to th

e us

e of

con

scio

us se

datio

n fo

r den

tistr

y, p

artic

ular

ly:

- car

diov

ascu

lar

- res

pira

tory

- n

euro

logi

cal

the

anat

omic

al a

nd p

hysi

olog

ical

diff

eren

ces b

etw

een

child

ren,

yo

ung

peop

le a

nd a

dults

as w

ell a

s how

thes

e re

late

to th

e us

e of

co

nsci

ous s

edat

ion

asse

ssm

ent o

f pre

viou

s and

cur

rent

airw

ay p

robl

ems t

o an

ticip

ate

pote

ntia

l diff

icul

ties d

urin

g se

datio

n or

if v

entil

atio

n is

requ

ired

appl

y th

eir k

now

ledg

e of

ana

tom

ical

stru

ctur

es a

nd

phys

iolo

gica

l res

pons

es in

pla

nnin

g an

d pr

ovid

ing

cons

ciou

s sed

atio

n

appl

y th

eir k

now

ledg

e of

the

anat

omic

al a

nd

phys

iolo

gica

l diff

eren

ces b

etw

een

child

ren,

you

ng p

eopl

e an

d ad

ults

in p

lann

ing

and

prov

idin

g co

nsci

ous s

edat

ion

carr

y ou

t airw

ay a

sses

smen

t and

ant

icip

ate

pote

ntia

l di

fficu

lties

dur

ing

seda

tion

or if

ven

tilat

ion

is re

quire

d

SDL

ST

FA PDP

WBA

Phar

mac

olog

yth

e ap

plie

d ph

arm

acol

ogy

of d

rugs

use

d in

bas

ic c

onsc

ious

se

datio

n fo

r chi

ldre

n, y

oung

peo

ple

and

adul

ts, f

or e

xam

ple:

- n

itrou

s oxi

de/o

xyge

n

the

term

inol

ogy

desc

ribin

g le

vels

of s

edat

ion

(min

imal

, con

scio

us,

mod

erat

e, d

eep)

and

gen

eral

ana

esth

esia

impo

rtant

dru

g in

tera

ctio

ns:

- bet

wee

n se

datio

n dr

ugs

- of s

edat

ion

drug

s with

oth

er p

resc

ribed

med

icat

ion

appl

y th

eir k

now

ledg

e of

the

phar

mac

olog

y of

dru

gs

used

in in

hala

tion

seda

tion

to th

e pr

actic

al si

tuat

ion

in

such

a w

ay a

s to

use

this

tech

niqu

e w

hen

it is

safe

and

ap

prop

riate

for t

he in

divi

dual

pat

ient

appl

y th

eir k

now

ledg

e of

seda

tion

drug

s and

pre

scrib

ed

med

icat

ion

to a

void

dru

g in

tera

ctio

ns in

the

clin

ical

se

ttin

g

dem

onst

rate

a w

illin

gnes

s to

use

this

kno

wle

dge

in

trea

tmen

t pla

nnin

g as

w

ell a

s in

the

prov

isio

n of

inha

latio

n se

datio

n in

ch

ildre

n, y

oung

peo

ple

and

adul

ts

SDL

ST

FA PDP

WBA

SYLLABUS 4APPENDICES

73

Patie

nt a

sses

smen

tho

w to

obt

ain

accu

rate

and

det

aile

d in

form

atio

n ab

out p

ast a

nd c

urre

nt

med

ical

/sur

gica

l con

ditio

ns (e

.g. c

urre

nt

and

prev

ious

med

icat

ion,

alle

rgie

s)

whe

n to

ask

for a

dvic

e or

cla

rific

atio

n of

the

patie

nt’s

med

ical

his

tory

and

w

hen

to li

aise

with

per

sonn

el fr

om th

e re

ferr

ing

dent

ist

how

info

rmat

ion

abou

t med

ical

pr

oble

ms a

ssoc

iate

d w

ith p

revi

ous

cons

ciou

s sed

atio

n or

ana

esth

esia

may

in

fluen

ce fu

ture

man

agem

ent

the

rele

vanc

e of

the

patie

nt’s

ASA

stat

us

pote

ntia

l pro

blem

s rel

atin

g to

the

adm

inis

tratio

n of

inha

latio

n se

datio

n fo

r yo

unge

r and

old

er p

atie

nts

the

use

of w

eigh

t and

hei

ght d

ata,

gr

owth

cha

rts a

nd n

orm

al ra

nges

to

estim

ate

a ch

ild’s

stag

e of

phy

sica

l de

velo

pmen

t

the

sign

ifica

nce

of th

e m

atur

ity o

f ai

rway

dev

elop

men

t as w

ell a

s any

pr

oble

ms t

hat m

ight

aris

e du

e to

airw

ay

abno

rmal

ities

how

the

patie

nt’s

psyc

holo

gica

l and

de

velo

pmen

tal s

tatu

s may

influ

ence

m

anag

emen

t

take

a d

etai

led

med

ical

, fam

ily, s

ocia

l an

d de

ntal

his

tory

to id

entif

y se

rious

m

edic

al a

nd su

rgic

al c

ondi

tions

that

im

pact

on

safe

del

iver

y of

Inha

latio

n se

datio

n

seek

adv

ice

or c

larif

icat

ion

of th

e pa

tient

’s m

edic

al h

isto

ry a

nd li

aise

with

th

e re

ferr

ing

dent

ist

iden

tify

serio

us p

robl

ems t

hat m

ight

im

pact

on

safe

del

iver

y of

inha

latio

n se

datio

n an

d kn

ow w

hen

to a

sk fo

r cl

arifi

catio

n

asse

ss p

oten

tial p

robl

ems r

elat

ing

to th

e ad

min

istra

tion

of in

hala

tion

seda

tion

for

youn

ger a

nd o

lder

pat

ient

s

iden

tify

child

ren

with

serio

us p

robl

ems

that

mig

ht im

pact

on

the

safe

del

iver

y of

co

nsci

ous s

edat

ion

who

are

not

in th

e no

rmal

rang

e

dem

onst

rate

a w

illin

gnes

s to

use

this

kn

owle

dge

in d

iagn

osis

and

trea

tmen

t pl

anni

ng a

s wel

l as i

n th

e pr

ovis

ion

of

inha

latio

n se

datio

n

be w

illin

g to

seek

adv

ice

or c

larif

icat

ion

of th

e pa

tient

’s m

edic

al h

isto

ry a

nd to

lia

ise

with

the

refe

rrin

g de

ntis

t

SDL

ST CA

FA PDP

WBA

cons

ider

atio

n of

the

evid

ence

and

gu

idan

ce re

latin

g to

fast

ing

reco

gnis

e w

hen

fast

ing

is d

esira

ble

the

prov

isio

n of

pre

- and

pos

t-sed

atio

n in

stru

ctio

ns fo

r pat

ient

s and

esc

orts

in

an a

ge a

ppro

pria

te fo

rmat

prov

ide

pre-

and

pos

t-sed

atio

n in

stru

ctio

ns fo

r pat

ient

s and

esc

orts

in

an a

ge a

ppro

pria

te fo

rmat

appr

opria

te c

omm

unic

atio

n te

chni

ques

fo

r chi

ldre

n, y

oung

peo

ple

and

adul

tsco

mm

unic

ate

effe

ctiv

ely

with

chi

ldre

n,

youn

g pe

ople

and

adu

lts

74

Adm

inis

trat

ion

of se

datio

nth

e ph

ysic

al si

gns o

f bot

h co

nsci

ous

(mod

erat

e) a

nd d

eep

seda

tion

as w

ell a

s ho

w to

reco

gnis

e th

e co

nsci

ous s

edat

ion

endp

oint

the

equi

pmen

t req

uire

d fo

r ad

min

istra

tion

of in

hala

tion

seda

tion

loca

l ana

esth

etic

dru

gs a

nd te

chni

ques

how

to c

heck

an

inha

latio

n se

datio

n m

achi

ne a

nd sc

aven

ging

syst

em

how

to c

onne

ct a

bre

athi

ng sy

stem

, se

lect

an

appr

opria

te n

asal

mas

k, a

nd

adju

st th

e ga

s flo

w ra

te a

nd m

ixtu

re o

n an

inha

latio

n se

datio

n m

achi

ne

how

to c

linic

ally

mon

itor a

pat

ient

to

dete

rmin

e th

e le

vel o

f con

scio

usne

ss,

co-o

pera

tion,

resp

iratio

n, h

eart

rate

an

d sk

in c

olou

r, an

d ho

w to

resp

ond

appr

opria

tely

to c

hang

es

appr

opria

te d

rug

dosa

ge(s

)

appr

opria

te a

dmin

istra

tion

tech

niqu

es

how

to re

cogn

ise

the

cons

ciou

s sed

atio

n en

dpoi

nt

tech

niqu

es fo

r adm

inis

terin

g se

datio

n dr

ugs b

y in

hala

tion

the

effe

ctiv

enes

s of c

onsc

ious

seda

tion

clin

ical

ly m

onito

ring

the

patie

nt,

incl

udin

g th

e de

pth

of se

datio

n

sele

ct th

e eq

uipm

ent r

equi

red

for

adm

inis

tratio

n of

inha

latio

n se

datio

n

safe

ly a

dmin

iste

r a p

resc

ribed

loca

l an

aest

hetic

chec

k th

e fu

nctio

ning

and

safe

ty

feat

ures

of a

n in

hala

tion

seda

tion

mac

hine

and

scav

engi

ng sy

stem

conn

ect a

bre

athi

ng sy

stem

, sel

ect a

n ap

prop

riate

nas

al m

ask,

and

adj

ust

the

gas f

low

rate

and

mix

ture

on

an

inha

latio

n se

datio

n m

achi

ne

clin

ical

ly m

onito

r pat

ient

s to

dete

rmin

e th

e le

vel o

f con

scio

usne

ss, c

o-op

erat

ion,

re

spira

tion,

hea

rt ra

te a

nd sk

in c

olou

r, an

d re

spon

d ap

prop

riate

ly to

cha

nges

sele

ct a

nd d

emon

stra

te u

se o

f ap

prop

riate

dru

g do

sage

(s)

dem

onst

rate

the

use

of a

n ap

prop

riate

in

hala

tion

seda

tion

adm

inis

tratio

n te

chni

que

dem

onst

rate

reco

gniti

on o

f the

co

nsci

ous s

edat

ion

endp

oint

and

avo

id

goin

g be

yond

it

dem

onst

rate

safe

use

of s

edat

ion

drug

s ad

min

iste

red

by in

hala

tion

asse

ss th

e ef

fect

iven

ess o

f con

scio

us

seda

tion

show

con

tinuo

us re

gard

for p

atie

nt

safe

tyAC

I

CA CBL

SDL

ST

FA MSF

PDP

WBA

SYLLABUS 4APPENDICES

75

Good

pra

ctic

e / m

edic

o-le

gal

requ

irem

ents

the

med

ico-

lega

l req

uire

men

ts re

latin

g to

adm

inis

terin

g in

hala

tion

seda

tion

the

oper

ator

’s le

gal r

equi

rem

ents

w

hen

ther

e is

a se

para

te o

pera

tor a

nd

seda

tioni

st

the

train

ing

and

resp

onsi

bilit

ies o

f the

pe

rson

(usu

ally

an

appr

opria

tely

trai

ned

and

expe

rienc

ed d

enta

l nur

se) w

ho

assi

sts a

n op

erat

or-s

edat

ioni

st

the

situ

atio

ns in

whi

ch a

sepa

rate

op

erat

or a

nd se

datio

nist

are

app

ropr

iate

the

know

ledg

e an

d ex

perie

nce

anot

her

prac

titio

ner m

ust h

ave

to b

e ab

le to

pr

ovid

e sa

fe c

onsc

ious

seda

tion

for a

de

ntis

t with

out t

rain

ing

in c

onsc

ious

se

datio

n

whe

n it

is sa

fe to

dis

char

ge a

pat

ient

and

w

hen

othe

r act

ions

mig

ht b

e re

quire

d

post

-ope

rativ

e an

d af

terc

are

inst

ruct

ions

ap

prop

riate

to e

ach

indi

vidu

al, t

akin

g in

to a

ccou

nt th

eir s

ocia

l circ

umst

ance

s

the

reco

gniti

on a

nd m

anag

emen

t of

seda

tion-

rela

ted

com

plic

atio

ns,

incl

udin

g:

- ove

r-sed

atio

n - r

espi

rato

ry d

epre

ssio

n - u

ncon

scio

us p

atie

nt

- airw

ay o

bstr

uctio

n - v

omiti

ng

- ana

phyl

axis

- d

elay

ed re

cove

ry

- fai

lure

of c

onsc

ious

seda

tion

curr

ent g

uide

lines

on:

- g

aini

ng v

alid

con

sent

- t

eam

wor

k - c

linic

al h

oldi

ng/r

estra

int

- end

ing

hold

ing/

rest

rain

t if r

equi

red

- app

ropr

iate

reco

rd k

eepi

ng

- con

trol

led

drug

s

act i

n ac

cord

ance

with

the

med

ico-

lega

l re

quire

men

ts re

latin

g to

adm

inis

terin

g in

hala

tion

seda

tion

act i

n ac

cord

ance

with

the

oper

ator

’s le

gal r

equi

rem

ents

whe

n th

ere

is a

se

para

te o

pera

tor a

nd se

datio

nist

act i

n ac

cord

ance

with

the

requ

irem

ents

re

latin

g to

the

pers

on (u

sual

ly a

n ap

prop

riate

ly tr

aine

d an

d ex

perie

nced

de

ntal

nur

se) w

ho a

ssis

ts a

n op

erat

or-

seda

tioni

st

reco

gnis

e th

e si

tuat

ions

in w

hich

a

sepa

rate

ope

rato

r and

seda

tioni

st a

re

requ

ired,

and

act

acc

ordi

ngly

reco

gnis

e w

hen

it is

safe

to d

isch

arge

a

patie

nt a

nd w

hen

othe

r act

ions

mig

ht

be re

quire

d

prov

ide

patie

nts w

ith a

ppro

pria

te

disc

harg

e an

d po

st-o

pera

tive

inst

ruct

ions

in a

form

at th

at th

ey c

an

unde

rsta

nd

reco

gnis

e an

d m

anag

e se

datio

n-re

late

d co

mpl

icat

ions

, inc

ludi

ng:

- ove

r-sed

atio

n - r

espi

rato

ry d

epre

ssio

n - u

ncon

scio

us p

atie

nt

- airw

ay o

bstr

uctio

n - v

omiti

ng

- ana

phyl

axis

- d

elay

ed re

cove

ry

- fai

lure

of c

onsc

ious

seda

tion

appl

y cu

rren

t gui

delin

es o

n:

- gai

ning

val

id c

onse

nt

- tea

mw

ork

- clin

ical

hol

ding

/res

train

t - e

ndin

g ho

ldin

g/re

stra

int i

f req

uire

d - a

ppro

pria

te re

cord

kee

ping

- c

ontr

olle

d dr

ugs

cons

ult a

nd c

olla

bora

te w

ith c

olle

ague

s in

oth

er sp

ecia

lties

whe

re n

eces

sary

reco

gnis

e th

e ro

le o

f the

ope

rato

r and

ot

her m

embe

rs o

f the

den

tal s

edat

ion

team

in th

e m

anag

emen

t of p

atie

nts

show

rega

rd fo

r ind

ivid

ual p

atie

nt,

fam

ily a

nd/o

r car

er n

eeds

reco

gnis

e th

e im

porta

nce

of te

am

train

ing

in th

e m

anag

emen

t of s

edat

ion/

med

ical

em

erge

ncie

s in

the

dent

al

surg

ery

show

rega

rd fo

r ind

ivid

ual p

atie

nt n

eeds

w

hen

utili

sing

gui

delin

es

ACI

CA CBL

SDL

ST

FA MSF

PDP

WBA

76

Trai

ning

and

cont

inui

ng p

rofe

ssio

nal

deve

lopm

ent (

CPD)

the

train

ing

requ

ired

so th

at th

e de

ntal

te

am c

an sa

fely

pro

vide

inha

latio

n se

datio

n

the

requ

irem

ents

for C

PD to

kee

p up

to

date

with

dev

elop

men

ts in

inha

latio

n se

datio

n an

d th

eir a

pplic

atio

n to

den

tistr

y

curr

ent I

mm

edia

te L

ife S

uppo

rt a

nd/o

r Pa

edia

tric

Imm

edia

te L

ife S

uppo

rt

the

curr

ent l

itera

ture

on

inha

latio

n se

datio

n dr

ugs a

nd te

chni

ques

the

impo

rtanc

e of

rele

vant

clin

ical

aud

it

dem

onst

rate

thro

ugh

safe

pra

ctic

e th

at

the

train

ing

requ

ired

so th

at th

e de

ntal

te

am c

an sa

fely

pro

vide

inha

latio

n se

datio

n is

con

tem

pora

neou

s

dem

onst

rate

thro

ugh

deba

te, s

afe

prac

tice

and

lead

ersh

ip th

at C

PD is

up

to d

ate

with

dev

elop

men

ts in

con

scio

us

seda

tion

tech

niqu

es a

s wel

l as t

heir

appl

icat

ion

to d

entis

try

perfo

rm Im

med

iate

Life

Sup

port

and

/or

Paed

iatr

ic Im

med

iate

Life

Sup

port

be a

ctiv

ely

invo

lved

in re

leva

nt c

linic

al

audi

t

keep

up

to d

ate

with

dev

elop

men

ts

in in

hala

tion

seda

tion

and

thei

r ap

plic

atio

n to

den

tistr

y

be p

repa

red

to re

ad a

nd a

ct o

n cu

rren

t lit

erat

ure

on in

hala

tion

seda

tion

ACI

CA CBL

SDL

ST

FA MSF

PDP

WBA

Key:

Te

achi

ng a

nd le

arni

ng m

etho

dsAC

I = a

udit/

criti

cal i

ncid

ent a

naly

sis;

CA

= cl

inic

al a

ttach

men

t; CB

L =

case

-bas

ed le

arni

ng; S

DL =

self-

dire

cted

lear

ning

; ST

= st

ruct

ured

teac

hing

Asse

ssm

ent m

etho

ds

FA

= fo

rmal

ass

essm

ent;

MSF

= m

ulti-

sour

ce fe

edba

ck; P

DP =

per

sona

l dev

elop

men

t por

tfolio

; WBA

= w

orkp

lace

-bas

ed a

sses

smen

t

SYLLABUS 4APPENDICES

77

Appendix 1:

1. General professional content

1.1 Maintaining good clinical practice

Each learning outcome should be prefaced by: ‘On completion of training, the trainee in dental sedation nursing…’

Syllabus 5: Dental nurses: Assistingduring conscious sedation

78

Subj

ect

Know

ledg

e …

shou

ld b

e ab

le to

des

crib

e:Sk

ills

… sh

ould

be

able

to:

Attit

udes

and

beh

avio

urs

… sh

ould

:Te

achi

ng a

nd

lear

ning

met

hod(

s)As

sess

men

t m

etho

d(s)

Prof

essi

onal

ap

proa

chth

e re

quire

men

ts o

f an

effe

ctiv

e de

ntal

seda

tion

nurs

e

the

diffe

rent

mod

els o

f wor

king

as

par

t of a

team

assi

st w

ith th

e pr

ovis

ion

of c

onsc

ious

se

datio

n te

chni

ques

for d

entis

try

beha

ve in

a p

rofe

ssio

nal m

anne

rCB

LM

SF

PDP

Life

-long

lear

ning

the

requ

irem

ents

for c

ontin

uing

pr

ofes

sion

al d

evel

opm

ent

reco

gnis

e an

d ta

ke a

dvan

tage

of

lear

ning

opp

ortu

nitie

s for

all

mem

bers

of

the

team

pro

vidi

ng c

onsc

ious

se

datio

n fo

r den

tistr

y

mai

ntai

n a

pers

onal

dev

elop

men

t po

rtfo

lio

mon

itor o

wn

perfo

rman

ce th

roug

h te

am

audi

t and

feed

back

com

ply

with

Gen

eral

Den

tal C

ounc

il re

quire

men

ts fo

r rev

alid

atio

nCB

L

SDL

ST

PDP

WBA

Evid

ence

the

prin

cipl

es o

f evi

denc

e-ba

sed

prac

tice

appl

y w

ithin

the

team

evi

denc

e an

d re

com

men

datio

ns o

f bes

t pra

ctic

e

prov

ide

cons

truc

tive

feed

back

with

in th

e de

ntal

seda

tion

team

use

evid

ence

in su

ppor

t of p

atie

nt c

are

and

to d

efen

d de

cisi

ons

take

nST

WBA

Writ

ten

reco

rds

the

prin

cipl

es a

nd g

uide

lines

fo

r goo

d cl

inic

al n

ote

keep

ing

the

reas

ons f

or c

onfid

entia

lity

com

mun

icat

e ef

fect

ivel

y th

roug

h w

ritte

n re

cord

s

appl

y th

e pr

inci

ples

of c

onfid

entia

lity

in

the

cont

ext o

f writ

ten

reco

rds

take

acc

ount

of c

onfid

entia

lity

requ

irem

ents

and

lega

l req

uire

men

ts

rela

ting

to w

ritte

n, e

lect

roni

c an

d di

gita

l rec

ords

, and

thei

r tra

nspo

rt

and

stor

age

CBL

ST

WBA

Use

of in

form

atio

n te

chno

logy

the

prin

cipl

es o

f ret

rieva

l and

ut

ilisa

tion

of d

ata

reco

rded

in

clin

ical

syst

ems

appl

y th

e pr

inci

ples

of c

onfid

entia

lity

in

the

cont

ext o

f inf

orm

atio

n te

chno

logy

take

acc

ount

of t

he le

gal a

spec

ts re

latin

g to

hol

ding

ele

ctro

nic

and

digi

tal r

ecor

ds

dem

onst

rate

a p

ositi

ve a

nd p

roac

tive

attit

ude

to n

ew te

chno

logy

ACI

ST

WBA

Org

anis

atio

nal

fram

ewor

k fo

r cl

inic

al g

over

nanc

e an

d its

app

licat

ion

in p

ract

ice

the

elem

ents

of c

linic

al

gove

rnan

ce

the

prin

cipl

es o

f clin

ical

go

vern

ance

, in

part

icul

ar

rela

ted

to in

fect

ion

cont

rol

part

icip

ate

activ

ely

in c

linic

al

gove

rnan

ce

part

icip

ate

in a

udit

repo

rt se

rious

unt

owar

d in

cide

nts

reco

gnis

e th

e im

porta

nce

of te

amw

ork

in im

plem

entin

g a

clin

ical

go

vern

ance

fram

ewor

k

reco

gnis

e an

d ta

ke a

ccou

nt o

f the

lear

ning

from

serio

us u

ntow

ard

inci

dent

s

ACI

SDL

ST

PDP

WBA

Risk

ass

essm

ent

and

risk

man

agem

ent

the

prin

cipl

es o

f ris

k as

sess

men

tca

rry

out r

isk

asse

ssm

ents

appl

y re

leva

nt p

roce

dure

s

mon

itor a

ctio

n pl

ans t

o ob

viat

e fu

rthe

r ris

k

reco

gnis

e th

e va

lue

of ri

sk a

sses

smen

tsAC

I

CBL

WBA

SYLLABUS 4APPENDICES

79

Audi

t (ge

nera

l)th

e pr

inci

ples

of i

nter

nal a

nd e

xter

nal

qual

ity a

ssur

ance

the

audi

t pro

cess

have

invo

lvem

ent i

n th

e co

mpl

etio

n of

au

dit p

roje

cts

dem

onst

rate

impr

ovem

ent a

s the

resu

lt of

aud

it

reco

gnis

e th

e be

nefit

of a

udit

to p

atie

nt

care

and

indi

vidu

al p

erfo

rman

ceAC

I

ST

PDP

WBA

Guid

elin

esth

e co

nten

t of g

uide

lines

app

licab

le to

th

e pr

actic

e an

d de

liver

y of

con

scio

us

seda

tion

tech

niqu

es in

den

tistr

y

appl

y gu

idel

ines

app

licab

le to

the

prac

tice

and

deliv

ery

of c

onsc

ious

se

datio

n te

chni

ques

in d

entis

try

show

rega

rd fo

r ind

ivid

ual p

atie

nt n

eeds

w

hen

utili

sing

gui

delin

esAC

I

CBL

ST

PDP

WBA

Patie

nt sa

fety

the

prin

cipl

es o

f Im

med

iate

Life

Sup

port

an

d/or

Pae

diat

ric Im

med

iate

Life

Su

ppor

t

the

man

agem

ent o

f med

ical

em

erge

ncie

s in

the

dent

al su

rger

y

the

prin

cipl

es o

f man

agem

ent o

f fitn

ess

to p

ract

ise

case

s

the

role

of o

rgan

isat

ions

cha

rged

with

en

surin

g pa

tient

safe

ty

perfo

rm Im

med

iate

Life

Sup

port

and

/or

Paed

iatr

ic Im

med

iate

Life

Sup

port

part

icip

ate

in th

e m

anag

emen

t of

med

ical

em

erge

ncie

s in

the

dent

al

surg

ery

show

rega

rd fo

r pat

ient

safe

ty

reco

gnis

e th

e im

porta

nce

of te

am

train

ing

in th

e m

anag

emen

t of m

edic

al

emer

genc

ies i

n th

e de

ntal

surg

ery

CBL

ST

WBA

Rele

vanc

e of

out

side

bod

ies

the

role

of:

- Gen

eral

Den

tal C

ounc

il - D

epar

tmen

t of H

ealth

- N

atio

nal E

xam

inin

g Bo

ard

for D

enta

l N

urse

s - r

oyal

col

lege

s - s

peci

alis

t soc

ietie

s - d

efen

ce so

ciet

ies

- pat

ient

adv

isor

y gr

oups

com

mun

icat

e w

ith a

nd in

volv

e th

ese

bodi

es in

app

ropr

iate

situ

atio

nsde

mon

stra

te a

ccep

tanc

e of

pro

fess

iona

l re

gula

tion

shar

e be

st p

ract

ice

part

icip

ate

in p

eer r

evie

w

SDL

ST

PDP

WBA

Key:

Te

achi

ng a

nd le

arni

ng m

etho

dsAC

I = a

udit/

criti

cal i

ncid

ent a

naly

sis;

CA

= cl

inic

al a

ttach

men

t; CB

L =

case

-bas

ed le

arni

ng; S

DL =

self-

dire

cted

lear

ning

; ST

= st

ruct

ured

teac

hing

Asse

ssm

ent m

etho

dsFA

= fo

rmal

ass

essm

ent;

MSF

= m

ulti-

sour

ce fe

edba

ck; P

DP =

per

sona

l dev

elop

men

t por

tfolio

; WBA

= w

orkp

lace

-bas

ed a

sses

smen

t

80

1.2

Rela

tions

hips

with

pat

ient

s, p

aren

ts a

nd ca

rers

Each

lear

ning

out

com

e sh

ould

be

pref

aced

by:

‘On

com

plet

ion

of tr

aini

ng, t

he tr

aine

e in

den

tal s

edat

ion

nurs

ing.

.’

Subj

ect

Know

ledg

e …

shou

ld b

e ab

le to

des

crib

e:Sk

ills

… sh

ould

be

able

to:

Attit

udes

and

beh

avio

urs

… sh

ould

:Te

achi

ng a

nd le

arni

ng

met

hod(

s)As

sess

men

t met

hod(

s)

Info

rmed

cons

ent

the

prin

cipl

es o

f val

id c

onse

nt

the

prin

cipl

es o

f the

Men

tal C

apac

ity

Act 2

00512

and

the

Depr

ivat

ion

of

Libe

rty

Safe

guar

ds54

(Sco

tland

: Adu

lts

with

Inca

paci

ty (S

cotla

nd) A

ct 2

00055

an

d Ad

ults

with

Inca

paci

ty (S

cotla

nd)

Amen

dmen

t Reg

ulat

ions

201

2)56

the

proc

ess f

or g

aini

ng v

alid

con

sent

play

an

activ

e ro

le in

app

lyin

g th

e pr

inci

ples

of

obta

inin

g co

nsen

t for

pat

ient

s who

fall

unde

r the

M

enta

l Cap

acity

Act

200

512 a

nd th

e De

priv

atio

n of

Lib

erty

Saf

egua

rds54

(Sco

tland

: Adu

lts w

ith

Inca

paci

ty (S

cotla

nd) A

ct 2

00055

and

Adu

lts w

ith

Inca

paci

ty (S

cotla

nd) A

men

dmen

t Reg

ulat

ions

20

12)56

wor

k w

ith o

ther

age

ncie

s to

obta

in a

bes

t int

eres

t de

cisi

on a

nd a

gree

men

t to

trea

t in

circ

umst

ance

s w

here

ther

e is

lack

of c

apac

ity

play

an

activ

e ro

le in

obt

aini

ng v

alid

con

sent

resp

ect p

atie

nts’

and

par

ents

’/car

ers’

au

tono

my

and

wis

hes,

incl

udin

g th

eir

right

to re

fuse

trea

tmen

t eve

n w

hen

it w

ould

be

in th

eir b

est i

nter

ests

CBL

SDL

ST

WBA

Conf

iden

tialit

yre

leva

nt st

rate

gies

to e

nsur

e co

nfid

entia

lity

the

situ

atio

ns w

hen

conf

iden

tialit

y m

ight

be

brok

en

appl

y th

e pr

inci

ples

of c

onfid

entia

lity

in re

latio

n to

cl

inic

al c

are

resp

ect t

he ri

ght t

o co

nfid

entia

lity

CBL

SDL

ST

WBA

Lega

l iss

ues

the

lega

l iss

ues r

elat

ing

to th

e pr

actic

e an

d de

liver

y of

con

scio

us se

datio

n te

chni

ques

in d

entis

try

wor

k w

ithin

rele

vant

lega

l fra

mew

orks

dem

onst

rate

em

path

y w

hile

act

ing

in

the

patie

nt’s/

fam

ily’s

best

inte

rest

s CB

L

SDL

ST

WBA

Key:

Te

achi

ng a

nd le

arni

ng m

etho

dsAC

I = a

udit/

criti

cal i

ncid

ent a

naly

sis;

CA

= cl

inic

al a

ttach

men

t; CB

L =

case

-bas

ed le

arni

ng; S

DL =

self-

dire

cted

lear

ning

; ST

= st

ruct

ured

teac

hing

Asse

ssm

ent m

etho

dsFA

= fo

rmal

ass

essm

ent;

MSF

= m

ulti-

sour

ce fe

edba

ck; P

DP =

per

sona

l dev

elop

men

t por

tfolio

; WBA

= w

orkp

lace

-bas

ed a

sses

smen

t

SYLLABUS 4APPENDICES

81

Subj

ect

Know

ledg

e …

shou

ld b

e ab

le to

des

crib

e:Sk

ills

… sh

ould

be

able

to:

Attit

udes

and

beh

avio

urs

… sh

ould

:Te

achi

ng

and

lear

ning

m

etho

d(s)

Asse

ssm

ent

met

hod(

s)

Dent

al a

nxie

tyth

e hi

stor

y of

pai

n an

d an

xiet

y co

ntro

l in

dent

istr

y

the

caus

es, s

igns

and

sym

ptom

s of d

enta

l anx

iety

an

d ph

obia

the

spec

trum

of a

nxie

ty m

anag

emen

t tec

hniq

ues,

in

clud

ing

beha

viou

ral/n

on-p

harm

acol

ogic

al

met

hods

, con

scio

us se

datio

n an

d ge

nera

l an

aest

hesi

a

the

dist

inct

ion

betw

een

cons

ciou

s sed

atio

n an

d ge

nera

l ana

esth

esia

as w

ell a

s giv

e th

e de

finiti

ons

of e

ach

tech

niqu

es fo

r com

mun

icat

ing

with

peo

ple

of a

ll ag

es a

nd a

bilit

ies

reco

gnis

e ad

vanc

es in

pai

n an

d an

xiet

y co

ntro

l in

dent

istr

y

reco

gnis

e th

e ca

uses

, sig

ns a

nd sy

mpt

oms o

f de

ntal

anx

iety

and

pho

bia

appl

y th

eir k

now

ledg

e of

the

spec

trum

of a

nxie

ty

man

agem

ent t

echn

ique

s, in

clud

ing

beha

viou

ral/

non-

phar

mac

olog

ical

met

hods

, con

scio

us se

datio

n an

d ge

nera

l ana

esth

esia

com

mun

icat

e w

ith p

eopl

e of

all

ages

and

abi

litie

s

reco

gnis

e th

e va

lue

of e

ffect

ive

pain

and

an

xiet

y co

ntro

l in

dent

istr

y

dem

onst

rate

a c

arin

g at

titud

e to

anx

ious

pa

tient

s

dem

onst

rate

a w

illin

gnes

s to

empl

oy th

e m

ost a

ppro

pria

te a

nxie

ty m

anag

emen

t te

chni

que

for i

ndiv

idua

l pat

ient

s

SDL

ST

FA PDP

WBA

Anat

omy

and

phys

iolo

gyan

atom

y an

d ph

ysio

logy

rele

vant

to th

e us

e of

co

nsci

ous s

edat

ion

for d

entis

try,

par

ticul

arly

: - c

ardi

ovas

cula

r - r

espi

rato

ry

- neu

rolo

gica

l - p

oten

tial c

annu

latio

n si

tes

the

anat

omic

al a

nd p

hysi

olog

ical

diff

eren

ces

betw

een

child

ren,

you

ng p

eopl

e an

d ad

ults

as w

ell

as h

ow th

ese

rela

te to

the

use

of c

onsc

ious

seda

tion

the

impa

ct o

f pre

viou

s and

cur

rent

airw

ay p

robl

ems

to a

ntic

ipat

e po

tent

ial d

iffic

ultie

s dur

ing

seda

tion

or

if ve

ntila

tion

is re

quire

d

appl

y th

eir k

now

ledg

e of

ana

tom

ical

stru

ctur

es a

nd

phys

iolo

gica

l res

pons

es in

pla

nnin

g an

d pr

ovid

ing

cons

ciou

s sed

atio

n

appl

y th

eir k

now

ledg

e of

the

anat

omic

al a

nd

phys

iolo

gica

l diff

eren

ces b

etw

een

child

ren,

you

ng

peop

le a

nd a

dults

SDL

ST

FA PDP

WBA

2.

Seda

tion-

rela

ted

cont

ent

Each

lear

ning

out

com

e sh

ould

be

pref

aced

by:

‘On

com

plet

ion

of tr

aini

ng, t

he tr

aine

e in

den

tal s

edat

ion

nurs

ing…

’

82

Phar

mac

olog

yth

e ap

plie

d ph

arm

acol

ogy

of d

rugs

use

d in

bas

ic

cons

ciou

s sed

atio

n fo

r chi

ldre

n, y

oung

peo

ple

and

adul

ts, f

or e

xam

ple:

- n

itrou

s oxi

de/o

xyge

n - b

enzo

diaz

epin

es

- pro

pofo

l - o

pioi

ds

- ket

amin

e - s

evof

lura

ne

the

term

inol

ogy

desc

ribin

g le

vels

of s

edat

ion

(min

imal

, con

scio

us, m

oder

ate,

dee

p) a

nd g

ener

al

anae

sthe

sia

impo

rtant

dru

g in

tera

ctio

ns:

- bet

wee

n se

datio

n dr

ugs

- of s

edat

ion

drug

s with

oth

er p

resc

ribed

med

icat

ion

diffe

renc

es in

the

phar

mac

okin

etic

and

ph

arm

acod

ynam

ic e

ffect

s whe

n dr

ugs a

re

adm

inis

tere

d by

diff

eren

t rou

tes

appl

y th

eir k

now

ledg

e of

the

phar

mac

olog

y of

dr

ugs u

sed

in c

onsc

ious

seda

tion

to th

e pr

actic

al

situ

atio

n to

ens

ure

safe

, effe

ctiv

e an

d ap

prop

riate

fo

r the

indi

vidu

al p

atie

nt

appl

y th

eir k

now

ledg

e of

seda

tion

drug

s and

pr

escr

ibed

med

icat

ion

to a

void

dru

g in

tera

ctio

ns in

th

e cl

inic

al se

ttin

g

dem

onst

rate

a w

illin

gnes

s to

use

this

kn

owle

dge

in th

e pr

ovis

ion

of c

onsc

ious

se

datio

n te

chni

ques

for d

entis

try

in

child

ren,

you

ng p

eopl

e an

d ad

ults

SDL

ST

FA PDP

WBA

SYLLABUS 4APPENDICES

83

Patie

nt a

sses

smen

tth

e im

porta

nce

of o

btai

ning

acc

urat

e an

d de

taile

d in

form

atio

n ab

out p

ast a

nd c

urre

nt m

edic

al/

surg

ical

con

ditio

ns (e

.g. c

urre

nt a

nd p

revi

ous

med

icat

ion,

alle

rgie

s)

the

need

to a

sk fo

r spe

cial

ist m

edic

al a

dvic

e or

cl

arifi

catio

n of

the

patie

nt’s

med

ical

his

tory

and

to

liais

e w

ith p

erso

nnel

from

oth

er d

isci

plin

es w

hen

requ

ired

how

info

rmat

ion

abou

t med

ical

pro

blem

s as

soci

ated

with

pre

viou

s con

scio

us se

datio

n or

an

aest

hesi

a m

ay in

fluen

ce fu

ture

man

agem

ent

the

rele

vanc

e of

the

patie

nt’s

ASA

stat

us

pote

ntia

l pro

blem

s rel

atin

g to

the

adm

inis

tratio

n of

co

nsci

ous s

edat

ion

for y

oung

er a

nd o

lder

pat

ient

s

the

use

of w

eigh

t and

hei

ght d

ata,

gro

wth

cha

rts

and

norm

al ra

nges

to e

stim

ate

a ch

ild’s

stag

e of

ph

ysic

al d

evel

opm

ent

how

the

patie

nt’s

psyc

holo

gica

l and

dev

elop

men

tal

stat

us m

ay in

fluen

ce m

anag

emen

t

how

the

plan

ned

dent

al p

roce

dure

may

influ

ence

th

e ch

oice

of c

onsc

ious

seda

tion

tech

niqu

e

the

asse

ssm

ent o

f the

suita

bilit

y of

per

iphe

ral v

eins

fo

r can

nula

tion

the

evid

ence

and

gui

danc

e re

latin

g to

fast

ing

the

prov

isio

n of

pre

- and

pos

t-sed

atio

n in

stru

ctio

ns

for p

atie

nts a

nd e

scor

ts in

an

age

appr

opria

te

form

at

appr

opria

te c

omm

unic

atio

n te

chni

ques

for c

hild

ren,

yo

ung

peop

le a

nd a

dults

assi

st in

taki

ng a

det

aile

d m

edic

al, f

amily

, soc

ial

and

dent

al h

isto

ry to

iden

tify

serio

us m

edic

al a

nd

surg

ical

con

ditio

ns th

at im

pact

on

safe

del

iver

y of

co

nsci

ous s

edat

ion

prov

ide

pre-

and

pos

t-sed

atio

n in

stru

ctio

ns fo

r pa

tient

s and

esc

orts

in a

n ag

e ap

prop

riate

form

at

com

mun

icat

e ef

fect

ivel

y w

ith c

hild

ren,

you

ng

peop

le a

nd a

dults

dem

onst

rate

a w

illin

gnes

s to

use

this

kn

owle

dge

in th

e pr

ovis

ion

of c

onsc

ious

se

datio

n

appr

ecia

te th

e ne

ed to

seek

spec

ialis

t m

edic

al a

dvic

e or

cla

rific

atio

n of

the

patie

nt’s

med

ical

his

tory

and

to li

aise

w

ith p

erso

nnel

from

oth

er d

isci

plin

es

CA SDL

ST

FA PDP

WBA

84

Assi

stin

g w

ith th

e ad

min

istr

atio

n of

seda

tion

the

prep

arat

ion

of th

e pa

tient

prio

r to

the

adm

inis

tratio

n of

co

nsci

ous s

edat

ion

the

prep

arat

ion

of th

e tr

eatm

ent a

rea

prio

r to

the

adm

inis

tratio

n of

con

scio

us se

datio

n

the

phys

ical

sign

s of b

oth

cons

ciou

s (m

oder

ate)

and

dee

p se

datio

n as

wel

l as h

ow to

reco

gnis

e th

e co

nsci

ous s

edat

ion

endp

oint

the

equi

pmen

t req

uire

d fo

r adm

inis

tratio

n of

intra

veno

us,

inha

latio

nal,

oral

and

intra

nasa

l sed

atio

n

the

sele

ctio

n of

a p

erip

hera

l vei

n fo

r can

nula

tion,

the

sign

s an

d sy

mpt

oms o

f ext

rava

scul

ar in

ject

ion,

and

the

safe

re

mov

al a

nd d

ispo

sal o

f an

intra

veno

us c

annu

la

how

to c

heck

an

inha

latio

n se

datio

n m

achi

ne a

nd sc

aven

ging

sy

stem

how

to c

onne

ct a

bre

athi

ng sy

stem

, sel

ect a

n ap

prop

riate

na

sal m

ask,

and

adj

ust t

he g

as fl

ow ra

te a

nd m

ixtu

re o

n an

in

hala

tion

seda

tion

mac

hine

how

to c

linic

ally

mon

itor a

pat

ient

to d

eter

min

e th

e le

vel o

f co

nsci

ousn

ess,

co-

oper

atio

n, re

spira

tion,

hea

rt ra

te a

nd sk

in

colo

ur, a

nd h

ow to

resp

ond

appr

opria

tely

to c

hang

es

the

use

of a

ppro

pria

te e

lect

rical

mon

itorin

g te

chni

ques

(SaO

2, N

IBP,

ECG

, end

-tida

l CO

2, BIS

) and

how

to re

spon

d to

cha

nges

com

mon

ele

ctric

al m

onito

ring

arte

fact

s and

mal

func

tions

appr

opria

te d

rug

dosa

ge(s

)

appr

opria

te d

rug

adm

inis

tratio

n te

chni

ques

dem

onst

rate

the

patie

nt c

heck

s req

uire

d pr

ior t

o th

e ad

min

istra

tion

of c

onsc

ious

seda

tion

dem

onst

rate

the

prep

arat

ion

of th

e no

tes,

equ

ipm

ent

and

trea

tmen

t are

a re

quire

d pr

ior t

o th

e ad

min

istra

tion

of c

onsc

ious

seda

tion

sele

ct th

e eq

uipm

ent r

equi

red

for a

dmin

istra

tion

of

intra

veno

us, i

nhal

atio

nal,

oral

and

intra

nasa

l sed

atio

n

prep

are

and

assi

st in

the

safe

del

iver

y of

seda

tion

drug

s

dem

onst

rate

how

to a

ssis

t with

safe

can

nula

tion,

in

clud

ing

disp

osal

of s

harp

s, a

nd c

annu

late

pat

ient

s if

requ

ired

chec

k th

e fu

nctio

ning

and

safe

ty fe

atur

es o

f an

inha

latio

n se

datio

n m

achi

ne a

nd sc

aven

ging

syst

em

conn

ect a

bre

athi

ng sy

stem

, sel

ect a

n ap

prop

riate

nas

al

mas

k, a

nd a

djus

t the

gas

flow

rate

and

mix

ture

on

an

inha

latio

n se

datio

n m

achi

ne

clin

ical

ly m

onito

r pat

ient

s to

dete

rmin

e th

e le

vel o

f co

nsci

ousn

ess,

co-

oper

atio

n, re

spira

tion,

hea

rt ra

te a

nd

skin

col

our,

and

resp

ond

appr

opria

tely

to c

hang

es

sele

ct a

nd d

emon

stra

te th

e us

e of

app

ropr

iate

ele

ctric

al

mon

itorin

g te

chni

ques

, and

resp

ond

to c

hang

es

reco

gnis

e co

mm

on e

lect

rical

mon

itorin

g ar

tefa

cts a

nd

mal

func

tions

dra

w u

p dr

ugs s

afel

y an

d w

ith re

gard

to

infe

ctio

n co

ntro

l and

hea

lth a

nd sa

fety

pro

cedu

res

show

a c

arin

g at

titud

e to

th

e sa

fety

of t

he p

atie

nt a

nd

unde

rsta

nd th

e im

porta

nce

of p

repa

ratio

n pr

ior t

o th

e ad

min

istra

tion

of c

onsc

ious

se

datio

n

show

con

tinuo

us re

gard

for

patie

nt sa

fety

ACI

CA CBL

SDL

ST

FA MSF

PDP

WBA

how

to re

cogn

ise

the

cons

ciou

s sed

atio

n en

dpoi

nt

cons

ciou

s sed

atio

n te

chni

ques

, inc

ludi

ng:

- inh

alat

ion

- int

rave

nous

- o

ral

- tra

nsm

ucos

al (i

ntra

nasa

l, bu

ccal

)

indi

catio

ns, a

dvan

tage

s and

dis

adva

ntag

es o

f adm

inis

terin

g in

tra- a

nd p

ost-o

pera

tive

supp

lem

enta

l oxy

gen

usin

g na

sal

cann

ulas

the

effe

ctiv

enes

s of c

onsc

ious

seda

tion

the

appr

oved

pro

cedu

re fo

r cle

arin

g an

d di

sinf

ectin

g th

e tr

eatm

ent a

rea

betw

een

patie

nts,

incl

udin

g th

e sa

fe d

ispo

sal

of se

datio

n eq

uipm

ent a

nd u

nuse

d dr

ugs

dem

onst

rate

reco

gniti

on o

f the

con

scio

us se

datio

n en

dpoi

nt a

nd su

ppor

t the

seda

tioni

st so

as t

o av

oid

goin

g be

yond

it

dem

onst

rate

how

to a

ssis

t in

the

safe

use

of c

onsc

ious

se

datio

n, in

clud

ing:

- i

nhal

atio

n - i

ntra

veno

us

- ora

l - t

rans

muc

osal

(int

rana

sal,

bucc

al)

adm

inis

ter i

ntra

- and

pos

t-ope

rativ

e su

pple

men

tary

ox

ygen

as p

resc

ribed

asse

ss th

e ef

fect

iven

ess o

f con

scio

us se

datio

n

dem

onst

rate

the

appr

oved

pro

cedu

re fo

r cle

arin

g an

d di

sinf

ectin

g th

e tr

eatm

ent a

rea

betw

een

patie

nts,

in

clud

ing

the

safe

dis

posa

l of s

edat

ion

equi

pmen

t and

un

used

dru

gs

appr

ecia

te th

e im

porta

nce

of a

dequ

ate

clea

ring

of th

e tr

eatm

ent r

oom

as w

ell a

s saf

e di

spos

al o

f sed

atio

n eq

uipm

ent

and

unus

ed d

rugs

SYLLABUS 4APPENDICES

85

Good

pra

ctic

e / m

edic

o-le

gal

requ

irem

ents

the

med

ico-

lega

l req

uire

men

ts re

latin

g to

ad

min

iste

ring

seda

tion

drug

s

the

lega

l req

uire

men

ts o

f the

mem

bers

of t

he d

enta

l te

am b

oth

whe

n th

ere

is a

n op

erat

or-s

edat

ioni

st o

r a

sepa

rate

ope

rato

r and

seda

tioni

st

the

train

ing

and

resp

onsi

bilit

ies o

f the

per

son

(usu

ally

an

appr

opria

tely

trai

ned

and

expe

rienc

ed

dent

al n

urse

) who

ass

ists

an

oper

ator

-sed

atio

nist

the

situ

atio

ns in

whi

ch a

sepa

rate

ope

rato

r and

se

datio

nist

are

app

ropr

iate

whe

n it

is sa

fe to

dis

char

ge a

pat

ient

and

whe

n ot

her a

ctio

ns m

ight

be

requ

ired

post

-ope

rativ

e an

d af

terc

are

inst

ruct

ions

ap

prop

riate

to e

ach

indi

vidu

al, t

akin

g in

to a

ccou

nt

thei

r soc

ial c

ircum

stan

ces

the

reco

gniti

on a

nd m

anag

emen

t of s

edat

ion-

rela

ted

com

plic

atio

ns, i

nclu

ding

: - o

ver-s

edat

ion

- res

pira

tory

dep

ress

ion

- unc

onsc

ious

pat

ient

- a

irway

obs

truc

tion

- vom

iting

- a

naph

ylax

is

- del

ayed

reco

very

- f

ailu

re o

f con

scio

us se

datio

n

curr

ent g

uide

lines

on:

- g

aini

ng v

alid

con

sent

- t

eam

wor

k - c

linic

al h

oldi

ng/r

estra

int

- end

ing

hold

ing/

rest

rain

t if r

equi

red

- app

ropr

iate

reco

rd k

eepi

ng

- con

trol

led

drug

s - ‘

off-l

icen

ce’ u

se o

f dru

gs

act i

n ac

cord

ance

with

the

med

ico-

lega

l re

quire

men

ts re

latin

g to

adm

inis

terin

g se

datio

n dr

ugs

act i

n ac

cord

ance

with

the

lega

l req

uire

men

ts

for d

enta

l nur

ses a

nd re

cogn

ise

thos

e fo

r oth

er

mem

bers

of t

he te

am

act i

n ac

cord

ance

with

the

requ

irem

ents

rela

ting

to th

e pe

rson

(usu

ally

an

appr

opria

tely

trai

ned

and

expe

rienc

ed d

enta

l nur

se) w

ho a

ssis

ts a

n op

erat

or-

seda

tioni

st

reco

gnis

e th

e si

tuat

ions

in w

hich

a se

para

te

oper

ator

and

seda

tioni

st a

re re

quire

d, a

nd a

ct

acco

rdin

gly

reco

gnis

e w

hen

it is

safe

to d

isch

arge

a p

atie

nt a

nd

whe

n ot

her a

ctio

ns m

ight

be

requ

ired

prov

ide

patie

nts w

ith a

ppro

pria

te d

isch

arge

and

po

st-o

pera

tive

inst

ruct

ions

in a

form

at th

at th

ey

can

unde

rsta

nd

reco

gnis

e an

d m

anag

e se

datio

n-re

late

d co

mpl

icat

ions

, inc

ludi

ng:

- ove

r-sed

atio

n - r

espi

rato

ry d

epre

ssio

n - u

ncon

scio

us p

atie

nt

- airw

ay o

bstr

uctio

n - v

omiti

ng

- ana

phyl

axis

- d

elay

ed re

cove

ry

- fai

lure

of c

onsc

ious

seda

tion

appl

y cu

rren

t gui

delin

es o

n:

- gai

ning

val

id c

onse

nt

- tea

mw

ork

- clin

ical

hol

ding

/res

train

t - e

ndin

g ho

ldin

g/re

stra

int i

f req

uire

d - a

ppro

pria

te re

cord

kee

ping

- c

ontr

olle

d dr

ugs

- ‘of

f-lic

ence

’ use

of d

rugs

reco

gnis

e th

e ro

le o

f all

the

mem

bers

of

the

dent

al se

datio

n te

am in

the

man

agem

ent o

f pat

ient

s

show

rega

rd fo

r ind

ivid

ual p

atie

nt,

fam

ily a

nd/o

r car

er n

eeds

reco

gnis

e th

e im

porta

nce

of re

gula

r te

am tr

aini

ng in

the

man

agem

ent o

f se

datio

n/m

edic

al e

mer

genc

ies

show

rega

rd fo

r ind

ivid

ual p

atie

nt n

eeds

w

hen

utili

sing

gui

delin

es

ACI

CA CBL

SDL

ST

FA MSF

PDP

WBA

86

Trai

ning

and

cont

inui

ng

prof

essi

onal

dev

elop

men

t (C

PD)

the

train

ing

requ

ired

so th

at th

e de

ntal

team

can

sa

fely

pro

vide

con

scio

us se

datio

n fo

r den

tistr

y

the

requ

irem

ents

for C

PD to

kee

p up

to d

ate

with

de

velo

pmen

ts in

con

scio

us se

datio

n te

chni

ques

an

d th

eir a

pplic

atio

n to

den

tistr

y

curr

ent I

mm

edia

te L

ife S

uppo

rt a

nd/o

r Pae

diat

ric

Imm

edia

te L

ife S

uppo

rt

the

curr

ent l

itera

ture

on

cons

ciou

s sed

atio

n dr

ugs

and

tech

niqu

es

the

impo

rtanc

e of

rele

vant

clin

ical

aud

it

dem

onst

rate

thro

ugh

safe

pra

ctic

e th

at th

e tra

inin

g re

quire

d so

that

the

dent

al te

am c

an

safe

ly p

rovi

de c

onsc

ious

seda

tion

for d

entis

try

is

cont

empo

rane

ous

dem

onst

rate

thro

ugh

deba

te a

nd sa

fe p

ract

ice

that

CP

D is

up

to d

ate

with

dev

elop

men

ts in

con

scio

us

seda

tion

tech

niqu

es a

s wel

l as t

heir

appl

icat

ion

to

dent

istr

y

perfo

rm Im

med

iate

Life

Sup

port

and

/or P

aedi

atric

Im

med

iate

Life

Sup

port

be

activ

ely

invo

lved

in re

leva

nt c

linic

al a

udit

keep

up

to d

ate

with

dev

elop

men

ts in

co

nsci

ous s

edat

ion

tech

niqu

es a

nd th

eir

appl

icat

ion

to d

entis

try

be p

repa

red

to re

ad a

nd a

ct o

n cu

rren

t lit

erat

ure

on c

onsc

ious

seda

tion

in

dent

istr

y

ACI

CA CBL

SDL

ST

FA MSF

PDP

WBA

Key:

Te

achi

ng a

nd le

arni

ng m

etho

dsAC

I = a

udit/

criti

cal i

ncid

ent a

naly

sis;

CA

= cl

inic

al a

ttach

men

t; CB

L =

case

-bas

ed le

arni

ng; S

DL =

self-

dire

cted

lear

ning

; ST

= st

ruct

ured

teac

hing

Asse

ssm

ent m

etho

dsFA

= fo

rmal

ass

essm

ent;

MSF

= m

ulti-

sour

ce fe

edba

ck; P

DP =

per

sona

l dev

elop

men

t por

tfolio

; WBA

= w

orkp

lace

-bas

ed a

sses

smen

t

SYLLABUS 4APPENDICES

87

Appendix 2:Course accreditation

1. Applications for accreditation of courses leading to independent practice must include the submission of a curriculum that complies with the checklist below:

• Purpose of the course • Aims and objectives of the

course • Learning outcomes mapped

against the syllabus: knowledge, skills, attitudes and behaviours

• Course content mapped against the syllabus: knowledge, skills, attitudes and behaviours

• Proposed course programme • Course providers:

qualifications and relevant experience

• Methods of learning, assessment and evaluation

• Details of supervised clinical practice

• Selection criteria for candidates

• Venue for course and/or clinical skills training (outlining suitability)

• Submission of a draft course certificate to record trainee attendance, continuing professional development hours – This must incorporate an explicit statement itemising the knowledge and/or skills

and/or competencies gained by the trainee on successful completion. The certificate must include the names and GDC numbers of the trainee and course provider(s).

• Internal and external quality control and assurance processes

2. Accreditation for a course may be retained for three years provided that there have been no substantive changes to the course/training programme.

3. Records of training and assessment for every course should be retained by trainees as part of their log of continuing experience. The lead course provider should also retain all the records of training as well as the course evaluations and attendance sheets. Records of training should be retained by the course provider for a minimum of five years.

4. In addition, a summary of the course evaluation should be submitted to the IACSD, which will reserve the right to inspect all the records relating to a course.

5. With revalidation in prospect, all trainers should be working

towards collecting and maintaining documented evidence of clinical practice (e.g. log records). Trainers should conform to equality and diversity legislation.

6. Supervised clinical practice should contain workplace-based assessments (WBAs) and patient feedback questionnaires. The WBAs should sample the organisational aspects of conscious sedation and the whole patient experience from assessment to discharge. They should cover a wide a range of patient care. One WBA should assess the management and provision of an entire patient episode of care. This evaluation must be made by an external assessor competent in the relevant sedation technique.

7. For revalidation in a sedation technique, the practitioner should undergo a minimum of 12 hours of verifiable continuing professional development every five years in the technique(s) being practised. However, practitioners not regularly practising a technique must consider the need for mentoring and/or retraining. (FAQ 4, 5, 7, 8, 9, 10).

SYLLABUS 4

88

Transitional arrangements

From the time of publication of this report (first edition 2015), no healthcare professional should commence the provision of conscious sedation for dental patients without the training described in this report having been satisfactorily completed. However, it is appreciated that there are experienced practitioners currently providing conscious sedation for dentistry who have not received the formal postgraduate training as described in this report. In order to maintain a service for patients, it is appropriate to have ‘grandfathering’ arrangements in place so that such practitioners can continue to provide conscious sedation services, assuming that they comply with the guidance laid down in this document.

There is also an understanding that it is appropriate to ensure a robust process of continuing education and monitoring of all healthcare practitioners providing sedation for dentistry, not all of whom will have benefitted from the initial competency-based training described in this document. For clinicians initially trained prior to the publication of this report, the following transitional arrangements are recommended:

1. Sedation practitioners should maintain a log in either written or electronic form of all sedation cases undertaken, with comprehensive details of patient type, baseline vital signs, sedation agent used/route/dose/reversals/untoward incidents etc.

2. Sedation practitioners and their clinical teams must undertake the similar, validated continuing professional development required for those following the pathway of training recommended in this report.

3. Sedation practitioners must undertake sedation-based audit and reflection frequently and regularly in each location sedation is provided.

4. Sedation practitioners and their clinical teams must be competent in the appropriate ‘rescue’ skills described in this report for the techniques of conscious sedation that are practised.

5. Sedation practitioners must meet the requirements for the environment and equipment and the patient

pathway checklist described in Section 1: Care pathways.

6. Sedation practitioners in primary care should ensure that appropriate clinical governance is in place to comply with the standards set in this report.

The records for points 1–6 above should be available to those who commission or carry responsibility for NHS provision of conscious sedation for dentistry. These requirements also apply to those practising conscious sedation for dentistry outwith the NHS. (FAQ 3, 6, 10, 12, 22).

SYLLABUS 4APPENDICES

89

Appendix 3: Examples of patient information

This appendix contains examples of patient information to be used for patients, those with parental responsibility and carers. Their use is subject to the conditions described in Section 4: Patient information. (FAQ 26).

Example 1: What is conscious sedation? (An introduction for adult patients) .........................90

Sedation-specific information for adultsExample 2: Inhalation sedation .........................91Example 3: Intravenous sedation ......................92Example 4: Intravenous sedation with more than one drug .............................................94Example 5: Oral sedation ....................................96Example 6: Transmucosal sedation: Information for parents and carers ...................98Example 7: Transmucosal sedation:Pictorial sequence ..............................................100Example 8: The day of your dental procedure.............................................................101Example 9: Patient escort information ..........102

Sedation-specific information for parents, those with parental responsibility, children and young peopleExample 10: Inhalation sedation: Parents or those with parental responsibility for children and young people aged under 16 years .............................103Example 11: Inhalation sedation:Young children ....................................................105

Example 12: Intravenous sedation: Parents or those with parentalresponsibility for children and young people aged under 16 years ................107Example 13: Intravenous sedation: Young people aged 12–16 years ......................109Example 14: Oral sedation: Parents or those with parental responsibilityfor children and young people agedunder 16 years .....................................................111Example 15: Dental filling: Pictorial sequence for young children ...........................113

Contents

SYLLABUS 4

90

Your dentist has recommended that you have your dental treatment with the help of sedation. Sedation is when drugs are used to make you feel less anxious and more relaxed. It will make you drowsy, less aware of what is happening and with few memories of what has happened to you during your treatment. It does not make you unconscious and you will be aware of what is happening.

Once you are sedated, the dentist may use local anaesthetic around the site of the dental treatment. Local anaesthetic as a paste is sometimes used to numb the site of the treatment. Any injections you need will then be given through this numbed area to minimise any discomfort.

Sedative drugs (medicines) can be given in a number of ways. Your dentist will decide, with you, which type is the best for your planned dental treatment.

There are different levels of sedation and several methods can be used. You may have sedation:

• by breathing in gas through a nosepiece (inhalation)

• by injection into a vein in your hand or arm (intravenous)

• by swallowing a medicine (oral)• by placing a medicine under

your tongue or into the nose (transmucosal)

Your dentist will discuss the best method to use for you and your treatment. The dentist will give you some information about the type of sedation you will be having for your treatment.

The dentist who agrees with you the plan for your treatment with sedation will give you some instructions to follow. These are important for your safe and comfortable care. For most types of sedation, you will need someone to come with you on the day of your treatment so that he or she can look after you when you go home. The dentist will confirm with you if you will need someone to act as an escort in this way. Your escort will also be given some important information about how best to look after you following your treatment under sedation.

This information is a general guide for patients having dental treatment with sedation. As part of the face-to-face discussions

with your dentist, you may be given advice that is specific to your treatment plan. This may differ in some areas to the general principles outlined here.

Before any treatment is started, the dentist will ask you to confirm your consent. This means that you understand the planned treatment and how you will receive the sedation.

If you have any questions or are unclear about having your sedation, then do not hesitate to ask your dentist.

Example 1: What is conscious sedation?(An introduction for adult patients, to be used in conjunction with sedation-specific information)

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What to expect

It is usual to have two appointments. The first appointment will be for an assessment when your dental treatment under sedation will be planned and discussed with you. The dental treatment under sedation will take place at the second and subsequent appointments. If the treatment is needed as an emergency, it may be possible to have some treatment under sedation at the first appointment.

It is important that you let the dentist know your medical history and any medicines that you are taking.

If you think you may be pregnant, you need to let the dentist know. You may need to come back to have your treatment at another time. You should let your dentist know if you are breastfeeding.

The dentist will confirm whether you need to restrict what you eat or drink on the day of treatment.If you have any questions or are unclear about having your

sedation, then do not hesitate to ask your dentist.

As you receive the gas via a nosepiece, you may get a feeling of warmth throughout your body as well as some mild tingling and light-headedness. You will stay awake and in control of all your reflexes, such as coughing.

Once you are sedated with the gas, the dentist may use local analgesia (pain relief that numbs the site of the dental treatment). Local anaesthetic as a paste is sometimes used to numb the site of the treatment. Any injection that you may need can then be given through this numbed area to reduce the chance of any discomfort.

After the treatment

You are unlikely to have any side effects, such as feeling sick or headache. At the end of the procedure, the dentist will give you some extra oxygen to make you feel more alert. This will speed up your recovery from the effects of the sedation.

You will spend time in the recovery area after the treatment is over. You will be checked by the dentist or an appropriate member of the dental team before you go home. It is not always necessary to have someone with you following this type of simple inhalation sedation. You may be advised not to drive a car, ride a bicycle or operate machinery for up to 2 hours following your treatment.

You will be given information relating to any local analgesia and the dental treatment you have received. The dental team will also advise you about any medicines you may need while recovering from the treatment. You will be given a telephone number of who to contact if you have any problems as a result of the treatment.

Example 2:Inhalation sedation

Inhalation sedation means that the sedation is given as a gas. Anxiety is reduced by breathing nitrous oxide with oxygen, given as a mixed gas. The dentist will give you the gas through a nosepiece. This will not cover your mouth.

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Your dentist has recommended that you have intravenous sedation. This means that a sedative drug (medicine) is given to you by injection into a vein. The sedation makes you drowsy and helps reduce anxiety.

Intravenous sedation is usually given by using a single drug called midazolam. A dose of the drug is chosen for you individually. It is given by injection. This is usually into a vein in the back of your hand or in your arm through a cannula.

A cannula is a thin flexible tube. A needle is used to put the cannula in but is then removed immediately. It is normal to feel a sharp scratch when the cannula is inserted. A local anaesthetic paste or liquid can be used first to reduce the pain of the injection. Once the cannula is in the vein, the sedation drug can be given without using any more needles. The cannula remains in until the dentist has checked that you have recovered from the sedation but it will be removed before you go home.

It is usual to have at least two appointments. The first appointment will be an assessment when your dental treatment under sedation will be planned and discussed with you. The dental treatment under sedation will take place at the second and subsequent appointments. If the treatment is needed as an emergency, it may be possible to have some treatment under sedation at the

first appointment.

Your dentist and members of the dental team are trained to give sedation. They watch you closely and treat any problems that may develop. They are also required to use appropriate monitoring equipment during sedation. There will be a recovery area where you will be observed until you have made a full recovery from the sedation.

As with the administration of any medicines, there are risks associated with intravenous sedation. These might include:

• A reduction of oxygen in the blood stream due to poor breathing during sedation. You may be asked by your dentist/sedationist to take deep breaths to correct this. Your breathing and oxygen levels will be monitored throughout the procedure.

• Bruising at the site of the cannula. This may take several days to fade completely.

Very rare risks include allergic reactions to the sedative drugs that you have been given or vomiting during the procedure. Your dentist/sedationist will discuss any

concerns that you may have prior to the procedure taking place.It is important that you let the dentist know your medical history, including any medicines that you are taking. The dentist will need to know if you have ever had any problems with having either sedation or a general anaesthetic.

If you think you may be pregnant, you need to let the dentist know. You may need to come back to have your treatment at another time. You should let the dentist know if you are breastfeeding.

Your dentist will discuss with you and explain what you are able to eat and drink prior to your appointment. You will also be given this information in writing. It is important that these instructions are followed carefully.

The information provided here is a general guide for patients having dental treatment with sedation. As part of the face-to-face discussions with your dentist, you may be given advice that is specific to your treatment plan. This may differ in some areas to the general principles outlined here.

Before any treatment is started, the dentist will ask you to confirm

Example 3:Intravenous sedation

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consent. This means that you understand the planned treatment and how you will receive the sedation.

What to expect

You will remain conscious during this kind of sedation.

You may experience a temporary loss of memory during the time that you are sedated. Many patients have no memory of the procedure at all. You may feel unsteady on your feet for some hours after the procedure. Your ability to think clearly and make judgements may be affected for the next 24 hours. You may experience some forgetfulness.

Once you are sedated, the dentist can use local analgesia (pain relief that numbs the site of the dental treatment). Local anaesthetic as a paste is sometimes used to numb the site of the treatment. Any injections that you may need can be given through this numbed area to reduce the chance of any discomfort.

You will spend some time in the recovery area following your treatment. You will be checked by the dentist or the person giving you the sedation before you can go home. You must be accompanied by an able-bodied adult who can take responsibility for you following your treatment. This person may need to stay with you overnight. If arrangements have not been made for someone to accompany you after treatment, you will not be able to have the sedation.

If you have any questions or are unclear about having your sedation, then do not hesitate to ask your dentist.

After the treatment

Your judgement will be affected by the drugs. This is similar to the effects of consuming alcohol. You should not drive a car, ride a bicycle or operate machinery until the following day. In some cases, this may be for as long as 24 hours. You should also not take responsibility for the care of others, use sharp implements or

cook. It would be unwise to make any irreversible decisions for up to 24 hours following your treatment. Owing to the after effects of the drugs used, care should be taken when using the internet for personal communication.

Before you are discharged, the dentist or dental nurse will give you and the adult accompanying you (escort) important information about your care. You will be given information relating to any local analgesia and the treatment you have received. The dentist will also provide details of pain relief as well as how and when to take other prescription medicines.

You will be given a telephone number of who to contact if you have any problems as a result of your treatment.

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More than one sedative medicine can be used for people having more complicated dental procedures or those with severe anxiety. Your dentist will tell you if this applies to you.

A dose of the sedative drugs will be chosen for you individually and given by injection. This is usually into a vein in the back of your hand or in your arm through a cannula.

A cannula is a thin flexible tube. A needle is used to put the cannula in but is then removed immediately. It is normal to feel a sharp scratch when the cannula is inserted. A local anaesthetic paste or liquid can be used first to reduce the pain of the injection. Once the cannula is in the vein, the sedation drugs can be given without using any more needles. The cannula remains in until the dentist has checked that you have recovered from the sedation but it will be removed before you go home.

It is usual to have at least two appointments. The first appointment will be an assessment when your dental treatment under sedation will be planned and discussed with you. The dental treatment under sedation will take place at the second and subsequent appointments. If the treatment is needed as an emergency, it may be possible to have some treatment under sedation at the first appointment.

Your dentist and members of the dental team are trained to give sedation. They watch you closely and treat any problems that may develop. They are also required to use appropriate monitoring equipment during sedation. There will be a recovery area where you will be observed until you have made a full recovery from the sedation.

As with the administration of any medicines, there are risks associated with intravenous sedation. Sedation with more than one drug can increase the risk of complications. Risks include:

• A reduction of oxygen in the blood stream due to poor breathing during sedation. You may be asked by your dentist/sedationist to take deep breaths to correct this. Your breathing and oxygen levels will be monitored throughout the procedure.

• Bruising at the site of the cannula. This may take several days to fade completely.

Very rare risks are allergic reactions to the sedative drugs that you have been given or vomiting during the procedure. There is a small risk of you becoming more deeply

sedated than intended when having more than one sedative drug. Your dentist/sedationist will discuss any concerns that you may have prior to the procedure taking place.

It is important that you let the dentist know your medical history and any medicines that you are taking. The dentist will need to know if you have ever had any problems with having either sedation or a general anaesthetic.

If you think you may be pregnant, you should let the dentist know. You may need to come back to have your treatment at another time. You should let your dentist know if you are breastfeeding.

Your dentist will discuss with you and explain what you are able to eat and drink prior to your appointment. You will also be given this information in writing. It is important that these instructions are followed carefully.

The information provided here is a general guide for patients having dental treatment with sedation. As part of the face-to-face discussions with your dentist, you may be given advice that is specific to your treatment plan. This may

Example 4:Intravenous sedation with more than one drug

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differ in some areas to the general principles outlined here.

Before any treatment is started, the dentist will ask you to confirm consent. This means that you understand the planned treatment and how you will receive the sedation.

What to expect

You will remain conscious during this kind of sedation.

You may experience a temporary loss of memory during the time that you are sedated. Many patients have no memory of the procedure at all. You may feel unsteady on your feet for some hours after the procedure. Your ability to think clearly and make judgements may be affected for the next 24 hours. You may experience some forgetfulness.

Once you are sedated, the dentist can use local analgesia (pain relief that numbs the site of the dental treatment). Local anaesthetic as a paste is sometimes used to numb the site of the treatment.

Any injections that you may need can be given through this numbed area to reduce the chance of any discomfort.

You will spend some time in the recovery area following your treatment. You will be checked by the dentist or the person giving you the sedation before you can go home.

You must be accompanied by an able-bodied adult who can take responsibility for you following your treatment. This person must be able to stay with you overnight. If arrangements have not been made for someone to accompany you after treatment, you will not be able to have the sedation.

If you have any questions or are unclear about having your sedation, then do not hesitate to ask the dentist.

After the treatment

Your judgement may be affected by the drugs. This is similar to the effects of consuming alcohol. You should not drive a car, ride

a bicycle or operate machinery until the following day. In some cases, this may be for as long as 24 hours. You should also not take responsibility for the care of others, use sharp implements or cook. It would be unwise to make any irreversible decisions for 24 hours following your treatment. Owing to the effects of the drugs used, care should be taken when using the internet for personal communication.

Before you are discharged, the dentist or dental nurse will give you and the adult accompanying you (escort) important information about your care. You will be given information relating to any local analgesia and the treatment you have received. The dentist will also provide details of pain relief as well as how and when to take other prescription medicines.

You will be given a telephone number of who to contact if you have any problems as a result of your treatment.

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Oral sedation means that the sedation drugs are swallowed as a tablet or liquid. It takes about 10 minutes for the effects of the drug to work.

Once you are sedated, you will usually have a small cannula placed in the back of your hand or in your arm.

A cannula is a thin flexible tube. A needle is used to put the cannula in but is then removed immediately. It is normal to feel a sharp scratch when the cannula is inserted. A local anaesthetic paste or liquid can be used first to reduce the pain of the injection. Once the cannula is in the vein, the sedation drug can be given without using any more needles. The cannula remains in until the dentist has checked that you have recovered from the sedation but it will be removed before you go home.

It is usual to have at least two appointments. The first appointment will be an assessment when your dental treatment under sedation will be planned and discussed with you. The dental treatment under sedation will take place at the second and subsequent appointments. If the treatment is needed as an emergency, it may be possible to have some treatment under sedation at the first appointment.

Your dentist and members of the dental team are trained to give

sedation. They watch you closely and treat any problems that may develop. They are also required to use appropriate monitoring equipment during sedation. There will be a recovery area where you will be observed until you have made a full recovery from the sedation.

As with the administration of any medicines, there are risks associated with oral sedation. Risks include:

• A reduction of oxygen in the blood stream due to poor breathing during sedation. You may be asked by your dentist/sedationist to take deep breaths to correct this. Your breathing and oxygen levels will be monitored throughout the procedure.

• Bruising at the site of the cannula. This may take several days to fade completely.

Very rare risks are allergic reactions to the sedative drugs that you have been given or vomiting during the procedure. Your dentist/sedationist will discuss any concerns that you may have prior to the procedure taking place.

It is important that you let the dentist know your medical history

and any medicines that you are taking. The dentist will need to know if you have ever had any problems with having either sedation or a general anaesthetic.

If you think you may be pregnant, you should let the dentist know. You may need to come back to have your treatment at another time. You should let your dentist know if you are breastfeeding.

Your dentist will discuss with you and explain what you are able to eat and drink prior to your appointment. You will also be given this information in writing. It is important that these instructions are followed carefully.

The information provided here is a general guide for patients having dental treatment with sedation. As part of the face-to-face discussions with your dentist, you may be given advice that is specific to your treatment plan. This may differ in some areas to the general principles outlined here.

Before any treatment is started, the dentist will ask you to confirm consent. This means that you understand the planned treatment and how you will receive the sedation.

Example 5:Oral sedation

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What to expect

You will remain conscious during this kind of sedation. You may experience a temporary loss of memory during the time that you are sedated. Many patients have no memory of the procedure at all. You may also feel unsteady on your feet for some hours after the procedure. Your ability to think clearly and make judgements may be affected for the next 24 hours. You may experience some forgetfulness.

Once you are sedated, the dentist can use local analgesia (pain relief that numbs the site of the dental treatment). Local anaesthetic as a paste is sometimes used to numb the site of the treatment. Any injections that you may need can be given through this numbed area to reduce the chance of any discomfort.

You will spend some time in the recovery area following your treatment. You will be checked by the dentist or the person giving you the sedation before you can go home. You must be

accompanied by an able-bodied adult who can take responsibility for you following your treatment. This person may need to be able to stay with you overnight. If arrangements have not been made for someone to accompany you after treatment, you will not be able to have the sedation.

If you have any questions or are unclear about having your sedation, then do not hesitate to ask your dentist.

After the treatment

Your judgement may be affected by the drugs. This is similar to the effects of consuming alcohol. You should not drive a car, ride a bicycle or operate machinery until the following day. In some cases, this may be for as long as 24 hours. You should also not take responsibility for the care of others, use sharp implements or cook. It would be unwise to make any irreversible decisions for 24 hours following your treatment.

Owing to the effects of the drugs used, care should be taken when

using the itnernet for personal communication.

Before you are discharged, the dentist or dental nurse will give you and the adult accompanying you (escort) important information about your care. You will be given information relating to any local analgesia and treatment you have received. The dentist will also provide details of pain relief as well as how and when to take other prescription medicines.

You will be given a telephone number of who to contact if you have any problems as a result of your treatment.

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What is transmucosal sedation?

The child or adult in your care may require dental treatment under sedation. Anxiety can be reduced by sedative drugs (medicines), which also make the patient drowsy. The dentist will be able to explain why the patient might benefit from having sedation.

Transmucosal sedation is generally given through a fine spray, which is squirted into the nose. The sedation drugs are absorbed through the lining of the nose and enter the bloodstream. It can take 5–10 minutes for the effects of the drug to work.

Once the sedation medicine has taken effect, for the patient’s safety, a needle is used to place a cannula (small plastic tube) in a vein in the back of the hand or in the arm. The dentist will use the cannula to reverse the effects of the sedation if necessary. A cream containing local anaesthetic may be used to make the injection site numb before the cannula is inserted.

Benefits and risks of transmucosal sedation

Transmucosal sedation reduces anxiety and fear of dental treatment. This is particularly helpful if the patient is having

a long, uncomfortable or more complicated procedure.

The dentist and members of the dental team are trained to give sedation. They watch the patient closely and treat any problems that may develop. An oxygen supply will be available and oxygen will be given by mask if necessary. They are also required to use appropriate monitoring equipment during sedation. There will be a recovery area where the patient will be observed until he or she has made a full recovery from the sedation.

It is a widely used technique but, as with the administration of any medicines, there are risks associated with intranasal sedation. These risks include:

• A reduction of oxygen in the blood stream due to poor breathing during sedation. The patient may be asked by the dentist/sedationist to take deep breaths to correct this. The dentist/sedationist will continually monitor the patient’s breathing and oxygen levels throughout the procedure.

• Bruising at the site of the cannula. This may take several days to fade completely.

Very rare risks are allergic reactions to the sedative drugs the patient

has been given or vomiting during the procedure. The dentist/sedationist will discuss any concerns that you may have about the patient prior to the procedure taking place.

What to expect

The method of dental treatment planned for the patient in your care will be discussed with you at a separate assessment appointment. The dental treatment will take place at second and subsequent appointments. In exceptional circumstances, treatment may be carried out on the same day as assessment. It is important that the dentist knows of any recent changes in the patient’s medical history and of any medicines being taken.

If you think the patient may be pregnant or breastfeeding, you need to let the dentist know. The patient may need to come back to have the treatment at another time.

Before the treatment is started, the dentist will need to take a full medical history and, if necessary, contact the patient’s general medical practitioner or specialist. The patient will need to have their blood pressure taken with a cuff on their arm and the level of oxygen in their blood measured with a clip on their finger.

Example 6:Transmucosal sedation: Information for parents or carers

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How to prepare the patient

The information provided here is to help parents or carers understand the process of sedation. It is a general guide. As part of the face-to-face discussions with the dentist, the patient in your care may be given specific advice that may differ from the general principles outlined here.

There are complicated rules regarding consent for patients with limited capacity. The dentist will explain to you and the patient what steps need to be taken to ensure that consent is properly obtained. No treatment can be started without consent.

Additional information, with pictures, has been developed to be used with this information. The pictures help explain the procedures and effects of sedation. The treatment pictures appear at the end of this leaflet.

The dentist will discuss with you and explain what the patient is able to eat and drink prior to the appointment. You will also be given this information in writing. It is important that these instructions are followed carefully.

If the patient is unwell on the day with cold/flu symptoms or any contagious illness, please contact the dentist for advice. The appointment may need to be rearranged.

What will happen during the sedation?

The patient will remain conscious during the sedation but may experience some temporary loss of

memory during the time that he or she is sedated. Many patients have no memory of the procedure at all. Patients may feel unsteady on their feet for some hours after the procedure. They may be affected for the rest of the day. They may experience some forgetfulness.

The patient will be monitored by the dentist and the dental team during the procedure. This will include measurements of blood pressure, heart rate and oxygen levels at regular intervals.

Once the patient is sedated, and feels drowsy and relaxed, the dentist can use local analgesia (pain relief that numbs the site of the dental treatment). Local anaesthetic as a paste is sometimes used to numb the site of the treatment. Any injections that the patient may need can then be given through this numbed area to reduce the chance of any discomfort.

The patient will spend some time in the recovery area following the treatment. He or she will be checked by the dentist or the person giving the sedation and will not be allowed to go home until alert and responsive. The patient will need to be accompanied home by an able-bodied adult who can take responsibility for him or her for the rest of the day. Escorts should not bring other children with them on the day of the treatment.

Children may not return to school and should not participate in active sports for the rest of the day. You may wish to make plans about how best to travel home with the patient following treatment.

All patients need to be supervised by a responsible adult for the remainder of the day. The parent/carer may need to make arrangements for the care of other children or elderly dependent relatives during this time.

Adult patients should be aware that their judgement may be affected and care should be taken for the next 24 hours if the patient is using the internet for personal communication. They are advised not to drive, ride a bicycle or operate machinery until the following day or, in some cases, for 24 hours.

You will be given information relating to any local anaesthetic or treatment that the patient has received. The dental team will give you advice about any medicines the patient will need while recovering from the treatment. You will be given a telephone number of who to contact if you have any concerns.

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Example 7:Transmucosal sedation: Pictorial sequence

Adult: Pictorial transmucosal sedation sequence (example 7)  

 

 

The design and artwork of Dr Charlotte Curl are gratefully acknowledged.

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Please arrive promptly for your appointment.

Do not bring children with you.

Make sure that you have followed any advice that you have been given by your dentist about eating and drinking before your appointment.

Bring with you a list of any medicines that you are currently taking. You should take your routine medicines on the day of the procedure. Please let the dentist know if your medical history has changed since you last saw the dentist.

If you think you may be pregnant, you need to let the dentist know. You may need to come back to have your treatment at another time. You should let the dentist know if you are breastfeeding.

It is sensible to wear loose, comfortable clothing and flat shoes. You may need to remove any contact lenses so remember to take your glasses or a replacement pair of lenses for use once the treatment is finished.

The dentist will need to monitor you carefully while you are sedated. To help with this, please remove nail varnish and do not wear excessive make up or jewellery.

Do not bring valuables with you.

If you feel unwell on the day of the procedure, please telephone the number provided.

If you have been asked to arrange for someone to go home with you, it is essential that this person is available. If you do not have an escort, you will not be able to have your procedure under sedation.

After your treatment, you will be given a telephone number of who to contact if there are any problems.

Example 8:The day of your dental procedure

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You have been asked to accompany someone who is having dental treatment under sedation.

Patients can feel less anxious if they receive a sedative drug (medicine) before or during their dental treatment. The drugs used can cause some patients to feel a little disorientated or confused for a short time after the treatment. It is important that someone will be responsible for them and take care of them for the remainder of the day. Occasionally, it may be necessary for someone to stay with them overnight.

It is important that you follow these instructions. The patient will have been given a telephone number of who to contact if you have any concerns.

The patient will not be allowed to go home until the dentist is satisfied that the patient is in the care of a responsible adult (over 18 years of age). The escort must be present with the patient as they leave the dental surgery. Some patients take a little longer than others to be ready to go home so please be aware that a precise time cannot always be given.

The patient’s judgement (ability to think clearly) is likely to be affected. Patients should not make any irreversible decisions for up to 24 hours following their treatment.

Patients should be encouraged to rest for a while once they are home. It is not recommended for them to be in charge of others until

the next day. Care should be taken when cooking or using domestic appliances.

Patients should not drive a vehicle, ride a bicycle, operate machinery or drink alcohol until the following day and, in some cases, for up to 24 hours. The dentist will advise the patient on the day of treatment. Owing to the after effects of the drugs used, care should be taken when using the internet for personal communication.The dentist will explain to the patient which pain relief medicines he or she may take. Patients should take their usual prescribed medicines unless directed otherwise by their doctor or dentist.

Example 9:Patient escort informationImportant information for adults accompanying patients having dental treatment with sedation

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What is inhalation sedation?The child in your care may require dental treatment under inhalation sedation. This will help the child feel less anxious, slightly drowsy and more relaxed for the dental treatment. Inhalation sedation does not make the child unconscious. The child remains awake but may feel warm and detached. The child’s memory of the treatment afterwards may be slightly reduced.

Inhalation sedation means that the child will breathe a mixture of nitrous oxide and oxygen from a nosepiece placed on the nose. This will have a relaxing effect.

Benefits and risks of inhalation sedationInhalation sedation is used to reduce anxiety and fear of dental treatment. This makes the child more co-operative. This is particularly helpful if the child is having a longer, uncomfortable or more complicated procedure. It is a widely used technique.

The dentist and members of the dental team are trained to give sedation. They watch the child closely and treat any problems that may develop. The nitrous oxide is completely breathed out

of the body within 30 minutes of the end of the treatment. This means that the child can recover very quickly from this type of sedation.

The dentist will give the child some oxygen at the end of the sedation to help prevent the child feeling a bit sick or having a headache.

The child will be asked to wait until the dentist has checked that he or she has fully recovered from the sedation. The child will not be allowed to go home with you until the dentist has checked this.

What to expectIt is usual to have two or more appointments. At the first appointment (assessment), the dentist will take a full dental history of the child. Various methods of providing the dental treatment with or without sedation will be explained. Other than in an emergency, the treatment will take place at the second or subsequent appointments.

If it is agreed that dental treatment with inhalation sedation is the best way to treat the child, then the dentist will confirm the child’s medical history. If further information is required, the child’s

general medical practitioner or specialist will be contacted.

How to prepare your childBefore the treatment, the child in your care can eat normally but with only a light meal being taken up to 2 hours before the treatment.Please give the child any routine medicines as normal. Any medicines or inhalers that the child may need should be brought to the dental treatment appointment.

Written consent will be required from the parent/carer before any treatment can be given to the child. If you have agreed and signed the consent form at the assessment appointment, and you are then unable to attend on the day of the treatment, the child must be accompanied by a responsible adult (over 18 years of age).

The child should wear loose, comfortable clothing. No valuables should be brought to the appointment.

If the child is unwell on the day with cold/flu symptoms or any contagious illness, please contact the dentist for advice. The appointment may need to be rearranged.

Example 10:Inhalation sedation: Parents or those with parental responsibility for children and young people aged under 16 years

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Please avoid bringing other children with you on the day of treatment.

What will happen during the sedation?During the procedure, the child will breathe the nitrous oxide and oxygen through a nosepiece on the nose. The child may feel warm with tingly fingers and toes.

Once the child is sedated, and feels drowsy and relaxed, the dentist can use local analgesia (pain relief that numbs the site of the dental treatment). Local anaesthetic as a paste is sometimes used to numb the site of the treatment. Any injections that the child may need can then be given through this numbed area to reduce the chance of any discomfort.

When the dental treatment is completed, the nitrous oxide mixture will be stopped and replaced with oxygen. The nosepiece will be taken off, and the child will be sat up in the dentist’s chair and will continue to recover fully for a few minutes. The dentist or a member of the dental team will monitor the child during recovery.

The child will be able to leave the surgery/dental practice once he or she has fully recovered, is alert and is not feeling dizzy. This usually takes about 30 minutes after the treatment has ended. The child will be checked by the dentist before being allowed to go home.

The child may not participate in organised or active sports for the rest of the day but may be able to

return to school. The dentist will discuss this with you.

The child can eat and drink normally after the treatment but care should be taken if areas of the mouth are still numb to avoid lip, cheek or tongue biting. You will be given information relating to any local analgesia and the treatment the child has received. The dentist will explain which pain relief medicines the child may have while recovering and the local analgesia wears off.

You will be given a telephone number of who to contact in case of any concerns.

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Hello! I am Fluffy the Bear.

Last week I had magic air sedation and had my tooth fixed at the dentist.

The dentist is someone who helps look after my teeth. I see them in a dental surgery.

Magic air helps make fixing my teeth easy.

Getting readyWhen I saw my dentist, I sat in a chair and the dentist looked at my teeth with a small mirror. My tooth had a hole in it and the dentist took a photograph (called an x-ray) of it to see it better.

The dentist said that I needed the hole to be fixed or my tooth would start to hurt. To make fixing it easy, I could have magic air.

The day I had my tooth fixed

Before I had magic air, I had breakfast but I did not eat too much.

I sat in the dentist chair, and the dentist and the dentist’s nurse showed me a mask to wear on my nose.The mask looked like an airline pilot’s mask and I could hold it on my nose.

So that it didn’t fall off my nose, the dentist laid the back of the chair down so I was lying flat. Tubes were attached to the nosepiece to let the magic air go through them.

Example 11:Inhalation sedation: Young children

The design and artwork of ‘Fluffy the Bear’ by John Holroyd is gratefully acknowledged.

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I practised breathing through my nose with fresh air first. It didn’t smell of anything. The dentist counted my teeth with the mirror.

Before I knew it, I felt warm and my fingers and toes felt all tingly. I felt a bit like I was flying. The dentist and the nurse talked to me while I had the magic air.

Having my tooth fixed

The dentist dried my tooth with cotton wool and washed my tooth with numbing liquid. My tooth felt all tingly, fuzzy and numb.

The dentist cleaned my tooth with an electric toothbrush that squirted water and made a buzzy sound. I had a filling put in the hole. The dentist and nurse held a light over my tooth to make the filling hard and strong.

I breathed the magic air through my nosepiece. I felt nice while my tooth was fixed.

When my tooth was mended, I started to feel less tingly and the floaty feeling began to go away.

Afterwards

The dentist sat the chair up gently and took off the nosepiece. My head felt a bit dizzy but it was alright.

After 5 minutes, the dizzy feeling had gone, and I sat in the waiting room and played for a little while. My tooth still felt tingly and numb, and the dentist told me not to bite my lip while it still felt funny. I then went home and played quietly.

My tooth stopped feeling tingly after I left the dentist and now it feels good because I don’t have a hole anymore.The design and artwork of ‘Fluffy the Bear’ by

John Holroyd is gratefully acknowledged.

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Example 12:Intravenous sedation: Parents or those with parental responsibility for children and young people aged under 16 years

What is intravenous sedation?The child in your care may require intravenous sedation for dental treatment. The use of a sedative drug (medicine) makes the child drowsy and relaxed and less aware of the treatment. The patient will often have few memories of what has happened during the treatment. Intravenous sedation does not make your child unconscious.

Intravenous sedation is usually given by using a single drug called midazolam. A dose, determined for your child individually, will be given into a vein in the back of the hand or arm using a cannula (a thin flexible tube). A needle is used to put the cannula into the vein and the needle is then removed straight away. Once the cannula is in the vein, the sedation drug can be given without using any more needles. The cannula remains in until the dentist has checked that you child has recovered but it will be removed before going home.

A cream containing local anaesthetic may be used to make the injection site numb before the cannula is inserted. You may be asked to put this cream on the child’s hand or arm before you leave home. This allows enough time for it to work properly before having the sedation medicine.

Benefits and risks of intravenous sedationIntravenous sedation is used to reduce anxiety and fear of dental treatment. This makes children more co-operative when having dental treatment. It is particularly helpful if children are having a long, uncomfortable or more complicated procedure.

The dentist and members of the dental team are trained to give sedation. They watch the child closely and treat any problems that may develop. They are required to use appropriate monitoring equipment during sedation. The child will go to a recovery area after the treatment where he or she will be observed until having made a full recovery from the sedation.

It is a widely used technique but, as with the administration of any medicines, there are risks associated with intravenous sedation. Risks include:

• A reduction of oxygen in the blood stream due to poor breathing during sedation. The child may be asked by the dentist/sedationist to take deep breaths to correct this. The dentist/sedationist will continually monitor the child’s breathing and oxygen levels

throughout the procedure.• Bruising at the site of the

cannula. This may take several days to fade completely.

Very rare risks are allergic reactions to the sedative drugs your child has been given or vomiting during the procedure. The dentist/sedationist will discuss any concerns that you may have about the child prior to the procedure taking place.

What to expectThe various methods of dental treatment planned for the child will be discussed with you at an assessment appointment following a full dental examination. The dental treatment planned will then take place at a second or subsequent appointment. In an emergency, the treatment may be carried out on the same day as assessment.

If it is agreed that intravenous sedation is the best way to treat the child, then the dentist will confirm:

• The child’s height and weight• The child’s blood pressure –

taken with a cuff on the child’s arm. This may not happen for young children.

• The level of oxygen in the blood – taken with a simple clip on

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the child’s finger• The child’s medical history. If

further information is required at this stage, the child’s general medical practitioner or specialist will be contacted.

If you have any questions or are unsure about the sedation planned for the child, do not hesitate to ask the dentist.

How to prepare your childThe dentist will discuss with you and explain what the child is able to eat and drink prior to the appointment. You will also be given this information in writing. It is important that these instructions are followed carefully.

Written consent will be required from the parent/carer before any treatment can be given to the child. If you have agreed and signed the consent form at the assessment appointment and you are then unable to attend with the child on the day of treatment, the child must be accompanied by a responsible adult (over 18 years of age).

Please give any routine medicines as normal. Any medicines or inhalers that the child may need should be brought with you to the appointment.

Dress your child in loose, comfortable clothing. No valuables should be brought to the appointment.

If the child is unwell on the day of treatment with cold/flu symptoms or any contagious illness, please contact the dentist for advice.

The appointment may need to be rearranged.

Please avoid bringing other children with you on the day of treatment.

What will happen?The child will be monitored during the procedure. This will include measurements of blood pressure, heart rate and oxygen levels at regular intervals.

Once the child is sedated, and feels drowsy and relaxed, the dentist can use local analgesia (pain relief that numbs the site of the dental treatment). Local anaesthetic as a paste is sometimes used to numb the site of the treatment. Any injections that the child may need can then be given through this numbed area to reduce the chance of any discomfort.

After the treatment has finished, the child will spend some time in the recovery area and will not be allowed to go home until alert and responsive. The dentist will check the patient before he or she is allowed to go home.

The child may not return to school and should not participate in active sports for the rest of the day. You may wish to make plans about how best to travel home with the child following the treatment.

The child must be supervised by a responsible adult for the rest of the day. Arrangements may need to be made for the care of other children or elderly dependent relatives during this time.

Children can be sleepy, upset or agitated for up to 3 hours after the treatment. They will, however, have little memory of the procedure. Occasionally, children feel a bit sick or may get hiccups. There may be some bruising on the hand or arm where the sedative medicine was given.You will be given information relating to any local analgesia and the treatment the child has received. The dental team will advise you about any medicines the child may need while recovering from the treatment.You will be given a telephone number of who to contact in case of any concerns.

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Example 13:Intravenous sedation: Young people aged 12–16 years

What is intravenous sedation?This is when you receive a drug to sedate you while you have your dental treatment. The drug makes you feel sleepy and relaxed but you will not be unconscious. It is given by your dentist, or by another dentist or a doctor.

Why should I have intravenous sedation?Having sedation this way helps reduce any worry or anxiety you have about having your teeth treated. It can also help if you need a very long procedure or a painful procedure, such as having a tooth out.

ConsentThe information provided here is a general guide for all patients having intravenous sedation. Your dentist will discuss with you your specific treatment plan and some of the advice described might not be relevant to the treatment you are going to have.

Nothing will happen until you and your parent or guardian understand and agree what has been planned for you. You will be able to discuss the treatment with your dentist. Your parent or guardian will need to be with you on the day of the treatment to sign the consent form, even if it was signed at an assessment visit.

Getting ready for your sedationBefore you have intravenous sedation, the dentist will ask you about your general health. If you have any long-term medical problems, the dentist will discuss these with you and your parent or guardian. The dentist will have also checked your height, weight, blood pressure (taken with a cuff that wraps around your arm) and oxygen levels in your blood, using a clip that attaches to your finger.

On the day of the treatment, you should take any regular medicines and bring your medicines or inhalers with you.

If you have a cold or feel unwell, you or your parent/guardian will need to tell the dentist as you need to be as healthy as possible on the day of treatment.

If you think you may be pregnant, you need to let the dentist know. You may need to come back to have your treatment at another time.

Leave all jewellery and valuables at home. Do not wear excessive make up or any nail polish to the appointment. These can interfere with the monitoring equipment that is used while you are sedated.

Your dentist will discuss with you and explain what you are able to eat and drink prior to your appointment. You will also be given this information in writing. It is important that these instructions are followed carefully.

You will be asked to turn off your mobile phone during the appointment.

ClothingWear loose, comfortable clothing and flat shoes. If you wear contact lenses, you may need to remove them. You may need to bring your glasses or spare lenses to wear after the appointment.

Having the intravenous sedationYour dentist or a member of the dental team may put an anaesthetic cream on the back of your hand or on your arm about 45–60 minutes before the appointment. You may be asked to do this at home, before you come to the dental surgery.

The cream makes the skin on your hand or arm go numb. The dentist (or doctor who will be helping with the sedation) will then place a cannula in a vein in your hand or arm. A cannula is a thin flexible tube. A needle is used to put the cannula in. The needle is then removed straight away but

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the cannula stays inside the vein. The anaesthetic cream placed on the hand or arm helps reduce the discomfort of having the cannula inserted.

Once the cannula is in the vein, the sedation drug can be injected through it without using any more needles. The cannula is left in until the dentist (or doctor) allows you to go home. He or she will check that you have recovered properly from the sedation before letting you leave the dental surgery.

Your parent or guardian will be with you until the sedative drug is given and will then usually wait for you outside the surgery while your teeth are treated.

While you are sedated and having your dental treatmentOnce you are sedated, and feel drowsy and relaxed, the dentist can use local analgesia (pain relief that numbs the site of the dental treatment). Local anaesthetic as a paste is sometimes used to numb the site of the treatment. Any injections that you may need can then be given through this numbed area to reduce the chance of any discomfort.

A small clip will be put on your finger to measure your heart rate and the level of oxygen in your blood. Your blood pressure will be taken while you are sedated.

How will I feel?You will feel drowsy and sleepy during the treatment. Afterwards you may not remember very much about the treatment.

AfterwardsYou may be moved to another area to recover fully. The dental team will decide when it is safe for you go home. You will need to rest at home. You cannot go home on your own – your parent, guardian or other responsible adult will need to stay with you for the rest of the day.

You may feel sick or drowsy. You may have a bruise where the cannula was. Your mouth may still feel numb or tingly for up to 3 hours. You will need to be careful not to bite your lip or cheek while it is numb.

You will need to avoid any strenuous exercise like riding a bike, driving a car or motorbike, playing active sports or training until at least the following day. Sometimes you may need to avoid these things for 24 hours but your dentist will advise you.

You should be careful about what you write or text on social media after your treatment as you may be a bit muddled and lack judgement.

Are there any risks to intravenous sedation I should know about?Intravenous sedation is widely used but, as with taking any medicines, there are risks. Your dentist and members of the dental team are trained to give sedation. They watch you closely and treat any problems that may develop.

The key risks are:

• A reduction of oxygen in the blood stream due to poor breathing during sedation. You

may be asked by the dentist/sedationist to take deep breaths to correct this. Your breathing and oxygen levels will be monitored throughout the procedure.

• Bruising at the site of the cannula. This may take several days to fade completely.

Very rare risks are allergic reactions to the sedative drugs that you have been given or vomiting during the procedure. Your dentist/sedationist will discuss any concerns that you may have prior to the procedure taking place.

Before you are discharged, you will be given information about pain relief as well as how and when to take any prescription medicines. You will be given information relating to any local analgesia and the treatment you have received. You or your parent/guardian will be given a telephone number of who to contact if you have any concerns.

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Example 14:Oral sedation: Parents or those with parental responsibility for children and young people aged under 16 years

What is oral sedation?The child in your care may require oral sedation for dental treatment. The use of a sedative drug (medicine) makes the child drowsy, less aware of what is happening and with few memories of what has happened during the treatment. Oral sedation does not make your child unconscious.

Oral sedation is usually given as a single drug called midazolam. A dose, chosen for your child individually, will be given as a drink or as a syrup. The sedation usually takes 20 minutes to take effect.

Once the child is sedated (drowsy), a needle is used to place a cannula (small plastic tube) into a vein in the back of the hand or in the arm. This allows a drug to be given that reverses the effect of the sedation, if necessary. A cream containing local anaesthetic will be used on the back of the hand to numb the area, before this cannula is placed. You may be asked to apply this cream to the child before coming to the dental surgery.

Benefits and risks of oral sedationOral sedation is used to reduce anxiety and fear of dental treatment. This usually makes children more co-operative when

having treatment. It is particularly helpful if children are having a long, uncomfortable or more complicated procedure.

The dentist and members of the dental team are trained to give sedation. They watch the child closely and treat any problems that may develop. They are required to use appropriate monitoring equipment during sedation. The child will go to a recovery area after the treatment where he or she will be observed until a full recovery from the sedation has been made.

It is a widely used technique but, as with the administration of any medicines, there are risks associated with oral sedation. Risks include:

• A reduction of oxygen in the blood stream due to poor breathing during sedation. The child may be asked by the dentist/sedationist to take deep breaths to correct this. The dentist/sedationist will continually monitor the child’s breathing and oxygen levels throughout the procedure.

• Bruising at the site of the cannula. This may take several days to fade completely.

Very rare risks are allergic reactions to the sedative drugs that your child has been given or vomiting during the procedure. Your dentist/sedationist will discuss any concerns that you may have about the child prior to the procedure taking place.

An oxygen supply will be available and oxygen will be given if necessary. There is also a risk that the child may not like the feeling of sedation and become tearful, in which case the sedation may be stopped.

What to expectThe various methods of dental treatment planned for the child will be discussed with you at a separate assessment appointment following a full dental examination. In exceptional circumstances, treatment may be carried out on the same day as assessment.

Before the sedation can be given, the dentist will confirm:

• The child’s height and weight• The child’s blood pressure –

taken with a cuff on the child’s arm. This may not happen for young children.

• The level of oxygen in the

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blood – taken with a simple clip on the child’s finger

• The child’s medical history. If further information is required at this stage, the child’s general medical practitioner or specialist will be contacted.

If you have any questions or are unclear about the sedation planned for the child, do not hesitate to ask your dentist.

How to prepare your childThe dentist will discuss with you and explain what the patient is able to eat and drink prior to the appointment. You will also be given this information in writing. It is important that these instructions are followed carefully.

Written consent will be required from the person with parental responsibility/carer before any treatment can be given to the child. If you have agreed and signed the consent form at the assessment appointment and you are then unable to attend with the child on the day of treatment, the child must be accompanied by a responsible adult (over 18 years of age).

Please give routine medicines as normal. Any medicines or inhalers that the child may need should be brought with you to the appointment.

Dress your child in loose, comfortable clothing. No valuables should be brought to the appointment.

If the child is unwell on the day with cold/flu symptoms or any contagious illness, please contact the dentist for advice.

The appointment may need to be rearranged.

Please avoid bringing other children with you on the day of treatment

What will happen?The child will be monitored during the procedure. This will include measurements of blood pressure, heart rate and oxygen levels at regular intervals.

Once the child is sedated, and feels drowsy and relaxed, the dentist can use local analgesia (pain relief that numbs the site of the dental treatment). Local anaesthetic as a paste is sometimes used to numb the site of the treatment. Any injections that the child may need can then be given through this numbed area to reduce the chance of any discomfort.

After the treatment has finished, the child will spend some time in the recovery area until alert and responsive. He or she will be checked by the dentist before being allowed to go home.

The child may not return to school and should not participate in active sports for the rest of the day. You may wish to make plans about how best to travel home with the child following the treatment.

The child must be supervised by a responsible adult for the rest of the day. Arrangements may need to be made for the care of other children or elderly dependent relatives during this time.

Children can be sleepy, upset or agitated for up to 3 hours after

treatment. They will, however, have little memory of the procedure. Occasionally, they get hiccups. There may be some bruising on the hand or arm where the cannula was inserted.

You will be given information relating to any local analgesia and the treatment the child has received. The dental team will advise you about any medicines the child may need while recovering from the treatment.

You will be given a telephone number of who to contact in case of any concerns.

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Example 15:Dental filling: Pictorial sequence for young children

The design and artwork of Dr Charlotte Curl are gratefully acknowledged.

Paediatric: Pictorial inhalation sedation sequence (example 15)

       

Meet the dentist

 

         

Sit in dentist chair

 

         

Lie down

 

         

Dentist checks teeth

 

         

Try on nosepiece

 

         

Feel nice with happy air

 

     

       

Have teeth cleaned

 

         

Have filling put in tooth

 

         

Bite down on filling

 

         

Wait until I stop feeling fuzzy

 

         

Sit up

 

         

Say goodbye

 

       

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Appendix 4:Frequently asked questions

1. Why were the new IACSD standards necessary?2. When do the new standards become effective?3. I am an experienced provider of conscious sedation. Do I need to re-train or undertake a postgraduate

certificate or diploma in conscious sedation?4. Must all sedation courses now be accredited?5. How do I apply for course accreditation?6. I enrolled on a training course prior to April 22 2015 and I am currently completing my mentored cases. Will I

be compliant with the new guidelines?7. I have been on the DSTG list of mentors for many years and have successfully mentored a number of dentists

learning to use conscious sedation. Must I now stop doing this?8. Does sedation carried out as part of DCT2 training satisfy the requirements for conscious sedation training?9. May new DF3’s provide IV and inhalational sedation under appropriate supervision?10. I have over 25 years of experience using IVS but now carry out less than one case per month. Should I

continue?11. I am intending to employ a GMP colleague to provide sedation in my practice – must he undertake training

in dental sedation?12. What training does the ‘second appropriate person’ now require?13. Is it possible to gain a qualification in dental nursing for IS alone?14. When will registered Dental Nurses be obliged to have the NEBDN Certificate in Dental Sedation Nursing?15. I have two dental nurses. Does the chairside nurse need to be sedation-trained?16. What level of life support training does the sedation team need?17. Can I continue to provide IS whilst waiting to attend an immediate life support course?18. How can I demonstrate that my practice facilities are equivalent to those of an ‘NHS Acute Trust in England’?19. How can I find out more about the SAAD Safe Sedation Practice Scheme?20. How can I show that I have ‘skills equivalent to those expected of a specialist/consultant in paediatric

dentistry’?21. How can I show that I have ‘skills equivalent to those expected of a consultant in anaesthesia competent in

sedation for dentistry’?22. I have been asked to provide IVS at another dental practice. I have many years of experience but no formal

qualification in sedation. Is this permitted?23. May a Dental Therapist or Hygienist provide inhalational sedation without a dentist being on the premises?24. When should I take an adult patient’s blood pressure during IVS?25. Should I consider buying a capnograph for my IVS service?26. May I use the IACSD information leaflets in my practice?

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1. Why were the new IACSD standards necessary?The new standards respond to changes in sedation practice and in the requirements for education, training and its validation. There was also an appreciation that common standards needed to be applied to the use of conscious sedation by everyone in the healthcare team - dentists, doctors, nurses and other DCPs. The new standards were agreed by a wide range of organisations including the Dental Faculties of the surgical Royal Colleges, the Royal College of Anaesthetists and specialist societies.

2. When do the new standards become effective?From the date of publication of the report on 22 April 2015.

3. I am an experienced provider of conscious sedation. Do I need to re-train or undertake a postgraduate certificate or diploma in conscious sedation?Experienced sedation practitioners are covered by the Transitional Arrangements but you must comply with the standards in all other sections of the report. A postgraduate sedation qualification is not mandatory.

4. Must all sedation courses now be accredited?All courses intended for practitioners who wish to undertake training in a sedation technique that leads to independent clinical practice must now include supervised clinical training and have external validation. UK university-based courses and those run by Postgraduate Deaneries are compliant. Other courses which lead to independent practice, including those run by private providers, must be accredited by STAC (Sedation Training Accreditation Committee). CPD and ‘update’ courses offering only knowledge and skills training do not need external accreditation.

5. How do I apply for course accreditation?You should contact Neil Sutcliffe at FDS RCS Eng (stac@rcseng.ac.uk) for information about the accreditation process.

6. I enrolled on a training course prior to April 22 2015 and I am currently completing my mentored cases. Will I be compliant with the new guidelines?Yes, you are compliant with the spirit of the IACSD standards. When you have completed your training you will then be covered by the Transitional Arrangements.

7. I have been on the DSTG list of mentors for many years and have successfully mentored a number of dentists learning to use conscious sedation. Must I now stop doing this?The STAC (Sedation Training Accreditation Committee) is able to accredit “sedation supervisors” (see above).

8. Does sedation carried out as part of DCT2 training satisfy the requirements for conscious sedation training?Training provided by a Deanery or a University does not need to be accredited, but to reach the level of independent practice, the training provided should follow the standards as set out in the IACSD Report. All sedation experience will be useful and should be recorded in your clinical logbook.

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9. May new DF3s provide IV and inhalational sedation under appropriate supervision?Yes, they may. However this will not allow them to undertake independent clinical practice using these techniques once DF3 is completed, unless the DF3 training programme meets the requirements set out in the IACSD standards.

10. I have over 25 years of experience using IVS but now carry out less than one case per month. Should I continue?This is a matter for you to decide, perhaps in consultation with your professional indemnity organisation. As an experienced practitioner you are covered by the Transitional Arrangements but carrying out only one case per month may not be considered sufficient for maintaining competence. You should also consider the IACSD CPD requirements.

11. I am intending to employ a GMP colleague to provide sedation in my practice – must he undertake training in dental sedation?Yes, the new guidance applies to doctors and dentists. Your colleague must acquire knowledge, skills and supervised clinical experience before providing sedation in your practice. Training opportunities are currently more limited for doctors than dentists.

12. What training does the ‘second appropriate person’ now require?Dental Nurses must be trained and experienced but, like dentists, are covered by the Transitional Arrangements. The NEBDN Certificate in Conscious Sedation Nursing is recommended but not mandatory.

13. Is it possible to gain a qualification in dental nursing for IS alone?We understand that NEBDN is considering offering this but do not know the timescale. You should contact either NEBDN or your local Dental Deanery for availability of courses.

14. When will registered Dental Nurses be obliged to have the NEBDN Certificate in Dental Sedation Nursing?There are no plans to make this qualification compulsory. However, all Dental Nurses should be encouraged to work towards it.

15. I have two dental nurses. Does the chairside nurse need to be sedation-trained?No, as long the sedation-trained nurse is appropriately trained and experienced and remains in the surgery throughout the procedure. However, it might offer greater flexibility if both nurses were sedation-trained.

16. What level of life support training does the sedation team need?Practitioners must be able to provide age-appropriate Immediate Life Support as defined by the main elements of the Resuscitation Council (UK) ILS and PILS training programmes. It is not essential to undertake a Resuscitation Council (UK) accredited ILS/PILS course. Alternative courses with equivalent content which are adapted to the needs of dental practice are acceptable: these might also include the management of common sedation, medical and dental emergencies.

17. Can I continue to provide IS whilst waiting to attend an immediate life support course?All dentists should have current Immediate Life Support skills. You should contact your professional indemnity organisation for advice.

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18. How can I demonstrate that my practice facilities are equivalent to those of an ‘NHS Acute Trust in England’)?You must be able to provide evidence that in the event of a patient collapse you have the knowledge, skills and facilities to offer the same quality of immediate care as would be expected in an NHS Acute Trust. Evidence might include written protocols for managing collapse and adverse reactions, the timely transfer of a collapsed patient to a hospital with appropriate resuscitation facilities and the regular checking of emergency drugs and equipment. Current Immediate Life Support certificates and records of regular team-based participation in real-time emergency scenarios would also be appropriate. The SAAD Safe Sedation Practice Scheme (www.saad.org.uk) covers some of these elements. The checklist used by SAAD inspectors is available for download and may be used for self-assessment. It is not the responsibility of IACSD to assess evidence.

19. How can I find out more about the SAAD Safe Sedation Practice Scheme?You should contact the Executive Secretary at SAAD at www.saad.org.uk.

20. How can I show that I have ‘skills equivalent to those expected of a specialist/consultant in paediatric dentistry’?You must be able to provide evidence that the person leading the team possesses the knowledge and skills which will ensure that treatment planning and care under conscious sedation will be delivered to the same standard as would be expected of a specialist. Evidence might include training (including CPD, postgraduate qualifications, clinical attachments, honorary NHS appointments etc.) and documented experience appropriate to the age group/s to be treated. A good record of experience would include dated (but anonymised) patient data including age, ASA status, sedation technique, monitoring, dental treatment, recovery, outcome, adverse incidents and a summary of the number of sedation cases managed per year. The training and experience of other members of the sedation team, any support available from a local peer, consultant or MCN and the equipment and facilities available might also be relevant. The SAAD Safe Sedation Practice Scheme covers some of these elements. The checklist used by SAAD inspectors is available for download and may be used for self-assessment. Written support from specialist/consultant who is familiar with your experience might also be helpful. The syllabuses in Appendix 1 define the knowledge and skills required of the whole team for a variety of techniques and age groups.

21. How can I show that I have ‘skills equivalent to those expected of a consultant in anaesthesia competent in sedation for dentistry’?If you are an anaesthetist (i.e. on the GMC Specialist Register in anaesthetics) wishing to commence providing dental conscious sedation for children and young people you must be able to demonstrate training and experience in paediatric anaesthesia to a standard equivalent to that detailed in the paediatric section of the RCoA curriculum and acquisition of the competencies outlined in the RCoA dental sedation curriculum (IACSD Reference 34).

If you are an anaesthetist already engaged in the provision of dental conscious sedation for children and young people you must be able to demonstrate that you possess the necessary competencies for safe independent sedation practice. Formal appraisal/revalidation for this activity would include demonstration of appropriate paediatric anaesthetic training and experience, possession of the necessary paediatric dental sedation competencies (IACSD Reference 34), ongoing experience (logbook of sedation activity), evidence of appropriate continuing professional development, participation in audit of practice and outcomes and documentation of any complaints.

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If you are a medical or dental practitioner you must be able to provide evidence that you possess the knowledge and skills which will ensure that conscious sedation will be delivered to the same standard as would be expected of a specialist in anaesthesia (see above) who is competent in sedation for dentistry. This includes competence in age-appropriate ‘rescue’ procedures in the event of cardio-respiratory complications associated with a deeper level of sedation than intended. However, you are not expected to possess broader anaesthetic skills which are not directly relevant to the administration of dental conscious sedation or its complications. Evidence might include formal appraisal/revalidation, training (including CPD, postgraduate qualifications, clinical attachments, honorary NHS appointments etc.) and documented experience appropriate to the age group/s to be treated. A satisfactory record of experience would include dated (but anonymised) patient data including age, ASA status, sedation technique, monitoring, dental treatment, recovery, outcome, adverse incidents and a summary of the number of sedation cases managed per year. The training and experience of other members of the sedation team, support available from a local peer, specialist anaesthetist or MCN and the equipment and facilities available might also be relevant. The SAAD Safe Sedation Practice Scheme covers some of these elements. The checklist used by SAAD inspectors is available for download and may be used for self-assessment. Written support from a specialist anaesthetist who is familiar with your experience might also be helpful. The syllabuses in Appendix 1 define the knowledge and skills required of the whole team for a variety of techniques and age groups.

22. I have been asked to provide IVS at another dental practice. I have many years of experience but no formal qualification in sedation. Is this permitted?Yes, you are covered by the ‘Transitional Arrangements’ but you must comply with all other sections of the IACSD document.

23. May a Dental Therapist or Hygienist provide inhalational sedation without a dentist being on the premises?Yes, as long as the Dental Therapist or Hygienist is supported by an appropriately trained and experienced Dental Nurse (‘second appropriate person’).

24. When should I take an adult patient’s blood pressure during IVS?NIBP should be performed before and after sedation and at ‘appropriate intervals’ during the procedure. The intervals are determined following individual patient assessment.

25. Should I consider buying a capnograph for my IVS service?Capnography is not currently recommended for routine use in fit dental patients. However, it detects hypoventilation sooner than pulse oximetry and so it is likely to become more widely used, especially for medically compromised patients.

26. May I use the IACSD information leaflets in my practice?Yes, you may use them unchanged as long as you acknowledge the Dental Faculties of the surgical Royal Colleges and the Royal College of Anaesthetists. The information leaflets are for guidance in good practice and if you wish to amend the leaflets for your local requirements, then they must not display the logo of any of the Royal Colleges.

SYLLABUS 4APPENDICES

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1. Intercollegiate Advisory Committee for Sedation in Dentistry. Royal College of Surgeons of England. http://www.rcseng.ac.uk/fds/committees/intercollegiate-advisory-committee-for-sedation-in-dentistry (cited January 2015).

2. Department of Health. Conscious Sedation in the Provision of Dental Care. London: DH; 2003.

3. Standing Committee on Sedation for Dentistry. Standards for Conscious Sedation in Dentistry: Alternative Techniques. London: Royal College of Surgeons of England and Royal College of Anaesthetists; 2007.

4a. Scottish Dental Clinical Effectiveness Programme. Conscious Sedation in Dentistry. 2nd edn. Dundee: SDCEP; 2012.

4b. Scottish Dental Clinical Effectiveness Programme. Conscious Sedation in Dentistry: Dental Clinical Guidance. 3rd edn. SDCEP; 2017.

5. Academy of Medical Royal Colleges. Safe Sedation Practice for Healthcare Procedures. London: AoMRC; 2013.

6. National Institute for Health and Care Excellence. Sedation in Children and Young People. London: NICE; 2010.

7. Academy of Medical Royal Colleges. Implementing and Ensuring Safe Sedation Practice for Healthcare Procedures in Adults. London: AoMRC; 2001.

8. Conscious Sedation. Dental Sedation Teachers Group. http://www.dstg.co.uk/conscious-sedation (cited January 2015).

9. Resuscitation Council (UK). Paediatric Basic Life Support. London: Resuscitation Council (UK); 2010.

10. Walvoord EC. The timing of puberty: is it changing? Does it matter? J Adolesc Health 2010; 47: 433–439.

11. General Dental Council. Standards for the Dental Team. London: GDC; 2013.

12. Mental Capacity Act 2005. legislation.gov.uk. http://www.legislation.gov.uk/ukpga/2005/9/contents (cited January 2015).

13. Children Act 1989. legislation.gov.uk. http://www.legislation.gov.uk/ukpga/1989/41/contents (cited January 2015).

14. Department of Health. Reference Guide to Consent for Examination or Treatment. London: DH; 2009.

15. NHS Brand Guidelines. Department of Health. http://www.nhsidentity.nhs.uk/ (cited January 2015).

16. Thorpe RJ, Benger J. Pre-procedural fasting in emergency sedation. Emerg Med J 2010; 27: 254–261.

17. Murphy PJ, Erskine R, Langton JA. The effect of intravenously administered diazepam, midazolam and

flumazenil on the sensitivity of upper airway reflexes. Anaesthesia 1994; 49: 105–110.

18. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology 2011; 114: 495–511.

19. Royal College of Nursing. Perioperative Fasting in Adults and Children. London: RCN; 2005.

20. Society for the Advancement of Anaesthesia in Dentistry. Standardised Evaluation of Conscious Sedation Practice for Dentistry in the UK. London: SAAD; 2009.

21. Ben-Schlomo I, abd-el-Khalim H, Ezry J et al. Midazolam acts synergistically with fentanyl for induction of anaesthesia. Br J Anaesth 1990; 64: 45–47.

22. Department of Health. The ‘Never Events’ List 2012/13. London: DH; 2012.

23. Serious Incident Reporting and Learning Framework (SIRL). National Patient Safety Agency. http://www.nrls.npsa.nhs.uk/report-a-patient-safety-incident/serious-incident-reporting-and-learning-framework-sirl/ (cited January 2015).

24. Safe Anaesthesia Liaison Group – What We Do. Royal College of Anaesthetists. http://www.rcoa.ac.uk/salg (cited January 2015).

25. General Dental Council. Continuing Professional Development for Dental Professionals. London: GDC; 2013.

26. National Examining Board for Dental Nurses. Certificate in Dental Sedation Nursing: Prospectus. Fleetwood: NEBDN; 2011.

27. Standards in Conscious Sedation for Dentistry. Dental Sedation Teachers Group. http://www.dstg.co.uk/standards-in-conscious-sedation-for-dentistry (cited January 2015).

28. Dental Sedation Teachers Group. Training in Conscious Sedation for Dentistry. Dublin: DSTG; 2005.

29. Dental Sedation Teachers Group. Conscious Sedation in Dentistry: Standards for Postgraduate Education. Dublin: DSTG; 2008.

30. Independent Expert Group on Training Standards for Sedation in Dentistry. Advanced Conscious Sedation Techniques for Adult Dental Patients: Training Syllabus. London: IEGTSSD; 2011.

31. Independent Expert Group on Training Standards for Sedation in Dentistry. Advanced Conscious Sedation Techniques for Paediatric Dental Patients: Training Syllabus. London: IEGTSSD; 2011.

References

REFERENCES

120

32. Independent Expert Group on Training Standards for Sedation in Dentistry. A Guide to Maintaining Professional Standards in Conscious Sedation for Dentistry. London: IEGTSSD; 2011.

33. Specialty Training Curriculum: Special Care Dentistry. London: Royal College of Surgeons of England; 2012.

34. CCT in Anaesthetics: Annex D – Higher Level Training. London: Royal College of Anaesthetists; 2010.

35. Regulation and Quality Improvement Authority. Review of Intravenous Sedation Use in General Dental Practice. Belfast: RQIA; 2009.

36. NHS BSA. NHSBSA Data on Sedation in England, 2013/14. Eastbourne: NHSBSA.

37. Coulthard P, Bridgman CM, Gough L et al. Estimating the need for dental sedation. 1. The Indicator of Sedation Need (IOSN) – a novel assessment tool. Br Dent J 2011; 211: E10.

38. Goodwin M, Pretty IA. Estimating the need for dental sedation. 3. Analysis of factors contributing to non-attendance for dental treatment in the general population, across 12 English primary care trusts. Br Dent J 2011; 211: 599–603.

39. Pretty IA, Goodwin M, Coulthard P et al. Estimating the need for dental sedation. 2. Using IOSN as a health needs assessment tool. Br Dent J 2011; 211: E11.

40. Goodwin M, Coulthard P, Pretty IA et al. Estimating the need for dental sedation. 4. Using IOSN as a referral tool. Br Dent J 2012; 212: E9.

41. Newton T, Asimakopoulou K, Daly B et al. The management of dental anxiety: time for a sense of proportion? Br Dent J 2012; 213: 271–274.

42. Harris R, Bridgman C. Introducing care pathway commissioning to primary dental care: the concept. Br Dent J 2010; 209: 233–239.

43. Reid PP, Compton WD, Grossman JH, Fanjiang G. Building a Better Delivery System. Washington: National Academies Press; 2005. pp19–26.

44. Davies C, Harrison M, Roberts G. Guideline for the Use of General Anaesthesia (GA) in Paediatric Dentistry. London: Royal College of Surgeons of England; 2008.

45. Ashley PF, Williams CE, Moles DR, Parry J. Sedation versus general anaesthesia for provision of dental treatment in under 18 year olds. Cochrane Library Syst Rev 2012; 11: CD006334.

46. Lourenço-Matharu L, Ashley PF, Furness S. Sedation of children undergoing dental treatment. Cochrane Library Syst Rev 2012; 3: CD003877.

47. Scottish Dental Clinical Effectiveness Programme. Prevention and Management of Dental Caries in Children. Dundee: SDCEP; 2010.

48. Eidelman E, Faibis S, Peretz B. A comparison of restorations for children with early childhood caries treated under general anesthesia or conscious sedation. Pediatr Dent 2000; 22: 33–37.

49. Kandiah P, Nichol RE. Audit of treatment planning by general dental practitioners for children undergoing exodontia under general anaesthesia in Doncaster. Int J Paediatr Dent 2013; 23(Suppl 2): 7.

50. General Dental Council. Scope of Practice. London: GDC; 2013.

51. Resuscitation Council (UK). Quality Standards for Cardiopulmonary Resuscitation Practice and Training: Primary Dental Care. London: Resuscitation Council (UK); 2013.

52. Resuscitation Council (UK). Immediate life Support. 3rd edn. London: Resuscitation Council (UK); 2011.

53. Resuscitation Council (UK). Paediatric Immediate Life Support. 2nd edn. London: Resuscitation Council (UK); 2011.

54. Social Care Institute for Excellence. The Deprivation of Liberty Safeguards. London: SCIE; 2011.

55. Adults with Incapacity (Scotland) Act 2000. legislation.gov.uk. http://www.legislation.gov.uk/asp/2000/4/contents (cited January 2015).

56. The Adults with Incapacity (Requirements for Signing Medical Treatment Certificates) (Scotland) Amendment Regulations 2012. legislation.gov.uk. http://www.legislation.gov.uk/ssi/2012/170/made (cited January 2015).

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Edited and proofread by Tara Nikovskis (V1.0).

©2020 The Royal College of Surgeons of England, The Royal College of Surgeons of Edinburgh, The Royal College of Physicians and Surgeons of Glasgow, and the Royal College of Anaesthetists.

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