New standards for conscious sedation 2015
The report of the Intercollegiate Advisory Committee for Sedation (IACS) in Dentistry was published in April 2015 and replaces the previous document, Conscious Sedation in the Provision of Dental Care (Department of Health 2003)
There are significant changes in the new guidance, and although Dental Protection does not act an arbiter of clinical opinion, members offering sedation procedures to either adults or children will need to be aware of these developments and ensure they are compliant.
Safety is the primary focus, and the report makes recommendations about information for patients, training for the entire dental team, sedation techniques and the appropriate environment for sedation delivery. As in other dental disciplines, for those colleagues who are already practising sedation to the standard of the previous guidelines, a grandfathering scheme has been included. The new guidance emphasises the need for team training rather than individual training and may result in more sedation centres rather than sedation practitioners working in many different practices.
The new standards apply to all those who practise conscious sedation procedures, whether they are dentists, doctors, nurses or dental care professionals and there are significant changes in what will be accepted as a training programme.
It is no longer acceptable for practitioners new to sedation to enrol on a course unless it has achieved accreditation by the IACSD and at the moment only courses provided by Universities or Deaneries are exempt form a course accreditation process. As a result, there may be a shortage of courses on which to enrol and the acquisition of sufficient CPD may become a challenge. 12 hours of sedation-based CPD will be now be required, in a five-year cycle ,for practitioners providing conscious sedation.
Other changes include the expectation that all members of a sedation team will be able to demonstrate training in the necessary life support skills which will include immediate life support in the treatment of adults and in the treatment of children. All dental nurses who currently act as the second appropriate person will be expected to study for the Certificate in Dental Sedation Nursing if they do not already hold that qualification.
Anyone who is involved in any form of conscious sedation should carefully assess their current protocols and test them against the previous and the current guidelines. If they find they have not satisfied the previous guidelines they should regard themselves as practitioners new to sedation. If, after reflection, they completely satisfy the old regulations, the grandfathering situation may be applicable.
A summary of changes in the new guidelines
2) If you already practise sedation but are not sure you satisfied the previous regulations
Consider all your previous theoretical and clinical training and reflect on whether it would be sufficiently robust to present to DC if required.
- If that is not the case you might wish to consider yourself new to sedation and engage with the new guidelines.
- Help to make such a decision can be sought from a local postgraduate deanery, or an organisation such as SAAD.
3) If you are new to sedation and wish to begin sedation practice
- Refer to the new sedation guidelines.
- You will need to complete and be assessed on an accredited course. As yet the accreditation scheme is not in place and it may take a while to be established. It would make sense to ask the course organisers if their course meets the requirements for accreditation and if it will be accredited.
1) If you already practice sedation techniques and are confident that you satisfied previous guidelines
This introduces the need to create a comprehensive log of the details of each case. In addition check the following aspects of your sedation training:
- Validated CPD
- Regular audit and reflection
- Competence in rescue skills
- Meet requirements for environment and equipment described in care pathway
- Ensure appropriate clinical governance is in place.