DEPARTMENT OF REGULATORY AGENCIES
Colorado Dental Board 
DENTISTS & DENTAL HYGIENISTS
3 CCR 709-1
[Editor’s Notes follow the text of the rules at the end of this CCR Document.]
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Rule XIII.  Limited Prescriptive Authority for Dental Hygienists 
(Effective June 30, 1996 as Rule XXIV; Amended December 2, 2002; Amended January 21, 2010, Effective March 30, 2010; Re-numbered December 30, 2011; Amended January 22, 2015, Effective March 30, 2015; Amended April 30, 2015, Effective June 30, 2015; Amended January 17, 2018, Effective March 17, 2018)
A.	Pursuant to section 12-35-124(1)(g)(I), C.R.S., a dental hygienist without supervision of a dentist may prescribe, administer, and dispense fluoride, fluoride varnish, antimicrobial solutions for mouth rinsing, and other nonsystemic antimicrobial agents, and related emergency drugs and reversal agents in collaboration with a licensed dentist and, if applicable, when issued a National Provider Identifier (NPI) number by the Centers for Medicare & Medicaid Services (CMS) under the U.S. Department of Health and Human Services.
1.	Collaboration with a dentist requires the dental hygienist to develop an articulated plan for safe prescribing which documents how the dental hygienist intends to maintain ongoing collaboration with a dentist in connection with the dental hygienist’s practice of prescribing as allowed in section 12-35-124(1)(g), C.R.S., and section C of this rule. 
2.  	The articulated plan shall guide the dental hygienist’s prescriptive practice and shall include at least the following: 
a.	A mechanism for consultation and referral to a dentist when the dental hygienist detects a condition that requires care beyond the scope of practicing unsupervised dental hygiene;
b.	A quality assurance plan; 
c.	Decision support tools; and 
i.	A decision support tool is an assistive tool commonly recognized by healthcare professionals as a valid resource for information on pharmaceutical agents or to aid the dental hygienist in making appropriate judgments regarding safe prescribing.
ii.	Such tools may include, but are not limited to, electronic prescribing databases, evidence-based guidelines, antimicrobial reference guides, and professional journals and textbooks.     
d.	Emergency protocols and standing orders, including use of emergency drugs. 
3.	The dental hygienist shall: 
a.	Retain the written articulated plan with the collaborating dentist’s signature on file;
b.	Review the plan annually; and  
c.	Update the plan as necessary. 
4.	The articulated plan is subject to Board review and the dental hygienist shall provide the plan to the Board upon request. 
B.	A dental hygienist shall not prescribe, administer, or dispense the following:
1.	Drugs whose primary effect is systemic, with the exception of fluoride supplements permitted under section 12-35-124(1)(g)(III)(A), C.R.S.; and 
2.	Dangerous drugs or controlled substances. 
C.	The related emergency and reversal agents a dental hygienist may prescribe, administer, and dispense in collaboration with a licensed dentist include the following:
	1.	Epinephrine (Epi-Pen) up to .3mg
	2.	Nitroglycerine up to .6mg
3.	Albuterol up to 200mcg inhalation powder
4.	Diphenhydramine
5.	Glucose (Dextrose or Glucagon)
6.	Oxygen
7. 	Narcan (naloxone)
 D.	A dental hygienist shall maintain clear documentation in the patient record of the: 
1.	Agent or drug prescribed, administered, or dispensed, including dose, amount, and refills;
2.	Date of the action; and 
3.	Rationale for prescribing, administering, or dispensing the agent or drug.  
E.	A prescriptive order shall include:
1.	Name of the patient, 
2.	Date of action, 
3.	Agent or drug prescribed including dose, amount and refills, and 
4.	Rationale for prescribing the agent or drug.  
F.	If a dental hygienist prescribes, administers, or dispenses without supervision of a dentist but fails to develop the required articulated plan, or fails to maintain clear documentation in the patient record; or prescribes, administers, or dispenses outside of what is allowed pursuant to section 12-35-124(1)(g), C.R.S., or in this rule, then such conduct constitutes grounds for discipline pursuant to section 12-35-129(1)(i), C.R.S.    
G.	Any dental hygienist placing therapeutic agents or prescribing drugs shall have proof of current Basic Life Support (BLS) for healthcare providers. 
H.	The placement and removal of therapeutic agents in periodontal pockets and limited prescriptive authority may not be delegated or assigned to a dental assistant. 

Editor’s Notes
History
Rules XVII, XXVI eff. 07/01/2007.
Rules XXVI, XXIX, XXX eff. 12/31/2007.
Rule XXVI eff. 11/30/2008.
Rule III eff. 05/30/2009.
Rule III eff. 12/30/2009.
Rules III, XIV - XXX eff. 03/30/2010.
Rules I - IX, XI - XIII, XV - XXII eff. 12/30/2011.
Rules I, II, III, IX, XI, XII, XIII, XVI (repealed), XXIII, and XXIV eff. 03/30/2015. 
Rules XIII, XIV, and XXIV eff. 06/30/2015. 
Rule XXIII eff. 03/16/2016. 
Rules I, III, IV, V, VI (repealed), VII (repealed), VIII (repealed), IX, X, XIV, XV, XVI, XVIII, XIX (repealed), XX, XXI, XXII (repealed), XXIII, XXIV, and XXV eff. 06/30/2016. 
Rule XVII eff. 09/14/2016
Rules XIII and XXIV eff. 11/30/2017