Rule XVII.  Administration of Nitrous Oxide/Oxygen Inhalation
(Amended February 1, 1998; August 11, 2004; October 26, 2006) 

A.   When conscious sedation is accomplished solely by means of nitrous oxide/oxygen inhalation 
       techniques, then this Rule shall apply.
  B.   The administration of nitrous oxide may be delegated to another dentist whose qualifications meet the education and training requirements of Rule XIV, a qualified physician anesthetist, or a certified registered nurse anesthetist.
C.   Education/Training Requirements:
	1.    In order to administer and induce conscious analgesia solely by means of nitrous   oxide/oxygen inhalation techniques, a dentist shall complete a course(s)                                    conducted at an institution accredited by the American Dental Association Commission on Dental Education or certified by the Colorado Department of Higher Education Division of Private Occupational Schools. The course(s) must have a minimum of sixteen (16) hours, including four (4) patient contact hours. As of January 1, 1994, the Board required all dentists who did not meet the requirements of subsection 2. below to submit an application and documentation of training in nitrous oxide/oxygen administration.
2.   A Colorado licensed dentist who has safely administered conscious analgesia solely by means of nitrous oxide/oxygen inhalation techniques within the State of Colorado for the three (3) years prior to October 30, 1987, should be deemed to have satisfied, the education/training specified under this Rule in making a determination on safe administration and inducement of conscious analgesia accomplished solely by means of nitrous oxide/oxygen inhalation techniques, the Board shall consider any and all anesthesia/analgesia related incidents, accidents or complaints filed against the licensee.
3.	The dentist and all personnel, including but not limited to, dental hygienists and dental auxiliaries, who render patient care services in a dental setting where nitrous oxide/oxygen is administered shall have proof of current basic life support (BLS) knowledge and skills.
4.	Upon its determination that the applicant has met the requirements found in either Rule XVII.C.1 or 2, the Board shall issue a permit to administer nitrous oxide/oxygen.  Any violation of this Rule XVII may result in suspension or revocation of the permit to administer nitrous oxide/oxygen.
             D.   Examination: Upon the effective date of this Rule, prior to administration of nitrous oxide/oxygen, the dentist, dental hygienist, or auxiliary shall record, in the patient’s chart, the patient’s medical and pertinent physical findings.
E.   Documentation: Upon the effective date of this Rule, when administering nitrous oxide/oxygen, the dentist, dental hygienist, or auxiliary shall record, in the patient's chart, the treatment given, the dosage administered and the patient's response to treatment.
F.   Emergency Care: Prior to the administration of nitrous oxide/oxygen, the supervising dentist, dental hygienist, and auxiliaries shall have appropriate training to recognize the symptoms and reasonably treat the complications and emergencies incident thereto.
G.   Office Facilities and Equipment: If conscious analgesia is accomplished solely by means of nitrous oxide/oxygen inhalation techniques, then the supervising dentist shall provide and ensure the following:
1.        Fail safe mechanisms in the delivery system and an appropriate scavenging system;
2.	The inhalation equipment must be evaluated for proper operation and delivery of inhalation agents prior to use on each patient;
3.       Determination of adequate oxygen supply must be completed prior to use with each     patient;
4.       Baseline vital signs may be obtained at the discretion of the operator depending on the medical status of the patient and the nature of the procedure to be performed; AND,
5.       Appropriate equipment to monitor vital signs and maintain an adequate airway including but not limited to a blood pressure cuff, stethoscope and a method for administering positive pressure oxygen.
H.         Delegating under direct supervision the monitoring and administration of nitrous oxide/oxygen to appropriately trained personnel pursuant to section 12-35-113 (1) (q), C.R.S.:
     1.      The supervising dentist is responsible for determining the maximum dosage of nitrous     oxide/oxygen analgesia and must record the dosage in the patient's dental chart prior to delegation; AND,  
	2.       The supervising dentist delegating must be approved by the Board under this Rule to administer nitrous oxide/oxygen; AND, 
3.       The dental hygienist or dental auxiliary accepting the delegation of the administration and monitoring of nitrous oxide/oxygen under direct supervision shall ensure that the dentist is approved by the Board to administer nitrous oxide/oxygen; AND, 
4.        Education/Training Requirements for dental hygienists and auxiliaries administering and monitoring nitrous oxide/oxygen under direct supervision;
	a.  In order to administer and induce conscious analgesia solely by means of    nitrous oxide/oxygen inhalation techniques, a dental hygienist or a dental auxiliary shall complete a course(s) conducted at an institution accredited by the American Dental Association Commission on Dental Education or certified by the Colorado Department of Higher Education Division of Private Occupational Schools. The course(s) must have a minimum of sixteen (16) hours, including four (4) patient contact hours. The dental hygienist and dental auxiliary shall certify to the Board, on a form approved by the Board, compliance with the educational requirement.
I. 	 “Monitoring”, as that term is used in Rule XVII means:
1.   The continual observation of the patient to ensure the stable physical condition of the patient and maintenance of a proper level of nitrous oxide/oxygen inhalation as determined by the supervising dentist; OR
2.   The continual observation of the patient to ensure stable physical condition of the patient during recovery from the nitrous oxide/oxygen inhalation.
  3.	Unless a dental hygienist or dental auxiliary has received the training to administer nitrous
oxide/oxygen inhalation, they may only monitor (observe) a patient during the use of nitrous oxide/oxygen inhalation. Monitoring may only be delegated under the direct supervision of a dentist approved/authorized to administer nitrous oxide/oxygen inhalation.
J.  	All equipment, as provided for in this Rule XVII shall be functional and operative at all times.
K.         Morbidity and Mortality Report - A completed written report shall be submitted to the Board by the    supervising dentist and any other person administering the nitrous oxide/oxygen inhalation within fifteen (15) days of any nitrous oxide/oxygen inhalation related incident resulting in patient morbidity or mortality which occurred while the patient was under the care of the dentist, and required hospitalization, emergency facility care, or emergency service response.
	1.  Such report shall include all of the following items:
	a.  Description of dental procedure;
	b.  Description of preoperative physical condition of the patient;
	c.  List of the drugs and dosages administered;
	d.  Detailed description of techniques utilized in administering the nitrous oxide;
	e.  Description of adverse occurrence to include:
	1)  Detailed description of symptoms of any complications including, but 
     not limited to, onset and type of symptoms in patient;
	2)  Treatment instituted on patient; AND, 
	3)  Response of the patient to treatment.
                  f.   Description of the patient's condition on termination of any procedure    undertaken.
	2.  The Board may request inspection of any written records related to this report.
3.  Pursuant to section 12-35-107(1)(d), C.R.S., the Board may request an on-site    evaluation of the dental facility related to this report.